Leptospirosis: Difference between revisions
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==Background== | ==Background== | ||
*Spirochete: Leptospira interrogans | *Spirochete: ''Leptospira interrogans'' | ||
*Human exposure from animal urine, contaminated water/soil, or infected animal tissue.<ref>Radl C. et al. Outbreak of leptospirosis among triathlon participants in Langau, Austria, 2010. Wien Klin Wochenschr. Dec 2011;123(23-24):751-5</ref> | *Human exposure from animal urine, contaminated water/soil, or infected animal tissue.<ref>Radl C. et al. Outbreak of leptospirosis among triathlon participants in Langau, Austria, 2010. Wien Klin Wochenschr. Dec 2011;123(23-24):751-5</ref> | ||
*Portal | *Portal to entry - break in skin, mucosa, or conjunctiva | ||
*Average incubation of 10 days | *Average incubation of 10 days | ||
*Also described following hiking, trekking, and following triathlon competitions<ref>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</ref> | *Also described following hiking, trekking, and following triathlon competitions<ref>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</ref> | ||
[[File:Conjunctivalsuffusion.jpg | |||
[[File:Conjunctivalsuffusion.jpg|thumb|Conjunctival suffusion]] | |||
==Clinical Features== | ==Clinical Features== | ||
*Acute phase lasts up to 1 week | *Acute phase (lasts up to 1 week) | ||
**Mild illness to abrupt high fever, chills, intense headache, and severe myalgias (75-100% of pts) | **Mild illness to abrupt high fever, chills, intense headache, and severe myalgias (75-100% of pts) | ||
*Conjunctival | *Conjunctival suffusion (redness without exudates) characteristic but not common | ||
*Meningitis, uveitis, transminitis, proteinuria, hematuria | *Meningitis, uveitis, transminitis, proteinuria, hematuria | ||
*Weil syndrome -severe manifestation with jaundice and renal failure, pulmonary hemorrhage, ARDS, myocarditis, and rhabdomyolysis (52% Mortality) | *Weil syndrome - severe manifestation with jaundice and renal failure, pulmonary hemorrhage, ARDS, myocarditis, and rhabdomyolysis (52% Mortality) | ||
**10% of patients | **10% of patients | ||
** | **Caused by circulating antibodies | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{Fever in Traveler DDX}} | {{Fever in Traveler DDX}} | ||
== | ==Diagnostic Evaluation== | ||
*Confirm by serology | *Confirm by serology | ||
*Culture | *Culture | ||
| Line 28: | Line 29: | ||
*CSF with elevated wbcs and protein with normal glucose | *CSF with elevated wbcs and protein with normal glucose | ||
== | ==Management<ref>http://www.moh.gov.my/images/gallery/Garispanduan/GL_Leptospirosis%202011.pdf Ministry of Health Malaysia 2011 Recommendations</ref> == | ||
*Penicillin G 100000U/ kg/ dose IV every 6 hours x 7days | *Penicillin G 100000U/ kg/ dose IV every 6 hours x 7days | ||
'''OR''' | |||
OR | |||
*'''>8yrs:''' Doxycycline 4mg/kg/dose oral every 12 hours x 7 days | *'''>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:''' [[Ampicillin]] 75-100mg/kg/dose oral every 6 hours x 7days | ||
*'''<8yrs:''' [[Amoxicillin]] 50mg/kg/dose oral 6- 8 hours x 7days | *'''<8yrs:''' [[Amoxicillin]] 50mg/kg/dose oral 6- 8 hours x 7days | ||
*Other 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> | **[[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.'' | |||
*Be aware of the potential for a [[Jarisch-Herxheimer Reaction]] | *Be aware of the potential for a [[Jarisch-Herxheimer Reaction]] | ||
==See Also== | |||
*[[Travel Medicine]] | |||
==References== | ==References== | ||
<references/> | <references/> | ||
[[Category:ID]] | [[Category:ID]] | ||
[[Category:TropMed]] | [[Category:TropMed]] | ||
Revision as of 08:54, 6 September 2015
Background
- Spirochete: Leptospira interrogans
- Human exposure from animal urine, contaminated water/soil, or infected animal tissue.[1]
- Portal to entry - break in skin, mucosa, 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
Diagnostic Evaluation
- Confirm by serology
- Culture
- Hypokalemia/Hyponatremia
- Thrombocytopenia
- Sterile pyuria
- Elevated CK
- CSF with elevated wbcs and protein with normal glucose
Management[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
- Other alternatives:
- Ceftriaxone, Cefotaxime[4]
- Prefer Azithromycin or Doxycycline if unable to distinguish from rickettsial infection.
- Be aware of the potential for a Jarisch-Herxheimer Reaction
See Also
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.