Leptospirosis

Question 1

Clinical findings

Answer 1

Contracted in a flooding tropical environment

1. Biphasic pattern of illness
2. Conjunctival suffusion
3. Hepatic and renal failure in the setting of a tropical febrile illness.

Severe forms : Weil’s disease and severe pulmonary haemorrhage

Question 2

2 distinct phases

Answer 2

A. Septicaemic :

4-7 days, the patient experiences fever,chills, weakness, myalgias, sore throat, cough, chest pain,haemoptysis, rash, frontal headache, photophobia, mental confusion, and other symptoms of meningitis.

B. Immune -

Consequence of the body’s immunologic response to infection and lasts 0-30 days or more. Aseptic meningitis, renal failure, cardiomyopathy, pulmonary manifestations, uveitis.

Question 3

Weil syndrome

Answer 3

severe form of leptospirosis and primarily manifests as profound jaundice,
renal dysfunction, hepatic necrosis, pulmonary dysfunction, and hemorrhagic diathesis - occurs at the end of the first stage and peaks in the second stage.

Question 4

RX

Answer 4

Penicillin (1.5 million units IV every 6 hours) OR
Doxycycline (100 mg IV twice daily) OR
Ceftriaxone (1 to 2 g IV once daily), OR
Cefotaxime (1 g IV every 6 hours).

The duration of treatment in severe disease is usually seven days.
Initiation of antibiotic treatment may be associated with the Jarisch-Herxheimer reaction
(inflammatory reaction to endotoxins released by bacterial lysis)

Question 5

Laboratory diagnosis

Answer 5

Gold standard: the microscopic agglutination test (MAT)

Culture (takes up to 2 weeks)

PCR

Question 6

Answer 6