Leptospirosis: Difference between revisions
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==Clinical Features== | ==Clinical Features== | ||
*Acute phase (lasts up to 1 week) | *Acute phase (lasts up to 1 week) | ||
**Mild illness to abrupt high fever, chills, intense headache, and severe | **Mild illness to abrupt high [[fever]], chills, intense [[headache]], and severe [[myalgia]]s (75-100% of patients) | ||
*Conjunctival suffusion (redness without exudates) characteristic but not common | *Conjunctival suffusion ([[red eye|redness]] without exudates) characteristic but not common | ||
*Meningitis, uveitis, transaminitis, hepatomegaly, proteinuria, hematuria | *[[Meningitis]], [[uveitis]], [[hepatitis|transaminitis]], [[hepatomegaly]], [[proteinuria]], [[hematuria]] | ||
*Weil syndrome - severe manifestation with jaundice and renal failure, aseptic meningitis, pulmonary hemorrhage, ARDS, myocarditis, and rhabdomyolysis (52% Mortality) | *Weil syndrome - severe manifestation with [[jaundice]] and [[renal failure]], aseptic [[meningitis]], [[diffuse alveolar hemorrhage|pulmonary hemorrhage]], [[ARDS]], [[myocarditis]], and [[rhabdomyolysis]] (52% Mortality) | ||
**10% of patients | **10% of patients | ||
**Caused by circulating antibodies | **Caused by circulating antibodies | ||
| Line 25: | Line 25: | ||
*Confirm by serology | *Confirm by serology | ||
*Culture | *Culture | ||
*Hypokalemia/Hyponatremia | *[[Hypokalemia]]/[[Hyponatremia]] | ||
*Thrombocytopenia | *[[Thrombocytopenia]] | ||
* | *[[UA]] with sterile pyuria | ||
*Elevated CK | *Elevated CK | ||
*CSF with elevated wbcs and protein with normal glucose | *[[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>== | ==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 | *[[Penicillin G]] 100000U/ kg/ dose IV every 6 hours x 7days | ||
'''OR''' | '''OR''' | ||
*'''>8yrs:''' Doxycycline 4mg/kg/dose oral every 12 hours x 7 days | *'''>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:''' [[Ampicillin]] 75-100mg/kg/dose oral every 6 hours x 7days | ||
*'''<8yrs:''' [[Amoxicillin]] 50mg/kg/dose oral 6- 8 hours x 7days | *'''<8yrs:''' [[Amoxicillin]] 50mg/kg/dose oral 6- 8 hours x 7days | ||
Latest revision as of 17:29, 16 October 2019
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)
- 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
- UA with 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.