179 Leptospirosis

Question 1

Severe leptospirosis characterized by jaundice, renal dysfunction, hemorrhagic diathesis

Answer 1

Weils syndrome

Question 2

With or without jaundice, this is increasingly recognized as important presentation of severe disease

Answer 2

Pulmonary hemorrhage

Question 3

Microscopic description of leptospires

Answer 3

Coiled thin motile organisms hooked ends and two peripheral flagella with Polar extrusions form the cytoplasmic membrane responsible for motility

Question 4

Important reservoir of leptospirosis

Answer 4

Rodents esp rats

Question 5

True or false. Leptospires can persist in the urogenital tract for years

Answer 5

True

Question 6

Mode of transmission of leptospires

Answer 6

Direct contact with urine, blood or tissues from infected animal or exposure to contaminated environment

Question 7

Important vehicle in the transmission of leptospirosis

Answer 7

Water

Question 8

True or false. Leptospires cause no or only mild disease in humans; severe fatal cases are only 1%

Answer 8

True

Question 9

How does leptospires evade compliment mediated killing

Answer 9

Binding to factor H

Question 10

Incubation period of leptospirosis

Answer 10

Usually 1-2 weeks but ranges from 1 to 30 days

Question 11

What are the phases of leptospirosis? And how can the organism be cultured in these phases

Answer 11

Leptospiremic phase (fever of 3-10 days duration) : cultured from blood and detected by PCR
Immune phase (resolution of symptoms): leptospires are cultured from urine

Question 12

Physical findings that are pathognomonic of leptospirosis

Answer 12

Fever
Conjunctiva suffusion
Pharyngeal injection
Muscle tenderness
Lymphadenopathy
Rash
Meningismus
Hepatomegaly
Splenomegaly

Question 13

Muscle pain in leptospirosis common affects what?

Answer 13

Calves
Back
Abdomen

Question 14

True or false. Leptospirosis can be cultured form CSF in the immune phase

Answer 14

False. Leptospira can be cultured from CSF in the early phase

Question 15

Natural course of mild leptospirosis usually resolves spontaneously within how many days?

Answer 15

7 to 10 days

Question 16

What is the case fatality of leptospirosis?

Answer 16

1-50%

Question 17

What factors are associated with higher mortality

Answer 17

Age more than 40
Altered mental status
Acute renal failure
Arrhythmias

Question 18

Triad that encompasses Weil’s syndrome

Answer 18

Hemorrhage
Jaundice
Acute kidney injury

Question 19

Bleeding complications in leptospirosis

Answer 19

Lungs
GIT
Urogenital
Skin: bleeding from venipuncture sites

Question 20

True or false. Jaundice in leptospirosis is associated with fulminant hepatic necrosis

Answer 20

False

Question 21

Loss of what in the urine is uniquely associated with leptospira nephropathy

Answer 21

Loss of magnesium

Question 22

Typical electrolyte imbalance in leptospirosis

Answer 22

Hypokalemia

Hyponatremia

Question 23

Recognized sequelae of leptospirosis

Answer 23

Auto immune associated uveitis

Question 24

Characteristic of early leptospirosis

Answer 24

Nonoliguric Hypokalemia renal insufficiency

Question 25

Most common radiographic findings in leptospirosis and what lobes are commonly affected

Answer 25

Patchy bilateral alveolar pattern that corresponds to scattered alveolar hemorrhage in the lower lobes

Question 26

Definite diagnosis of leptospirosis

Answer 26

Isolation of organism on PCR

Question 27

True or false: antibodies in leptospirosis are detected as early as the first week of infection

Answer 27

False. Antibodies generally do not reach detectable levels until second week of illness

Question 28

Dual infection in leptospirosis has been reported. It is advisable to contact serologic test for what diseases when leptospirosis is suspected?

Answer 28

Rickettsiae
Dengue virus
Hantavirus

Question 29

Antibiotics susceptible to leptospirosis

Answer 29

Beta lactans
Cephalosporins
Aminoglycosides
Macrolides

Question 30

Leptospirosis is not susceptible to what antibiotics

Answer 30

Vancomycin
Rifampicin
Metronidazole
Chloramphenicol

Question 31

Treatment of leptospirosis. Which is not given during pregnancy?
Mild
Moderate/severe
Chemoprophylaxis

Answer 31

Mild: doxycycline, amoxicillin, ampicillin
Moderate/Severe: penicillin, Ceftriaxone, cefotaxime, doxycycline IV
Chemoprophylaxis: doxycycline, Azithromycin
Not given during pregnancy: doxycycline

Question 32

Drug of choice for leptospirosis when Rickettsial disease are co endemic?

Answer 32

Doxycycline

Azithromycin

Question 33

True or false. Glucocorticoids and desmopressin are adjunct therapy for pulmonary hemorrhage in leptospirosis

Answer 33

False. Evidence is contradictory

Question 34

Treatment of leptospirosis. Mild

Answer 34

Doxycycline 100 mg BID
Amoxicillin 500 mg TID
Ampicillin 500 mg TID

Question 35

Treatment of leptospirosis. Moderate

Answer 35

Penicillin 1. 5 million units q6hrs
Ceftriaxone 2 grams IV per day
Cefotaxime 1 gram IV q6hrs
Doxycycline 200 mg IV LD then 100 mg IV q12h

Question 36

Chemoprophylaxis leptospirosis. Pregnant vs non pregnant

Answer 36

Non pregnant: doxycycline 200 mg PO weekly or Azithromycin 250 mg PO once or twice a week
Pregnant: Azithromycin 250 mg PO once or twice a week

Question 37

How long does acute phase in leptospirosis lasts?

Answer 37

5-7 days

Question 38

How long does immune phase lasts

Answer 38

4-30 days

Question 39

When does immune phase commence

Answer 39

Appearance of IgM antibodies