Leptospirosis

Introduction 

-Leptospirosis is a waterborne zoonosis of worldwide distribution, caused by spirochetes of the genus Leptospira

-it is excreted in urine of reservoir animals, especially rodents

-it is spread by animal urine contaminating lakes and streams

-Hawaii has the highest incidence in the United States

-Leptospira are tightly coiled, thin, flexible spirochetes, with very fine spirals, one end is often bent, forming a hook

-Human infection usually occurs often in bodies of water, entering the body through mucous membranes (mouth, nose, conjunctivae) and breaks in the skin (cuts and abrasions) 

Symptoms & Signs 

-Most human infections are asymptomatic and self-limited

-In symptomatic patients, Leptospirosis is a biphasic illness

Leptospiremic phase:  fever,severe headache, chills, myalgias, hepatitis (with or without jaundice), nausea, vomiting, conjunctival injection without purulent discharge 

Severe leptospirosis (Weil’s syndrome): hemorrhage, jaundice, acute renal injury, aseptic meningitis,uveitis, hepatic failure, renal failure, uveitis, rash, and circulatory collapse

Diagnosis 

Serum agglutination tests are the primary diagnostic method 

Other diagnostic aids: Dark-field examination, whole blood or urine culture

Treatment 

Mild leptospirosis: Oral doxycycline, ampicillin or amoxicillin 

Moderate or severe leptospirosis: intravenous penicillin, ampicillin, or ceftriaxone

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