{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T02:57:08Z","timestamp":1787021828806,"version":"build-2736575974"},"update-to":[{"DOI":"10.1371\/journal.pntd.0014315","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T00:00:00Z","timestamp":1778803200000}}],"reference-count":67,"publisher":"Public Library of Science (PLoS)","issue":"5","license":[{"start":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T00:00:00Z","timestamp":1778457600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Conselho Nacional de Desenvolvimento Cient\u00c3fico e Tecnol\u00c3\u00b3gico (CNPq), Brazil"},{"name":"Federal University of Cear\u00c3\u00a1"},{"name":"Federal University of Cear\u00c3\u00a1"}],"content-domain":{"domain":["www.plosntds.org"],"crossmark-restriction":false},"short-container-title":["PLoS Negl Trop Dis"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Leptospirosis is a globally distributed zoonotic disease with a broad clinical spectrum. Central nervous system (CNS) involvement is uncommon and under-recognized, and leptospiral-associated meningitis (LAM) is primarily described in isolated case reports and small series. No study to date has integrated institutional cases with published reports to characterize cerebrospinal fluid (CSF) profiles in LAM.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective cohort study of patients with meningitis, encephalitis, or meningoencephalitis admitted to a tertiary infectious diseases center in northeastern Brazil. Cases of LAM were identified among patients with aseptic meningitis. In parallel, a narrative literature review was performed, and a meta-summary of published cases was constructed. CSF parameters from both datasets were extracted and analyzed using descriptive statistics and graphical (boxplot) methods.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 809 patients with meningitis or encephalitis, 447 presented with aseptic meningitis. Three cases (0.67%) of LAM were identified, presenting as isolated meningitis or meningoencephalitis. Among 179 patients, including 176 identified in the medical literature, mean CSF values were: cellularity 68 cells\/mm\n                      <jats:sup>3<\/jats:sup>\n                      (range, 30\u20137800), lymphocytes 73% (0\u2013100), neutrophils 18% (0\u201396), glucose 60\u2009mg\/dL (0\u2013140), and protein 67\u201390\u2009mg\/dL (31\u20132590). CSF findings in the institutional cohort showed mild to moderate pleocytosis with lymphocytic predominance, normal to elevated glucose levels, and increased protein concentrations. The integrated analysis of cohort and published cases\u2014the first combined CSF profile synthesis of LAM\u2014demonstrated a consistent pattern of lymphocytic pleocytosis, mildly elevated cellularity, preserved glucose levels, and increased protein, with substantial inter-case variability.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>LAM is an uncommon but clinically relevant cause of CNS infection in endemic settings. This study provides the first integrated synthesis of CSF profiles from both institutional cases and published literature, supporting a characteristic but variable CSF pattern in leptospiral CNS disease. Clinicians should consider leptospirosis in patients with aseptic meningitis in endemic areas, particularly when epidemiological risk factors are present. Improved diagnostic capacity and prospective studies using standardized criteria are needed to better define disease burden and refine diagnostic and therapeutic approaches.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pntd.0014315","type":"journal-article","created":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T17:44:46Z","timestamp":1778521486000},"page":"e0014315","update-policy":"https:\/\/doi.org\/10.1371\/journal.pntd.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["Leptospirosis-associated meningitis in an urban tropical endemic setting in northeastern Brazil: Three New cases and a meta-summary of 176 reported cases"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8978-9903","authenticated-orcid":true,"given":"Lu\u00eds Arthur Brasil","family":"Gadelha Farias","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Osvaldo Mariano Viana","family":"Neto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ednaldo Pereira Lima","family":"Sobrinho","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caroline Lucena","family":"de Almeida Vale","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Geraldo Bezerra Silva","family":"J\u00fanior","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth","family":"de Francesco Daher","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Glaura Fernandes Teixeira","family":"de Alc\u00e2ntara","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ant\u00f4nio Silva Lima","family":"Neto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tania Mara Silva","family":"Coelho","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maura Salaroli","family":"de Oliveira","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauro Vieira Perdig\u00e3o","family":"Neto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,5,11]]},"reference":[{"issue":"1","key":"pntd.0014315.ref001","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1038\/s41572-025-00614-5","article-title":"Leptospirosis","volume":"11","author":"S Rajapakse","year":"2025","journal-title":"Nat Rev Dis Primers"},{"key":"pntd.0014315.ref002","doi-asserted-by":"crossref","first-page":"103512","DOI":"10.1016\/j.bjid.2023.103512","article-title":"Avalia\u00e7\u00e3o da taxa de letalidade devido \u00e0 leptospirose nos estados do Nordeste brasileiro entre os anos de 2019 a 2022","volume":"27","author":"MDM Silva","year":"2023","journal-title":"Braz J Infect Dis"},{"issue":"9","key":"pntd.0014315.ref003","doi-asserted-by":"crossref","first-page":"1413","DOI":"10.2217\/fmb.10.102","article-title":"Leptospira as an emerging pathogen: a review of its biology, pathogenesis and host immune responses","volume":"5","author":"KV Evangelista","year":"2010","journal-title":"Future Microbiol"},{"key":"pntd.0014315.ref004","doi-asserted-by":"crossref","DOI":"10.1590\/s1678-9946201860023","article-title":"Pathology and pathogenesis of human leptospirosis: a commented review","volume":"60","author":"T De Brito","year":"2018","journal-title":"Rev Inst Med Trop Sao Paulo"},{"issue":"1","key":"pntd.0014315.ref005","doi-asserted-by":"crossref","first-page":"14","DOI":"10.7861\/clinmed.2021-0784","article-title":"Leptospirosis: clinical aspects","volume":"22","author":"S Rajapakse","year":"2022","journal-title":"Clin Med"},{"key":"pntd.0014315.ref006","unstructured":"Wellcome Collection. 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