Leptospirosis
Background
- Spirochete: Leptospira interrogans
- Human exposure from animal urine, contaminated water/soil, or infected animal tissue.[1]
- Portal to entry - break in skin, mucosa, or conjunctiva
- Average incubation of 10 days
- Also described following hiking, trekking, and following triathlon competitions[2]
- Global estimate 1 million cases annually, 58,900 deaths[3]
- Uncommon in the US, although 50% of cases diagnosis in Hawaii
Conjunctival suffusion
Clinical Features
- Acute phase (lasts up to 1 week)
- Conjunctival suffusion (redness without exudates) characteristic but not common
- Meningitis, uveitis, transaminitis, hepatomegaly, proteinuria, hematuria
- Weil syndrome - severe manifestation with jaundice and renal failure, aseptic meningitis, pulmonary hemorrhage, ARDS, myocarditis, and rhabdomyolysis (52% Mortality)
- 10% of patients
- Caused by circulating antibodies
Differential Diagnosis
Evaluation
- Confirm by serology
- Culture
- Hypokalemia/Hyponatremia
- Thrombocytopenia
- UA with sterile pyuria
- Elevated CK
- CSF with elevated wbcs and protein with normal glucose
Management[4]
- Penicillin G 100000U/ kg/ dose IV every 6 hours x 7days
OR
- >8yrs: Doxycycline 4mg/kg/dose oral every 12 hours x 7 days
- <8yrs: Ampicillin 75-100mg/kg/dose oral every 6 hours x 7days
- <8yrs: Amoxicillin 50mg/kg/dose oral 6- 8 hours x 7days
- Other alternatives:
- Ceftriaxone, Cefotaxime[5]
- Prefer Azithromycin or Doxycycline if unable to distinguish from rickettsial infection.
- Be aware of the potential for a Jarisch-Herxheimer Reaction
See Also
References
- Radl C. et al. Outbreak of leptospirosis among triathlon participants in Langau, Austria, 2010. Wien Klin Wochenschr. Dec 2011;123(23-24):751-5
- CDC. Update: leptospirosis and unexplained acute febrile illness among athletes participating in triathlons--Illinois and Wisconsin, 1998. MMWR Morb Mortal Wkly Rep. 1998;47(32):673-6
- Costa, F., Hagan, J.E., Calcagno, J., Kane, M., Torgerson, P., Martinez-Silveira, M.S., Stein, C., Abela-Ridder, B. and Ko, A.I. (2015) ‘Global morbidity and mortality of Leptospirosis: A systematic review’, PLOS Neglected Tropical Diseases, 9(9),
- http://www.moh.gov.my/images/gallery/Garispanduan/GL_Leptospirosis%202011.pdf Ministry of Health Malaysia 2011 Recommendations
- Inada R, Ido Y, Hoki R. The etiology, mode of infection, and specific therapy of Weil's disease (spirochaetosis icterohaemorrhagica. J Exper Med. 1916;23:377-402.
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