Leptospirosis

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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
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

Fever in traveler

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

See Also

References

  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. 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),
  4. http://www.moh.gov.my/images/gallery/Garispanduan/GL_Leptospirosis%202011.pdf Ministry of Health Malaysia 2011 Recommendations
  5. 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.