Leptospirosis

Leptospirosis is caused by the spirochaete Leptospira interrogans (serogroup L. icterohaemorrhagiae), classically being spread by contact with infected rat urine.

Epidemiology

leptospirosis is commonly seen in questions referring to sewage workers, farmers, vets or people who work in an abattoir
however, on an international level, leptospirosis is far more common in the tropics so should be considered in the returning traveller

Weil's disease should always be considered in high-risk patients with hepatorenal failure

Features

the early phase is due to bacteraemia and lasts around a week
- may be mild or subclinical
- fever
- flu-like symptoms
- subconjunctival suffusion (redness)/haemorrhage
second immune phase may lead to more severe disease (Weil's disease)
- acute kidney injury (seen in 50% of patients)
- hepatitis: jaundice, hepatomegaly
- aseptic meningitis

Investigation

serology: antibodies to Leptospira develop after about 7 days
PCR
culture
- growth may take several weeks so limits usefulness in diagnosis
- blood and CSF samples are generally positive for the first 10 days
- urine cultures become positive during the second week of illness

Management

mild-moderate disease: doxycycline or azithormycin
severe disease: IV benzylpencillin

+PassMedicine Notes

Leptospirosis is caused by the spirochaete Leptospira interrogans (serogroup L. icterohaemorrhagiae), classically being spread by contact with infected rat urine.

Epidemiology

leptospirosis is commonly seen in questions referring to sewage workers, farmers, vets or people who work in an abattoir
however, on an international level, leptospirosis is far more common in the tropics so should be considered in the returning traveller

Weil's disease should always be considered in high-risk patients with hepatorenal failure

Features