Leptospirosis in a previously unreported area: a human case from Jembrana Regency, Bali Province, 2023

Introduction: Bali Province had never reported leptospirosis cases in humans. However, on March 24, 2023, one case of leptospirosis was reported in Jembrana District. This study aims to describe the epidemiological investigation of the leptospirosis case in Jembrana District. Case presentation: A 48-year-old man who worked as a janitor at a Vihara experienced fever, nausea, body aches, and chest pain. Laboratory results showed impaired kidney and liver function, accompanied by anuria, and a positive rapid diagnostic test (RDT). He was diagnosed as a probable case of leptospirosis. A field investigation was conducted, targeting the patient's home and workplace (Vihara). A rodent investigation was conducted by placing 100 rat traps around the Vihara within a 500-meter radius (April 5, 2023). On the following day (April 6, 2023), rat kidney samples were sent to the BBTKLPP laboratory in Surabaya. Contact tracing and RDT screening were also conducted on April 6, 2023, to identify potential additional cases. Many rats were observed inside the Vihara. The family confirmed that stagnant water with the smell of rat urine was often present in the Vihara, and the patient frequently cleaned the area without using personal protective equipment. A total of 12 rats were caught, all of which tested negative by PCR. Contact tracing results showed that 2 out of 4 family members and all 6 Vihara contacts tested negative on RDT. Conclusion: The first human case of leptospirosis has been identified in Jembrana District, associated with occupational and environmental risk factors.