Diferencia entre revisiones de «Leptospirosis»
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==Background== | ==Background== | ||
#Human exposure from animal urine, contaminated water/soil, or infected animal tissue. | #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> | ||
#Portal from break in skin, mucousa, or conjunctiva | #Portal from break in skin, mucousa, or conjunctiva | ||
#Average incubation of 10 days | #Average incubation of 10 days | ||
#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> | |||
[[File:Conjunctivalsuffusion.jpg|200px|thumb|Conjunctival suffusion]] | [[File:Conjunctivalsuffusion.jpg|200px|thumb|Conjunctival suffusion]] | ||
==Clinical Manifestations== | ==Clinical Manifestations== | ||
# | # Fever, Myalgias, Headaches (75-100% of pts) | ||
# | # Conjuntival suffusion characteristic but not common | ||
# | # Meningitis, uveitis, transminitis, proteinuria, hematuria | ||
# Weil syndrome-severe manifestation with jaundice and renal failure, pulmonary hemorrhage, ARDS, myocarditis, and rhabdomyolysis (52% Mortality) | # Weil syndrome-severe manifestation with jaundice and renal failure, pulmonary hemorrhage, ARDS, myocarditis, and rhabdomyolysis (52% Mortality) | ||
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==Treatment== | ==Treatment== | ||
#Ceftriaxone, | #[[Ceftriaxone]], [[Cefotaxime]], [[Penicillin|PCN]], [[Azithromycin], or [[Doxycycline]]<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 | #Prefer [[Azithromycin]] or [[Doxycycline]] if unable to distinguish from rickettsial infection. | ||
#Beware of Jarisch-Herxheimer reaction | #Beware of Jarisch-Herxheimer reaction | ||
Revisión del 17:33 7 jun 2014
Background
- Human exposure from animal urine, contaminated water/soil, or infected animal tissue.[1]
- Portal from break in skin, mucousa, or conjunctiva
- Average incubation of 10 days
- Also described following hiking, trekking, and following triathlon competitions[2]
Clinical Manifestations
- Fever, Myalgias, Headaches (75-100% of pts)
- Conjuntival suffusion characteristic but not common
- Meningitis, uveitis, transminitis, proteinuria, hematuria
- Weil syndrome-severe manifestation with jaundice and renal failure, pulmonary hemorrhage, ARDS, myocarditis, and rhabdomyolysis (52% Mortality)
Laboratory findings
- Confirm by serology
- Culture
- Hypokalemia/Hyponatremia
- Thrombocytopenia
- Sterile pyuria
- Elevated CK
- 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
- Chikungunya
- Yellow fever
- Rift valley fever
- Q fever
- Amebiasis
- Zika virus
Treatment
- Ceftriaxone, Cefotaxime, PCN, [[Azithromycin], or Doxycycline[3]
- Prefer Azithromycin or Doxycycline if unable to distinguish from rickettsial infection.
- Beware of Jarisch-Herxheimer reaction
Source
- Palaniappan RU, Ramanujam S, Chang YF. Leptospirosis: pathogenesis, immunity, and diagnosis. Curr Opin Infect Dis. 2007;20(3):284-92
See Also
- ↑ 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
- ↑ 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.