Coinfection by Salmonella and Leptospira Presenting as Subacute Intestinal Obstruction with Colitis: A Diagnostic Dilemma

Abstract

Coinfection with Salmonella and Leptospira is a rare entity even in regions where both pathogens are endemic. As clinical features are nonspecific and overlapping, it is very difficult to differentiate between these two infections. However, many cases of coinfections of leptospirosis and scrub typhus; dengue and Leptospirosis, typhoid and dengue have been reported but coinfections by Salmonella and Leptospira have been reported rarely. Clinically they should be suspected in endemic areas and here we are presenting such a case. A 30-year-old female presented with chief complaints of loose stools for 10 days, high grade fever and jaundice for three days. CT enterography showed mildly enlarged liver and features of small bowel obstruction. Blood culture was sterile. No improvement was seen with empirical antibiotics. Widal titers were very high and IgM antibodies for Leptospira was positive by Enzyme-Linked Immune Sorbent Assay (ELISA) test in third week of illness. She was started on ceftriaxone 1 gm Intravenous (IV) twice a day as both the infections respond excellently to ceftriaxone. Over next couple of days her conditions improved and she was discharged in stable condition. This case highlights the need for optimal use of microbiological laboratory services and timely intervention to reach a final diagnosis.

Keywords

• differential diagnosis
• jaundice
• widal test