Leptospirosis 2010 Flashcards
What clinical manifestations should alert a health practitioner to suspect leptospirosis among patients presenting with acute fever?
Any individual presenting with acute febrile illness of at least 2 days AND either residing in a flooded area or has high-risk exposure (defined as wading in floods and contaminated water, contact with animal fluids, swimming in flood water or ingestion of contaminated water with or without cuts or wounds) AND presenting with at least two of the following symptoms: myalgia, calf tenderness, conjunctival suffusion, chills, abdominal pain, headache, jaundice, or oliguria should be considered a suspected leptospirosis case. [Grade A]
presenting with at least two of the following symptoms:
myalgia, calf tenderness, conjunctival suffusion, chills, abdominal pain, headache, jaundice, or oliguria should be considered a suspected leptospirosis case.
mortality may be as high as
15%.
Who should be admitted
MODERATE – SEVERE LEPTOSPIROSIS and BEST managed in a HEALTHCARE / HOSPITAL SETTING. [Grade A]
incubation period of leptospirosis may range from
2 to 28 days.
(most commonly pulmonary) severe manifestation
hemorrhage
Weil’s disease is characterized by a triad of
fever, jaundice, and splenomegaly.
remains the GOLD standard BUT is time-consuming,
labor-intensive, requires 6 to 8 weeks for the result
Culture and isolation
has the advantage of early confirmation of the diagnosis especially during the acute leptospiremic phase (first week of illness) before the appearance of antibodies.
Polymerase Chain Reaction (PCR)
a four-fold rise of the titer from acute to
convalescent sera is confirmatory of the diagnosis.
Microagglutination Test (MAT) -
LAATS (Leptospira Antigen- Antibody Agglutination Test (Leptospira Serology Bio-Rad)
This is used as a screening test but is NOT sensitive.
A positive result should be confirmed with MAT.
occurs during the first stage of the disease, beginning before the onset of symptoms, and ends by the first week of the illness. Thus blood cultures should be taken as soon as possible after the patient’s presentation and before antibiotics.
Leptospiremia
Ideal time of collection for Blood with heparin (to prevent clotting)
First 10 days
Ideal time of collection for Clotted blood or serum for serology
Collected twice at an interval of several days
Ideal time of collection Urine for culture
Inoculated into an appropriate culture medium not more than 2 hours after voiding
Ideal time of collection
Fo Cerebrospinal fluid and dialysate for culture
First week of illness
IgM antibodies become detectable during the _____ allowing the diagnosis to be confirmed and treatment initiated while it is likely to be most effective
first week of illness
For mild leptospirosis, ____ is the drug of choice.
doxycycline 100mg bid (hydrochloride, hyclate)
Alternative drugs include amoxicillin and azithromycin dihydrate. [Grade B]
For moderate-severe leptospirosis, _____ remains the drug of choice.
penicillin G 1.5 MU q6-8hrs
Alternative drugs include parenteral ampicillin, 3rd generation cephalosporin (cefotaxime, ceftriaxone), and parenteral azithromycin dihydrate. [Grade A]
The recommended regimen for pre-exposure prophylaxis for non-pregnant, non-lactating adults is:
Doxycycline (hydrochloride and hyclate) 200 mg once weekly, to begin 1 to 2 days before exposure and continued throughout the period of exposure [Grade B]
Post-exposure prophylaxis for LOW-RISK EXPOSURE is defined as those individuals with a single history of wading in flood or contaminated water without wounds, cuts or open lesions of the skin.
Doxycycline 200 mg single dose within 24 to 72 hours from exposure [Grade B]
Post-exposure prophylaxis for MODERATE-RISK EXPOSURE is defined as those individuals with a single history of wading in flood or contaminated water and the presence of wounds, cuts, or open lesions of the skin, OR accidental ingestion of contaminated water.
Doxycycline 200 mg once daily for 3-5 days to be started immediately within 24 to 72 hours from exposure6 [Grade C]
Post-exposure prophylaxis for HIGH-RISK EXPOSURE is defined as those individuals with continuous exposure (those having more than a single exposure or several days such as those residing in flooded areas, rescuers and relief workers) of wading in flood or contaminated water with or without wounds, cuts or open lesions of the skin. Swimming in flooded waters especially in urban areas infested with domestic/sewer rats and ingestion of contaminated water are also considered high risk exposures.
Doxycycline 200 mg once weekly until the end of exposure [Grade B]
underlying pathology in renal leptospirosis is a combination of
acute tubular damage and tubule-interstitial nephritis.
