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Leptospirosis 

Leptospirosis

Chapter:
Leptospirosis
Author(s):

George Watt

DOI:
10.1093/med/9780199204854.003.070634_update_001

Update:

Epidemiology—recent Sri Lanka epizootic.

Diagnosis—PCR and serological methods.

Updated on 31 May 2012. The previous version of this content can be found here.
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date: 24 March 2017

Leptospirosis is a worldwide zoonosis of greatest importance in the tropics that is caused by spirochaetes of the 16 species of the genus Leptospira. Rodents are the most important reservoir, with transmission of infection usually occurring through contact with contaminated water or moist soil. Organisms enter the human body through abrasions of the skin or through mucosal surfaces.

Clinical features—subclinical infection is common, but symptomatic disease typically begins with abrupt onset of intense headache, fever, chills, and myalgia. Conjunctival suffusion is a helpful diagnostic clue. Most patients recover within a week, but some then relapse, commonly with meningitis. Less than 10% of symptomatic infections result in severe, icteric illness (Weil’s disease) that is characterized by jaundice, renal dysfunction, haemorrhagic manifestations, and high mortality. Leptospirosis-associated severe pulmonary haemorrhage syndrome, which can occur either with or without jaundice and renal failure, has a case fatality rate of about 50%.

Diagnosis—most cases go undiagnosed because serological confirmation is rarely available where most disease transmission occurs. The gold standard microscopic agglutination test is impracticable, and commercially available rapid serodiagnostic kits have unacceptably low sensitivities and lack specificity in regions of high endemic transmission.

Treatment and prognosis—aside from supportive care, antibiotics should be given to all patients with leptospirosis, regardless of age, the stage of their disease, or fear of a possible Jarisch–Herxheimer reaction. High-dose intravenous penicillin is the treatment of choice for adults and children with severe, late disease: doxycycline, ceftriaxone, cefotaxime, and azithromycin are effective in mild disease. Ensuring adequate renal perfusion prevents renal failure in most oliguric patients. Failure to make the diagnosis of leptospirosis is particularly unfortunate: severely ill patients with leptospirosis often recover completely with prompt treatment, but they may die if therapy is delayed or not given.

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