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| Notifiable Diseases UK
Leptospirosis is spread in the urine of infected animals most commonly rats, mice, cows, pigs and dogs. Start antibiotics on basis of clinical signs before cultures are available
- Leptospirosis is a zoonotic infection due to the organism leptospira interrogans
- Live in the renal tubules of chronically infected asymptomatic mammals
- Bacteria are then shed through the urine of these animals
- Bacteria can survive for weeks to months in shaded, warm, and humid conditions
- Animal workers, sewage workers.
- Those involved with water sports are at risk
- Pets and bites rare
- Human-to-human transmission is exceptional.
- Gram negative coiled bacteria. No capsule, non-sporing.
- Spirochetes with hooked ends
- Gain entry to human hosts via mucous membranes or abraded skin
- Rat - Rattus Norvegicus shed living in convoluted tubules in huge numbers in rat urine
- Symptoms come on 1-2 weeks following exposure
- Fever with conjunctival suffusion hyperaemia is a useful sign
- Oliguric renal failure with renal casts and proteinuria and haematuria
- Tender hepatosplenomegaly and jaundice but liver failure and encephalopathy are classically not seen. There may be a prolonged PT and haemorrhage.
- ARDS and total bilateral pulmonary consolidation with a "pulmonary syndrome" has been seen more in Asia and can lead to multi-organ failure, ARDS and very high mortality, haemoptysis, patchy lung infiltrates on CXR and respiratory failure.
- Bleeding leads to skin and bruising, epistaxis, haematemesis, melaena, bloody pericardial/pleural effusions or bloody subarachnoid space
- Aseptic meningitis resembling a viral meningitis (increased neutrophils and elevated AST)
- Myocarditis, Encephalitis
- Mild influenza-like illness
- Weil's syndrome characterized by jaundice, renal failure, haemorrhage, and myocarditis with arrhythmias,
- Pulmonary haemorrhage with respiratory failure.
- Dengue, Typhoid fever, Malaria, Scrub typhus, Hantavirus
- FBC - ↓ platelets, ↑ WCC (classically neutrophils)
- U&E - ↑ Creatinine, proteinuria, haematuria
- LFT: ↑PT, ↑ ↑ AST ↑ ALT ↑ Bilirubin ↑ CK
- LP/CSF - ↑ protein and normal glucose
- Before day 10 - positive blood cultures. After 7 days - positive urine cultures
- Positive IgM serology after 1st week so treat on suspicion
- Microscopic agglutination test (MAT): seroconversion or ↑ x4 in titre between acute and convalescent sera is confirmatory
- PCR to detect leptospiral DNA blood or urine (after day 8 and for months)
- Wash your hands with soap and water after handling animals or animal products and clean any wounds as soon as possible
- Cover any cuts and grazes with waterproof plasters
- Wear protective clothing if you're at risk through your job
- Shower as soon as possible if you've been in potentially infected water
- Vaccinate dogs (there isn't a vaccine for people)
- Don't touch dead animals with your bare hands
- Don't drink water from rivers, canals or lakes that hasn't been boiled
- Oliguria caused by acute renal failure
- Haemorrhage can also be a major concern.
- Severe pulmonary haemorrhage often needs ventilation
- Aseptic meningitis
- ARDS, Haemolytic anaemia
- Guillain-Barre syndrome.
- Circulatory collapse
- Usually supportive as usually self-limiting.
- Transfuse for significant haemorrhage
- Renal support/replacement can be life-saving. AKI typically resolves
Antibiotic (Several choices)
- Severe Disease: IV BenzylPenicillin 1.5 MU 6 hourly for 1 week or Ceftriaxone 1 g daily for one week.
- Oral Doxycycline 100 mg bd for 1 week for mild disease
- A mild Jarisch-Herxheimer reaction may occur with Penicillin therapy. High mortality > 10%
- Doxycyline 200 mg weekly has been shown to help in high-risk individuals