Leptospirosis

Question 1

Characteristics of the etiologic agent of leptospirosis

Answer 1

Leptospires
- coiled, thin highly motile organisms that have hooked ends, and two periplasmic flagella with polar extrusion from the cytoplasmic membrane that are sponsisble for motility

Question 2

Sources of transmission of leptospirosis

Answer 2

direct contact with urine, blood, tissue from an infected animal, or more commonly, exposure to environmental contamination

Question 3

Most important reservoir of leptospirosis

Answer 3

Rodents (esp rats)

Question 4

Pathogenesis of leptospirosis

Answer 4

Question 5

Temporal pattern of detection of leptospires in blood, CSF and urine

Answer 5

Question 6

Incubation period of leptospirosis

Answer 6

1-2 weeks (ranges 1-30 days)

Question 7

characterized by fever of 3-10 days duration, during which time the organism can be cultured from blood and detected by PCR

Answer 7

Acute leptospiremic phase

Question 8

phase characterized by resolution of symptoms that may coincide with the appearance of antibodies, and leptospires can be cultured from the urine

Answer 8

Immune phase

Question 9

Clinical features of mild leptospirosis

Answer 9

flu-like illness of sudden onset, with fever, chills, headache, nausea, vomiting, abdominal pain, conjunctival suffusion , and myalgia

Question 10

clinical features of severe leptospirosis/Weil’s syndrome

Answer 10

hemorrhage
jaundice
acute kidney injury

Question 11

Associated with higher mortality rates

Answer 11

Age >40
Altered mental status
Acute renal failure
Respiratory insufficiency
Hypotension
Arrhythmias

Question 12

Uniquely associated with leptospiral nephropathy

Answer 12

Loss of magnesium in the urine

Question 13

Approach to the diagnosis of leptospirosis

Answer 13

Clinical diagnosis should be based on an appropriate exposure hx combined with any of the protean manifestations

Question 14

Characteristic of early leptospirosis

Answer 14

Nonoliguric hypokalemic renal insufficiency

Question 15

Most common radiographic finding in severe leptospirosis

Answer 15

Patchy bilateral alveolar pattern that corresponds to scattered alveolar hemorrhage

Question 16

Definitive diagnosis of leptospirosis

Answer 16

Positive PCR result or on seroconversion or a rise in antibody titer

Question 17

Standard serologic procedure for leptospirosis

Answer 17

MAT

*lacks sensitivity in the early acute phase (up to D5), it cannot be used as the basis for a timely decision about whether to start tx

Question 18

Treatment recommendations

Answer 18

Question 19

Highest mortality in leptospirossi

Answer 19

elderly
severe disease (pulmonary hemorrhage, weil’s syndrome)

Question 20

Prophylaxis for leptospirosis

Answer 20