{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T15:11:41Z","timestamp":1780499501480,"version":"3.54.1"},"reference-count":72,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,6,3]]},"abstract":"<jats:title>ABSTRACT.<\/jats:title>\n                  <jats:p>\n                    Leptospirosis is difficult to diagnose because of protean nonspecific clinical manifestations and the lack of rapid, actionable laboratory testing. A previously healthy woman who presented with nausea is described in the present study. She had modestly elevated liver function tests, an unusual pretibial rash, and no fever. She had recently swum in a waterfall in Costa Rica. After the clinicians proposed a leptospirosis diagnosis to the patient, an artificial intelligence program was selected for use by the clinicians to enhance confidence in proposing a rare and unknown diagnosis. The program independently produced a differential diagnosis that led with leptospirosis. Presumptive doxycycline administration led to symptom resolution. Blood (but not urine) Polymerase chain reaction (PCR) test for the\n                    <jats:italic>LipL32<\/jats:italic>\n                    gene and a novel antibody detection test confirmed leptospirosis. This case represents an unusual clinical presentation of leptospirosis, including the absence of fever, the presence of a pretibial rash, and isolated, mildly elevated bilirubin and transaminases as sole laboratory abnormalities, and highlights difficulties associated with making a rapid, actionable diagnosis.\n                  <\/jats:p>","DOI":"10.4269\/ajtmh.26-0120","type":"journal-article","created":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T18:08:54Z","timestamp":1776794934000},"page":"1062-1065","source":"Crossref","is-referenced-by-count":0,"title":["Isolated Nausea and Pretibial Rash in a Returning Traveler: Forme Fruste of Leptospirosis"],"prefix":"10.4269","volume":"114","author":[{"given":"Joseph M.","family":"Vinetz","sequence":"first","affiliation":[{"name":"Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA;"},{"name":"Luna Bioscience, Inc., New Haven, Connecticut, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Logan","family":"Flaxman","sequence":"additional","affiliation":[{"name":"Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2795","reference":[{"issue":"9","key":"b1","series-title":"PLoS Negl Trop Dis","first-page":"e0003898","article-title":"Global morbidity and mortality of leptospirosis: A systematic review","volume":"9","author":"Costa","year":"2015"},{"key":"b2","article-title":"Getting Leptospirosis onto the Lists of Neglected Tropical Diseases.","author":"Vinetz","year":"2024"},{"issue":"10","key":"b3","series-title":"BMJ Glob Health","first-page":"e006946","article-title":"Estimating the burden of leptospirosis: Global lessons from Sri Lanka","volume":"6","author":"Warnasekara","year":"2021"},{"issue":"4","key":"b4","series-title":"PLoS Negl Trop Dis","first-page":"e0010331","article-title":"Diagnostic method-based underestimation of leptospirosis in clinical and research settings; an experience from a large prospective study in a high endemic setting","volume":"16","author":"Warnasekara","year":"2022"},{"issue":"2","key":"b5","series-title":"Clin Microbiol Rev","first-page":"296","article-title":"Leptospirosis","volume":"14","author":"Levett","year":"2001"},{"issue":"12","key":"b6","series-title":"Lancet Infect Dis","first-page":"757","article-title":"Leptospirosis: A zoonotic disease of global importance","volume":"3","author":"Bharti","year":"2003"},{"issue":"8","key":"b7","series-title":"PLoS Med","first-page":"e308","article-title":"Determining risk for severe leptospirosis by molecular analysis of environmental surface waters for pathogenic Leptospira.","volume":"3","author":"Ganoza","year":"2006"},{"issue":"3","key":"b8","series-title":"Am J Trop Med Hyg","first-page":"399","article-title":"Increase of leptospirosis in dengue-negative patients after a hurricane in Puerto Rico in 1996 [correction of 1966]","volume":"61","author":"Sanders","year":"1999"},{"issue":"9181","key":"b9","series-title":"Lancet","first-page":"820","article-title":"Urban epidemic of severe leptospirosis in Brazil. 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chemoprophylaxis against leptospirosis","volume":"310","author":"Takafuji","year":"1984"},{"issue":"6","key":"b15","series-title":"Am J Trop Med Hyg","first-page":"1331","article-title":"Potential for early diagnosis of leptospirosis in experimentally infected rhesus macaques based on detection of leptospiral virulence-modifying protein exotoxin antigen and antibody","volume":"113","author":"Chaurasia","year":"2025"},{"issue":"11","key":"b16","series-title":"Microbiol Spectr","first-page":"e0001825","article-title":"Development of leptospiral virulence-modifying protein detection assay: Implications for pathogenesis and diagnostic test development","volume":"13","author":"Chaurasia","year":"2025"},{"issue":"1","key":"b17","series-title":"Am J Trop Med Hyg","first-page":"17","article-title":"Early diagnosis of human leptospirosis by detection of antibodies to Leptospira-secreted virulence-modifying protein exotoxins","volume":"114","author":"Chaurasia","year":"2025"},{"issue":"6","key":"b18","series-title":"JAMA","first-page":"361","article-title":"Pretibial fever: An obscure disease","volume":"122","author":"Daniels","year":"1943"},{"issue":"8","key":"b19","series-title":"Public Health Rep (1896)","first-page":"811","article-title":"Leptospiral etiology of Fort Bragg fever","volume":"67","author":"Gochenour","year":"1952"},{"issue":"3","key":"b20","series-title":"Diagn Microbiol Infect Dis","first-page":"247","article-title":"Detection of pathogenic Leptospira spp. through TaqMan polymerase chain reaction targeting the LipL32 gene","volume":"64","author":"Stoddard","year":"2009"},{"issue":"4","key":"b21","series-title":"Am J Trop Med Hyg","first-page":"388","article-title":"Penicillin therapy in icteric leptospirosis","volume":"39","author":"Edwards","year":"1988"},{"issue":"8583","key":"b22","series-title":"Lancet","first-page":"433","article-title":"Placebo-controlled trial of 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