{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,8]],"date-time":"2026-04-08T07:12:38Z","timestamp":1775632358086,"version":"3.50.1"},"reference-count":13,"publisher":"BMJ","issue":"8","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2019,8,13]]},"published-print":{"date-parts":[[2019,8]]},"abstract":"<jats:p>Neurological manifestations of leptospirosis without severe multiorgan involvement are a rare clinical entity. Despite the increasing prevalence of the disease in many tropical countries, its protean clinical presentations make its timely diagnosis challenging. We report the case of a 44-year-old Filipino man presenting with fever, myalgia, behavioural changes and altered sensorium. Neurological examination did not show any focal neurological deficits or clear signs of meningoencephalitis. Lumbar tap, cranial CT scan and cranial MRI were inconclusive. The diagnosis of leptospirosis with acute encephalitis relied heavily on the patient\u2019s clinical clues, appropriate exposure history and patterns in ancillary laboratory tests. Empiric antibiotic therapy with ceftriaxone was initiated. Seroconversion and fourfold increase in serological antibody titres by leptospirosis microagglutination test later confirmed the diagnosis. The patient was successfully treated, and all neurological complications were reversed.<\/jats:p>","DOI":"10.1136\/bcr-2019-230619","type":"journal-article","created":{"date-parts":[[2019,8,31]],"date-time":"2019-08-31T07:35:15Z","timestamp":1567236915000},"page":"e230619","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":9,"title":["Behavioural change: a rare presentation of leptospirosis"],"prefix":"10.1136","volume":"12","author":[{"given":"Isabelle Dominique","family":"Tomacruz","sequence":"first","affiliation":[{"name":"Department of Medicine, Philippine General Hospital, University of the Philippines, Manila, Philippines"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joanne Carmela","family":"Sandejas","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Medicine, Philippine General Hospital, University of the Philippines, Manila, Philippines"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Regina","family":"Berba","sequence":"additional","affiliation":[{"name":"Division of Adult Medicine and Hospital Infection Control Unit, Philippine General Hospital, University of the Philippines, Manila, Philippines"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dennis Raymond","family":"Sacdalan","sequence":"additional","affiliation":[{"name":"Department of Radiology, Philippine General Hospital, University of the Philippines, Manila, Philippines"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2019,8,30]]},"reference":[{"key":"2025082803130403000_12.8.e230619.1","unstructured":"World Health Organization. The global burden of leptospirosis [Internet]. Geneva: World Health Organization. [cited 2018 November]. Available from. http:\/\/www.who.int\/zoonoses\/diseases\/lerg\/en\/index2.html"},{"key":"2025082803130403000_12.8.e230619.2","first-page":"179","article-title":"Unusual clinical manifestations of leptospirosis","volume":"51","author":"Bal","year":"2005","journal-title":"J Postgrad Med"},{"key":"2025082803130403000_12.8.e230619.3","doi-asserted-by":"crossref","unstructured":"Levett PN , Haake DA . Leptospirosis. In: Mandell GL , Bennet Je , Dolin R , eds. Principles and practice of infectious diseases. 7th edn. New York: Churchill Livingstone, 2009:3059\u201365.","DOI":"10.1016\/B978-0-443-06839-3.00240-X"},{"key":"2025082803130403000_12.8.e230619.4","unstructured":"Leptospirosis Task Force. The Philippine clinical practice guidelines on the diagnosis, treatment and prevention of leptospirosis in adults. Philippines: Leptospirosis Task Force, 2010."},{"key":"2025082803130403000_12.8.e230619.5","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cit458"},{"key":"2025082803130403000_12.8.e230619.6","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(03)00830-2"},{"key":"2025082803130403000_12.8.e230619.7","doi-asserted-by":"crossref","first-page":"361","DOI":"10.3855\/jidc.8613","article-title":"Acute encephalitis as initial presentation of leptospirosis","volume":"11","author":"Puca","year":"2017","journal-title":"J Infect Dev Ctries"},{"key":"2025082803130403000_12.8.e230619.8","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1186\/s13104-016-1964-z","article-title":"Atypical leptospirosis: an overlooked cause of aseptic meningitis","volume":"9","author":"Wang","year":"2016","journal-title":"BMC Res Notes"},{"key":"2025082803130403000_12.8.e230619.9","doi-asserted-by":"crossref","first-page":"bcr-2018-225281","DOI":"10.1136\/bcr-2018-225281","article-title":"Uncommon manifestation of leptospirosis: a diagnostic challenge","volume":"3","author":"Bhatt","year":"2018","journal-title":"BMJ Case Rep"},{"key":"2025082803130403000_12.8.e230619.10","first-page":"155","article-title":"Neuroleptospirosis - revisited: experience from a tertiary care neurological centre from south India","volume":"124","author":"Mathew","year":"2006","journal-title":"Indian J Med Res"},{"key":"2025082803130403000_12.8.e230619.11","doi-asserted-by":"crossref","first-page":"133","DOI":"10.4103\/1755-6783.85771","article-title":"Acute disseminated encephalomyelitis subsequent to Leptospira infection","volume":"4","author":"Singh","year":"2011","journal-title":"Annals of Tropical Medicine and Public Health"},{"key":"2025082803130403000_12.8.e230619.12","doi-asserted-by":"publisher","DOI":"10.1136\/pmj.77.911.589"},{"key":"2025082803130403000_12.8.e230619.13","unstructured":"Wagenaar JF , Goris MG . 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