Leptospirosis
Revisión del 17:44 7 jun 2014 de Ostermayer (discusión | contribs.) (→Treatment [http://www.moh.gov.my/images/gallery/Garispanduan/GL_Leptospirosis%202011.pdf Ministry of Health Recommendations)
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[3]
- Ceftriaxone, Cefotaxime, PCN, [[Azithromycin], or Doxycycline[4]
- 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
- ↑ 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
- ↑ [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.