Diferencia entre revisiones de «Leptospirosis»

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==Background==
==Background==
#Human exposure from animal urine, contaminated water/soil, or infected animal tissue.
*Spirochete: ''Leptospira interrogans''
#Portal from break in skin, mucousa, or conjunctiva
*Human exposure from animal urine, contaminated water/soil, or infected animal tissue.<ref>Radl C. et al. Outbreak of leptospirosis among triathlon participants in Langau, Austria, 2010. Wien Klin Wochenschr. Dec 2011;123(23-24):751-5</ref>
#Average incubation of 10 days
*Portal to entry - break in skin, mucosa, or conjunctiva
[[File:Conjunctivalsuffusion.jpg|200px|thumb|Conjunctival suffusion]]
*Average incubation of 10 days
==Clinical Manifestations==
*Also described following hiking, trekking, and following triathlon competitions<ref>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</ref>
# fvr, myalgia, ha (75-100% of pts)
*Global estimate 1 million cases annually, 58,900 deaths<ref>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),</ref>
# conjuntival suffusion characteristic but not common
*Uncommon in the US, although 50% of cases diagnosis in Hawaii
# meningitis, uveitis, transminitis, proteinuria, hematuria
# Weil syndrome-severe manifestation with jaundice and renal failure, pulmonary hemorrhage, ARDS, myocarditis, and rhabdomyolysis (52% Mortality)


==Laboratory findings==
[[File:Conjunctivalsuffusion.jpg|thumb|Conjunctival suffusion]]
#Confirm by serology
 
#Culture
==Clinical Features==
#Hypokalemia/Hyponatremia
*Acute phase (lasts up to 1 week)
#Thrombocytopenia
**Mild illness to abrupt high [[fever]], chills, intense [[headache]], and severe [[myalgia]]s (75-100% of patients)
#Sterile pyuria
*Conjunctival suffusion ([[red eye|redness]] without exudates) characteristic but not common
#Elevated CK
*[[Meningitis]], [[uveitis]], [[hepatitis|transaminitis]], [[hepatomegaly]], [[proteinuria]], [[hematuria]]
#CSF with elevated wbcs and protein with normal glucose
*Weil syndrome - severe manifestation with [[jaundice]] and [[renal failure]], aseptic [[meningitis]], [[diffuse alveolar hemorrhage|pulmonary hemorrhage]], [[ARDS]], [[myocarditis]], and [[rhabdomyolysis]] (52% Mortality)
**10% of patients
**Caused by circulating antibodies


==Differential Diagnosis==
==Differential Diagnosis==
{{Template:Fever in Traveler DDX}}
{{Fever in Traveler DDX}}
 
==Evaluation==
*Confirm by serology
*Culture
*[[Hypokalemia]]/[[Hyponatremia]]
*[[Thrombocytopenia]]
*[[UA]] with sterile pyuria
*Elevated CK
*[[CSF]] with elevated wbcs and protein with normal glucose
 
==Management<ref>http://www.moh.gov.my/images/gallery/Garispanduan/GL_Leptospirosis%202011.pdf Ministry of Health Malaysia 2011 Recommendations</ref>==
*[[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]]<ref>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.</ref>
**''Prefer [[Azithromycin]] or [[Doxycycline]] if unable to distinguish from rickettsial infection.''


==Treatment==
*Be aware of the potential for a [[Jarisch-Herxheimer Reaction]]
#Ceftriaxone, cefotaxime, PCN, azithromycin, or doxycycline
#Prefer azithro or doxy if unable to distinguish from rickettsial infection.
#Beware of Jarisch-Herxheimer reaction


==Source==
*Uptodate
==See Also==
==See Also==
*[[Travel Medicine]]
*[[Travel Medicine]]
==References==
<references/>


[[Category:ID]]
[[Category:ID]]
[[Category:TropMed]]
[[Category:Tropical Medicine]]

Revisión actual - 17:29 16 oct 2019

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

Differential Diagnosis

Fever in traveler

Evaluation

Management[4]

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

See Also

References

  1. ↑ Radl C. et al. Outbreak of leptospirosis among triathlon participants in Langau, Austria, 2010. Wien Klin Wochenschr. Dec 2011;123(23-24):751-5
  2. ↑ 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
  3. ↑ 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),
  4. ↑ http://www.moh.gov.my/images/gallery/Garispanduan/GL_Leptospirosis%202011.pdf Ministry of Health Malaysia 2011 Recommendations
  5. ↑ 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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