Diferencia entre revisiones de «Leptospirosis»
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==Treatment<ref> [http://www.moh.gov.my/images/gallery/Garispanduan/GL_Leptospirosis%202011.pdf Ministry of Health Malaysia 2011 Recommendations</ref> ==
==Treatment<ref> [http://www.moh.gov.my/images/gallery/Garispanduan/GL_Leptospirosis%202011.pdf Ministry of Health Malaysia 2011 Recommendations</ref> ==
#[[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>
[[Penicillin|PCN]]
#Prefer [[Azithromycin]] or [[Doxycycline]] if unable to distinguish from rickettsial infection.
*Penicillin G 100000U/ kg/ dose IV every 6 hours x 7days
#Beware of Jarisch-Herxheimer reaction
 
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
 
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.''
*Be aware of the potential for a [[Jarisch-Herxheimer Reaction]]


==Source==
==Source==

Revisión del 17:51 7 jun 2014

Background

  1. Human exposure from animal urine, contaminated water/soil, or infected animal tissue.[1]
  2. Portal from break in skin, mucousa, or conjunctiva
  3. Average incubation of 10 days
  4. Also described following hiking, trekking, and following triathlon competitions[2]
Conjunctival suffusion

Clinical Manifestations

  1. Fever, Myalgias, Headaches (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

Treatment[3]

PCN

  • Penicillin G 100000U/ kg/ dose IV every 6 hours x 7days

OR

  1. >8yrs: Doxycycline 4mg/kg/dose oral every 12 hours x 7 days
  2. <8yrs: Ampicillin 75-100mg/kg/dose oral every 6 hours x 7days
  3. <8yrs: Amoxicillin 50mg/kg/dose oral 6- 8 hours x 7days

Alternatives:

  1. Ceftriaxone, Cefotaxime[4]

Source

  • Palaniappan RU, Ramanujam S, Chang YF. Leptospirosis: pathogenesis, immunity, and diagnosis. Curr Opin Infect Dis. 2007;20(3):284-92
  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. ↑ [http://www.moh.gov.my/images/gallery/Garispanduan/GL_Leptospirosis%202011.pdf Ministry of Health Malaysia 2011 Recommendations
  4. ↑ 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.

See Also

Obtenido de «https://www.wikem.org/w/index.php?title=Leptospirosis&oldid=21525»