Leptospirosis: Difference between revisions
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==Background== | ==Background== | ||
*Spirochete: ''Leptospira interrogans'' | |||
*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 to entry - break in skin, mucosa, or conjunctiva | |||
*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> | |||
*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> | |||
*Uncommon in the US, although 50% of cases diagnosis in Hawaii | |||
== | [[File:Conjunctivalsuffusion.jpg|thumb|Conjunctival suffusion]] | ||
==Clinical Features== | |||
*Acute phase (lasts up to 1 week) | |||
**Mild illness to abrupt high fever, chills, intense headache, and severe myalgias (75-100% of patients) | |||
*Conjunctival suffusion (redness without exudates) characteristic but not common | |||
*Meningitis, uveitis, transaminitis, hepatomegaly, proteinuria, hematuria | |||
*Weil syndrome - severe manifestation with jaundice and renal failure, aseptic meningitis, pulmonary hemorrhage, ARDS, myocarditis, and rhabdomyolysis (52% Mortality) | |||
**10% of patients | |||
**Caused by circulating antibodies | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{ | {{Fever in Traveler DDX}} | ||
==Evaluation== | |||
*Confirm by serology | |||
*Culture | |||
*Hypokalemia/Hyponatremia | |||
*Thrombocytopenia | |||
*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.'' | |||
*Be aware of the potential for a [[Jarisch-Herxheimer Reaction]] | |||
==See Also== | ==See Also== | ||
*[[Travel Medicine]] | *[[Travel Medicine]] | ||
==References== | |||
<references/> | |||
[[Category:ID]] | [[Category:ID]] | ||
[[Category: | [[Category:Tropical Medicine]] |
Revision as of 09:02, 28 January 2018
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
Clinical Features
- Acute phase (lasts up to 1 week)
- Mild illness to abrupt high fever, chills, intense headache, and severe myalgias (75-100% of patients)
- Conjunctival suffusion (redness without exudates) characteristic but not common
- Meningitis, uveitis, transaminitis, hepatomegaly, proteinuria, hematuria
- Weil syndrome - severe manifestation with jaundice and renal failure, aseptic meningitis, pulmonary hemorrhage, ARDS, myocarditis, and rhabdomyolysis (52% Mortality)
- 10% of patients
- Caused by circulating antibodies
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
Evaluation
- Confirm by serology
- Culture
- Hypokalemia/Hyponatremia
- Thrombocytopenia
- Sterile pyuria
- Elevated CK
- CSF with elevated wbcs and protein with normal glucose
Management[4]
- 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[5]
- Prefer Azithromycin or Doxycycline if unable to distinguish from rickettsial infection.
- Be aware of the potential for a Jarisch-Herxheimer Reaction
See Also
References
- ↑ 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
- ↑ 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),
- ↑ 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.