Leptospirosis presenting with mania and psychosis: four consecutive cases seen in a military hospital in Turkey.

OBJECTIVE

To present the clinical features and the treatment alternatives of manic and psychotic symptoms in patients with leptospirosis.

METHODS

Clinical observation and diagnosis of four cases with leptospirosis presenting with psychiatric symptoms.

RESULTS

Leptospirosis diagnoses were established by recovery of the organism from culture, macroagglutination tests, and dark field microscopy in all cases. Leptospira ELISA-Ig M was also positive in all cases. Microagglutination tests were positive in case 1 and case 2. All of the cases were also screened for other possible medical, infectious, and neurological disorders that could account for their clinical symptoms. Patients were treated with a combination of antibiotics, antipsychotics and mood stabilizers.

CONCLUSIONS

The presence of manic and psychotic symptoms with fever and high transaminase and/or CPK levels in high risk occupational groups during rainy periods should alert the physician to the possibility of leptospirosis. The psychiatric symptoms are sensitive to anti-psychotics and mood stabilizers but not to antimicrobial treatment, suggesting that the psychiatric picture may not be related to direct invasion of the central nervous system by the infectious agent.