Leptospirosis!

3 Feb

QUICK HITS:

-caused from spirochete Leptospira interrogans

Excreted by infected animals in urine

Dogs are principal vector in humans

-Infected patients usually have contact with dogs or contaminated water

Outbreaks usually after flooding

 

Diagnosis:  

50% sensitivity for CSF and or blood detection of leptospires during the first week;

30% detection in urine in second week

 

Features

                –Incubation of 2-20 days

-Initial phase

                -usually high fever headaches, myalgias, hepatitis and other non-specific flu-like symptoms.  

                –Conjunctival injection without purulence is common.  

                -Initial phase usually resolves after 4-7 days, followed by severe icteric “Weil Disease” phase caused by circulating antibodies.

-Weil Phase

                –Lasts up to 4 weeks 

                -can include aseptic meningitis, renal failure, uveitis, rash.

 

Treatment (may prevent second disease phase)

                -Mild disease:  PO amoxicillin or PO doxycycline

                -Severe cases:  IV PCN, ceftriaxone or ampicillin

-When suspected, consider empiric PO therapy with doxycycline or PCN

 

Submitted by Joey Grover.

 

Sources: Tintinalli’s Emergency Medicine:  7th Edition;  Rosen’s Emergency Medicine:  7th Edition; picture

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