Leptospirosis (Weil's Disease)- Sign & Symptoms | Causes | Pathogen | Types | Treatment

LEPTOSPIROSIS
Leptospirosis is the most common zoonotic disease worldwide & most common in the tropics.
Low incidence in the US (100-200 cases per year): Half of these cases are reported in Hawaii.

Pathogen: Leptospira (especially L. interrogans); a genus of gram-negative spirochete with hook-shaped ends

Route of infection
Contact with soil, food, and/or water contaminated with the urine of infected animals (most commonty rodents ) entry of Leptospira through skin/mucouS membrane lesions.

Occupational groups at risk: Farmers, sewer workers & Water sports enthusiasts (surfers)


LEPTOSPIROSIS Or Weil's Disease

Chief Complaints:
Incubation time is 2-30 days.
Mild (anicteric) leptospirosis: Clinical
manifestations during the early phase
are due to bacteremia.
» High fever, headache
» Diarrhea, vomiting
» suffusion: bilateral
diffuse reddening of the
conjunctivae without exudates
» Photophobia and Rashes
» Myalgias; (especialy in the calves
and lower back)
» Possibly aseptic meningitis
worsening headache and
photophobia.

Severe leptospirosis (Weil disease,
icterohemorrhagic leptospirosis) →
Clinical features are due to systemic
spread and multiorgan involvement.
» Fever
»Hepatitis with hepatomegaly and
jaundice can cause acute liver failure
» Acute kidney injury (interstitial
nephritis, acute tubular necrosis)
oliguria, hematuria
» Anemia, azotemia
» Hemorrhagic diathesis
1. Purpura
2. Pulmonary hemorrhage-
hemoptysis
» Cardiac abnormalities
Myocarditis & Pericarditis.
Arrhythmia
Conductivity impairment

Microscoplc agglutination test (MAT)
is a gold standard investigation.
Treatment duration is typically 7 days
Severe leptospirosis is associated with
a high mortality rate


Diagnostics

Dark-field microscopy of urine or blood; samples (the thin Leptospira spirochetes cannot be visualized by light microscopy)
Serological tests
» Four-fold rise in the level of lgM titers within one month of the onset of symptoms.

Microscopic agglutination test (MAT)
- Patient serum is incubated with Leptospira serovars, and titers are obtained for serovars that react with patient serum.
- Positive one week after the onset of symptoms.
- PCR: Detect leptospiral DNA in bodily fluids
serum.
- Culture
- CBC: Leukocytosis (neutrophilic) & Can show thrombocytopenia and anemia in Weil disease
- Kidney function tests: elevated BUN in Weil disease
- Liver function tests (LFTS): incresse AST/ALT

Rx
Mild Leptospirosis

1. Cap. Doxycycline 100mg (Doxyn,Vibramycin)1-0-1(BD).
2. Cap Ampicilin 50Omg (Penbritin)
OR Amoxicillin 500mg (Amoxil, Zeemox)
1-0-1(BD).
OR Azithromycin 500mg x BD (Zetro, Azomax) followed by 500mg OD for 2 days.

Severe Leptospirosis
- Treatment of underlying cause: cough, fever, vomiting.
- IV fluid and Electrolyte correction.
- Supportive therapy for multiorgan failure.

1. Inj. Ceftriaxone 1g (Rocephin) x IV for 7 days.
Or Inj Penicillin 1.5MU OR Inj cefotaxime lgm iv 6-hourly for 7days
2. Inj. Paracetamol 1g/100ml (Provas) x IV x BD/TDS/S0S.
3. Inj. Dimenhydrinate 50mg/1ml (OR) Inj. Metoclopramide 10mg xIV.

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