A previously healthy 25-year-old man who is on active duty in the US Navy comes to the military urgent care clinic with fever, headache, reddening of the eyes, and muscle ache for the past 4 days. He has not had itching or eye discharge. He has been stationed in Hawaii for the past year. He has no travel history and none of his other colleagues have similar complaints. He received the hepatitis A vaccine 2 years ago. He is not in acute distress. His temperature is 38.5°C (101.3°F), pulse is 90/min, respirations are 16/min, and blood pressure is 110/70 mm Hg. Examination of the eyes shows diffusely erythematous conjunctiva bilaterally without an exudate. Bilateral calves are tender to palpation. The remainder of the physical examination is unremarkable. This patient most likely acquired the infection via which of the following?

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Eductional Objective: Leptospirosis is a zoonotic infection caused by the motile spirochete Leptospira.  Transmission primarily occurs when humans come into contact with water contaminated with animal urine during outdoor recreational or occupational activities.  Patients classically have a mild, self-limited, flulike illness but may develop more serious complications such as renal or hepatic failure.

A Previously Healthy 25-Year-Old Man Who Is on Active Duty