Leptospirosis

Question 1

Leptospirosis causative agent

Answer 1

Leptospira interrogans

Question 2

Most important reservoir of leptospirosis

Answer 2

rodents

Question 3

Incubation period

Answer 3

5-14 days (range 2-30 days)

Question 4

Suspected leptospirosis

Answer 4

acute febrile illness of at least 2 days
residing in a flooded area or has high risk exposure

w/ at least 2 of the ff:

• myalgia (calf muscle tenderness)
• conjunctival suffusion (red eyes w/o exudate)
• chills
• abdominal pain
• headache
• jaundice

Question 5

Weil’s disease

Answer 5

jaundice
renal failure
hemorrhage

Question 6

Leptospiremic (acute) phase

Answer 6

5-7 days w/ fever, chills, myalgia, conjuctival suffusion, N/V

1-3 day period of improvement: fever lyses and asymptomatic patient

Question 7

Immune Phase

Answer 7

recurrence of fever heralds onset of this phase

leptospires CANNOT be cultured from blood
antibiotics may NOT be useful in this phase

Question 8

Recovery Phase

Answer 8

most recover completely

patients w/ renal failure on dialysis may regain most of their renal function

Question 9

Gold standard of diagnosis in leptospirosis

Answer 9

Culture and isolation (time consuming)

1st week - blood, CSF, peritoneal dialysate
2nd week - urine

Question 10

Determines agglutinating antibodies in the serum of a patient by mixing it with various dilutions of live or killed formalized leptospires

Answer 10

Microagglutination Test (MAT)

4fold rise in titer from acute to convalescent sera - confirmatory of diagnosis

Philippines (endemic area)
-single titer of at least 1:1600 - indicative of leptosipirosis

Question 11

Jarisch Herzheimer reaction

Answer 11

occurs after initiation of antibiotic therapy for leptospirosis

Question 12

Jarisch Herxheimer reaction

Answer 12

fever, chills, myalgia, tachycardia, tachypnea, neutrophilia and vasodilation with mild hypotension

Question 13

Mild leptospirosis

Answer 13

Doxycyxline - first line of agent - 100 mig BID PO
Amoxicillin - 500 mg q6h PO or 1 g q8h PO
Azithromycin - 1 g followed by 500 mg OD PO for 2 more days

Question 14

Moderate to Severe Leptospirosis

Answer 14

Penicillin G - first line - 1.5 M units q6-8h IV
Ampicillin-0.5-1 g q6h
Ceftriaxone - 1 g q24h IV
Cefotaxime - 1 g q6h IV
Azithromycin - 500 mg OD PO for 5 days

Question 15

Complications of Leptospirosis

Answer 15

Systemic Inflammatory Syndrome
Acute Kidney Injury
Pulmonary Injury or ARDS
Cardiac Complications

Question 16

Low Risk Exposure

Answer 16

single exposure
no wounds, cuts, or open skin lesions

Doxycycline - 200 mg single dose
given within 24-72 hrs from exposure

Question 17

Moderate Risk Exposure

Answer 17

single exposure
w/ wounds, cuts or open skin lesions
accidental ingestion of contaminated water

Doxycyline - 200 mg OD for 3-5 days
given within 24-72 hours from exposure

Question 18

High Risk Exposure

Answer 18

continuous exposure
with or without wounds, cuts or open skin lesions
swimming in flooded waters esp if infested w/ sewer rats and ingestion of contaminated water

Doxycycline - 200 mg weekly until the end of exposure