Joey R. Quino Gullas College of Medicine Dept.

of Family Medicine

An infectious disease caused by pathogenic leptospires (Leptospira interrogans) Characterized by a broad spectrum of clinical manifestations, varying from inapparent infection to fulminant, fatal disease

Worldwide Occurs most commonly in the tropics

Peak incidence during the rainy seasons

Male predominance

Occupations that involve contact with contaminated water, soil, or animals Recreational exposure (water exposure) Domestic animal contact Travel to tropical countries where incidence is high

Leptospira interrogans
Coiled, thin, highly motile organisms with hooked ends and 2 flagella that permit burrowing into tissue Transmission is direct contact with urine, blood or tissue from an infected animal or exposure to a contaminated environment Most important reservoir: rodents

Entry via skin abrasions or intact mucous membranes, followed by leptospiremia and widespread dissemination, including entry into the CSF, damaging blood vessel walls and cause vasculitis with leakage and extravasation of cells, including hemorrhages Incubation period is usually 1-2 weeks

90% of symptomatic persons have a relatively mild and usually anicteric form, with or without meningitis. First (leptospiremic) phase
Acute influenza-like illness
Fever Chills Severe headache (frontal or retro-orbital) Nausea Vomiting Myalgias (especially affect calves, back, abdomen)

Less common manifestations

Sore throat Photophobia Mental confusion Cough Chest pain Hemoptysis

Physical findings
Fever Conjunctival suffusion Muscle tenderness Lymphadenopathy Pharyngeal injection Maculopapular, erythematous, urticarial rash Hepatomegaly and splenomegaly

Second (immune) phase

Fever, less pronounced Myalgias, less severe Aseptic meningitis in up to 15% of patients (more common among children than adults) Iritis and chorioretinitis

Develops in 5-10% of infected persons 4-9 days of mild illness followed by

Jaundice Hepatomegaly Right upper quadrant tenderness Splenomegaly Renal dysfunction Pulmonary involvement Hemorrhagic manifestations

CBC (leukocytosis, thrombocytopenia) CSF ( pleocytosis, elevated protein) Blood chemistry (elevated bilirubin, creatinine, aminotransferases) Chest x-ray (patchy pattern in lower lobes) Culture/isolation of leptospires

Mild leptospirosis
Treat for 7 days with:
Tetracycline (500 mg PO qid) Doxycycline (100 mg PO bid) Ampicillin (500-750 mg PO qid)

Moderate or severe leptospirosis Treat for 7 days with 1 of the following:

Penicillin family -Penicillin G (1.5 million units IV qid) -Ampicillin (1g IV qid) o Third generation cephalosporins -Ceftriaxone (1g IV every 24 hours) -Cefotaxime (1g IV every 6 hours) o Doxycycline (200 mg, then 100 mg IV every 12 hours) o Erythromycin (500 mg IV qid)

Jarisch-Herxheimer reaction may develop rarely within hours after the start of treatment
manifestations:
Fever, headache and chills Myalgia and tachycardia Increased respiratory rate Increased circulating neutrophil count Vasodilation with mild hypotension

Anicteric leptospirosis
Iritis Chorioretinitis Uveitis

Weils syndrome

Renal failure Hemolysis Pericarditis Adult respiratory distress syndrome Necrotizing pancreatitis Multiorgan failure

Mortality is almost nil in anicteric leptospirosis Mortality rate is 5-15% in Weils syndrome Associated with high fetal mortality rate in pregnancy

Persons who may be exposed should be informed of risks. Avoidance of exposure to urine and tissues from infected animals Rodent control Chemoprophylaxis
Doxycycline (200 mg once weekly)