infectious diseases
Leptospirosis
Key Points
Leptospirosis is a zoonosis that occurs in many domestic and wild animals (particularly dogs and rats); human infections are rare in the US and are acquired by contact with infected urine or tissue or contaminated water or soil. There are 2 phases of illness: septicemic and immune. The septicemic phase starts abruptly with headache, severe muscular aches, fever to>39°C, chills, cough, sore throat, conjunctival suffusion, and sometimes hemoptysis; this phase lasts 4 to 9 days. The immune phase occurs between the 6th day and 12th day of illness when antibodies appear in serum; fever and other symptoms recur, and some patients develop meningitis. Weil syndrome is a severe form with jaundice and usually azotemia, anemia, diminished consciousness, and sometimes hemorrhagic manifestations. Diagnose using blood cultures, cerebrospinal fluid (in patients with meningeal findings), urine cultures, serologic tests, and polymerase chain reaction testing. Treat severe illness with parenteralpenicillin G,ampicillin, orceftriaxoneand less severe cases with oraldoxycycline,ampicillin, oramoxicillin. 