Occupational Leptospirosis in Urban Sanitation: Lessons for Early Recognition and Worker Protection.

Leptospirosis is a globally distributed disease associated with recreational aquatic activities; environmental exposure; and a range of occupational exposures, including animal handling, sanitation work, military operations, and sewer maintenance. We report a case of severe leptospirosis in a New York City sanitation worker after exposure to contaminated water. Because of the nonspecific presentation of his infection and the nuances of diagnostic testing, the patient presented to multiple care settings before leptospirosis was diagnosed. This case illustrates the importance of clinician awareness of urban leptospirosis and its broadening epidemiology in the United States, the time-dependent performance of diagnostic testing, and opportunities to improve personal protective equipment recommendations for sanitation employees.