Todays sketch: 9th August 2006 6.

Diagnostic Principles:
Leptospirosis □ There is no sensitive, specific, low cost, rapid and widely
available diagnostic test and the diagnosis is considered to be
1. Definition: difficult3.
□ Good clinical history with plausible history of exposure 8.
□ One of the most common zoonosis5, 2, 1 following incorporation
of Leptospira interrogans, a finely coiled, thin, motile, obligate, 7. Management Principles:
slow-growing and anaerob spirochaete.
□ Treatment regime and efficacy are highly controversial2.
□ Usually a self limiting flue-like illness7 with unspecific
□ Oral prophylaxis with Doxycycline is use and highly
symptoms. The majority of cases is likely to remian
efficacious3.
undiagnosed and therefore unreported3.
□ Antibiotic therapy does not seem to reduce mortality, although
□ Over 200 serovars in 25 serogroups5, 2 are known.
it may shorten the duration of renal failure and hospital stay3.
□ Serious to fatal courses of the disease are known5, 2.
For moderate to severe cases the following recommendation
2. Signs: exist:
□ Penicillin G, 1.5 million units IV qid, OR
Occuring after incubation phase (see Etiology): □ Ampicillin, 1 g IV qid OR
□ Fever, chills, vomiting, conjunctival suffusion3. □ Amoxicillin, 1 g IV qid OR
□ In the past, jaundice has been the indicator of severe disease □ Erythromycin, 500 mg IV qid
(Weil’s syndrome), characterised by hepatic and renal
impairment, haemorrhage and vascular collapse. Recent 8. Risk Factors:
studies showed that jaundice is no longer an accurate marker
□ Occupational contact to animals,
of disease severity3.
□ Contact with contatminated water in endemic areas.
Less often (<15%):
□ Renal involvement. 9. Complications:
□ Respiratory symptoms, pulmonary haemorrhages.
□ Vasculitis
3. Symptoms: □ Multiorgan failure (fatal acute renal failure, jaundice,
respiratory failure, myocarditis and rhabdomyolysis) 1.
Occuring after incubation phase (see Etiology) as:
□ Headache, myalgia, sweats, abdominal pain, nausea3. 10. Prognosis:
4. Epidemiology: Highest mortality have the elderly and those with Weil's disease.
Leptospirosis in pregnancy is assciated with high fetal
□ Effecting all with potential contact to animals or recreational
mortality2.
activities involving water3, 2 mainly in subtropical/tropical
regions.
□ Considered rare in developed countries (Australia had 245
cases reported in 20013, approximately 30/year in UK 2), but
seroepidemiologic studies suggest that prevalence can reach
>30% in selected urban populations in some industrialized
countries4.
□ There seems to be a low but persistant prevalence4 and
mortality (4 – 10%, usually from multiorgan failure3).
5. Etiology:
□ The primary reservoir are wild animals and although rodents
are the most important, it effects at least 160 different mamal
species1, reptiles and amphibians3.
□ L enters the host through skin abrasions, through intact
mucous membrane, conjunctivae or by ingestion of
contaminated water 5, 6, 7, contact with urine, blood and
contaminated tissue. Human-to-human transmission is rare2.
□ Their flagella allows them to burrow into tissue followed by
rapid invasion of the blood stream 1, 3 and signs and
symptoms can be observed after an incubation period
between 1 day to 4 weeks 3.
□ Multiplication occurs in the small vessel endothelium, causing
vasculitis and damage to organs.
□ L establishes a symbiotic relationship with the host and may
persist in renal tubules for years2.
□ They are excreted into the environment via urine (L.i. ictero-
haemorrhagiae/ rodents (“Weil's disease”), L.i. canicola/ dogs
+ pigs; L.i. hardjo/ cattle L.i. pomona/pigs + cattle.
□ L. i. survives for many days3/months2 in warm fresh water and
up to 24hrs in sea water3, 2.
1
"Leptospirosis in Humans", eMedicine, 19th October 2005, J Green-McKenzie,
Assistant Professor, Department of Emergency Medicine, University of
Pennsylvania School of Medicine.
2
Harrison's Internal Medicine > Part 6. Infectious Diseases > Section 9. Spirochetal
Diseases > Chapter 155. Leptospirosis
3
"Fatal leptospirosis presenting as musculoskeletal chest pain", MJA 2004; 180 (1):
29-31, Fenton M O’Leary, J S Hunjan, R Bradbury and G Thanakrishnan.
4
“Leptospirosis in Germany, 1962–2003”; J A Schöneberg et al; Emerg Infect Dis,
07/2005 7
"Leptospirosis", GPnotebook
5
“Leptospirosis”, Clinical Medicine, Kumar&Clark, 6th Edition, Pg: 77f 8
"Leptospirosis", S G Gompf, Associate Professor, James A Haley Veterans Affairs
6
"Leptospirosis", Family Practice Notebook.com Medical Center.