Leptospirosis

Background

1. Human exposure from animal urine, contaminated water/soil, or infected animal tissue.
2. Portal from break in skin, mucousa, or conjunctiva
3. Average incubation of 10 days

Conjunctival suffusion

Clinical Manifestations

1. fvr, myalgia, ha (75-100% of pts)
2. conjuntival suffusion characteristic but not common
3. meningitis, uveitis, transminitis, proteinuria, hematuria
4. Weil syndrome-severe manifestation with jaundice and renal failure, pulmonary hemorrhage, ARDS, myocarditis, and rhabdomyolysis (52% Mortality)

Laboratory findings

1. Confirm by serology
2. Culture
3. Hypokalemia/Hyponatremia
4. Thrombocytopenia
5. Sterile pyuria
6. Elevated CK
7. CSF with elevated wbcs and protein with normal glucose

Differential Diagnosis

Fever in traveler

• Normal causes of acute fever!
• Malaria
• Dengue
• Leptospirosis
• Typhoid fever
• Typhus
• Viral hemorrhagic fevers
  • Ebola virus disease
  • Marburg virus disease
  • Lassa fever
  • Crimean-Congo hemorrhagic fever
• Chikungunya
• Yellow fever
• Rift valley fever
• Q fever
• Amebiasis
• Zika virus

Treatment

1. Ceftriaxone, cefotaxime, PCN, azithromycin, or doxycycline
2. Prefer azithro or doxy if unable to distinguish from rickettsial infection.
3. Beware of Jarisch-Herxheimer reaction

Source

1. Palaniappan RU, Ramanujam S, Chang YF. Leptospirosis: pathogenesis, immunity, and diagnosis. Curr Opin Infect Dis. 2007;20(3):284-92

See Also

• Travel Medicine