LEPTOSPIROSIS

Question 1

Severe leptospirosis is characterized by ______, ______, _______ , often referred to as ________

Answer 1

Severe leptospirosis is characterized by jaundice, renal dysfunction, and hemorrhagic diathesis, is often referred to as Weil’s syndrome.

Question 2

In this phase of leptospirosis infection, highly motile organisms proliferate, cross tissue barriers, and disseminate hematogenously to all organs.

Answer 2

Leptospiremic phase

*leptospires can be isolated from the bloodstream

Question 3

This phase is characterized by the appearance of antibodies which coincides with the disappearance of leptospires from the blood.

Answer 3

Immune phase

Question 4

TRUE OR FALSE? The incubation period is usually 1–2 weeks but ranges from 2 to 30 days

Answer 4

TRUE

Question 5

Common electrolyte abnormalities in severe leptospirosis?

Answer 5

Hypokalemia and Hyponatremia.

• Loss of magnesium in the urine is uniquely associated with leptospiral nephropathy.

Question 6

A potentially chronic condition that is a recognized sequela of leptospirosis.

Answer 6

Autoimmune associated uveitis

Question 7

In what leptospirosis phase can the organism be cultured from blood and detected by polymerase chain reaction (PCR)?

Answer 7

Acute Leptospiremic phase

* Acute leptospiremic phase - characterized by fever of 3–10 days’ duration, during which time the organism can be cultured from blood and detected by polymerase chain reaction (PCR).

Question 8

In what phase can the organism be cultured from the urine?

Answer 8

Immune phase

* Immune phase - resolution of symptoms may coincide with the appearance of antibodies, and leptospires can be cultured from the urine.

Question 9

TRUE OR FALSE: Leptospira can be cultured from the cerebrospinal fluid (CSF) in the early phase

Answer 9

TRUE

Question 10

TRUE OR FALSE: Loss of magnesium in the urine is uniquely associated with leptospiral nephropathy.

Answer 10

TRUE

Question 11

Most common pulmonary radiographic finding in severe leptospirosis?

Answer 11

patchy bilateral alveolar pattern that corresponds to scattered alveolar hemorrhage.

*predominantly affect the lower lobes

Question 12

Definitive diagnosis of leptospirosis

Answer 12

1) Isolation of the organism from the patient
2) positive result in the PCR
3) seroconversion or a rise in antibody titer

* single antibody titer of 1:200–1:800 (depending on whether the case occurs in a low- or high-endemic area) in the microscopic agglutination test (MAT) is required.
* Fourfold or greater rise in titer is detected between acute- and convalescent-phase serum specimens.

Question 13

TRUE OR FALSE: Serologic testing lacks sensitivity in the early acute phase of the disease (up to day 5)

Answer 13

TRUE

Question 14

TRUE OR FALSE: PCR offers a great advantage and has the capacity to confirm the diagnosis of leptospirosis with a high degree of accuracy during the first 5 days of illness.

Answer 14

TRUE

Question 15

DRUG OF CHOICE for severe leptospirosis?

Answer 15

IV Penicillin

• ceftriaxone, cefotaxime, or doxycycline is a satisfactory alternative to penicillin for the treatment of severe leptospirosis

DOSE:
Penicillin 1.5MU IV or IM q6
Ceftriaxone 2g IV OD
Cefotaxime 1g IV q6
Doxycycline 200mg IV LD then 100mg IV q12

Question 16

TRUE OR FALSE: ALL treatment regimens should be given for 7 days.

Answer 16

TRUE

Question 17

The most important reservoir for leptospirosis?

Answer 17

• Rodents, especially rats, are the most important reservoir

Question 18

Renal pathology seen in the immune phase of leptospirosis?

Answer 18

Renal pathology shows both acute tubular damage and interstitial nephritis.

• Acute tubular lesions progress in time to interstitial edema and acute tubular necrosis.
• Severe nephritis is observed in patients who survive long enough to develop it