Leptospirosis: Difference between revisions
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==Diagnosis== | ==Diagnosis== | ||
*Confirm by serology | |||
*Culture | |||
*Hypokalemia/Hyponatremia | |||
*Thrombocytopenia | |||
*Sterile pyuria | |||
*Elevated CK | |||
*CSF with elevated wbcs and protein with normal glucose | |||
==Treatment<ref> [http://www.moh.gov.my/images/gallery/Garispanduan/GL_Leptospirosis%202011.pdf Ministry of Health Malaysia 2011 Recommendations</ref> == | ==Treatment<ref> [http://www.moh.gov.my/images/gallery/Garispanduan/GL_Leptospirosis%202011.pdf Ministry of Health Malaysia 2011 Recommendations</ref> == | ||
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OR | 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 | |||
Alternatives: | Alternatives: | ||
*[[Ceftriaxone]], [[Cefotaxime]]<ref>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.</ref> | |||
*''Prefer [[Azithromycin]] or [[Doxycycline]] if unable to distinguish from rickettsial infection.'' | *''Prefer [[Azithromycin]] or [[Doxycycline]] if unable to distinguish from rickettsial infection.'' | ||
Revision as of 02:32, 10 June 2015
Background
- Spirochete: Leptospira interrogans
- Human exposure from animal urine, contaminated water/soil, or infected animal tissue.[1]
- Portal from break in skin, mucousa, or conjunctiva
- Average incubation of 10 days
- Also described following hiking, trekking, and following triathlon competitions[2]
Clinical Features
- Acute phase lasts up to 1 week
- Mild illness to abrupt high fever, chills, intense headache, and severe myalgias (75-100% of pts)
- Conjunctival Suffusion (redness without exudates) characteristic but not common
- Meningitis, uveitis, transminitis, proteinuria, hematuria
- Weil syndrome -severe manifestation with jaundice and renal failure, pulmonary hemorrhage, ARDS, myocarditis, and rhabdomyolysis (52% Mortality)
- 10% of patients
- caused by circulating antibodies
Differential Diagnosis
Fever in traveler
- Normal causes of acute fever!
- Malaria
- Dengue
- Leptospirosis
- Typhoid fever
- Typhus
- Viral hemorrhagic fevers
- Chikungunya
- Yellow fever
- Rift valley fever
- Q fever
- Amebiasis
- Zika virus
Diagnosis
- Confirm by serology
- Culture
- Hypokalemia/Hyponatremia
- Thrombocytopenia
- Sterile pyuria
- Elevated CK
- CSF with elevated wbcs and protein with normal glucose
Treatment[3]
- 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
Alternatives:
- Prefer Azithromycin or Doxycycline if unable to distinguish from rickettsial infection.
- Be aware of the potential for a Jarisch-Herxheimer Reaction
References
- ↑ Radl C. et al. Outbreak of leptospirosis among triathlon participants in Langau, Austria, 2010. Wien Klin Wochenschr. Dec 2011;123(23-24):751-5
- ↑ 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
- ↑ [http://www.moh.gov.my/images/gallery/Garispanduan/GL_Leptospirosis%202011.pdf Ministry of Health Malaysia 2011 Recommendations
- ↑ 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.