Leptospirosis (Weil's)



Background

  • Zoonosis - caused by Leptospira spirochetes
  • Assoc. with rodent urine and poor sanitation (or sports yahoos)
  • Usually occupational in Ireland - Water workers, farmers, sewer workers
  • May present with sepsis, acute renal failure and jaundice

Clinical

Sudden onset:

Symptoms

  • Fever.
  • "Meningism" ±photophobia etc.
  • Conjunctivitis.
  • Myalgia (esp. back or leg).
  • Dry Cough.
  • GI upset (D&V).

Signs

  • Jaundice.
  • Acute renal failure.
  • Shock.
  • Thrombocytopenia ±haemorrhage (check the palate).
  • Pulmonary haemorrhage - mistaken for "pneumonia"
  • DIC or HUS (TTP (less common).

Differential Dx


Investigations

  • FBC (↓platelets ± ↓Hb), Coag (±normal).
  • LFT may show ↑bili but relatively normal INR (unless DIC).
  • Cultures.
  • Serum (±CSF) for Leptospira IgM/IgG.
  • Leptospira PCR (blood, CSF or urine).
  • CXR - pneumonia is more common than Weil's but beware pulm. haemorrhage mistaken for "pneumonia" or "aspiration".

Management

  • ABC ... as in sepsis ... early inotropes in shock.
  • PO Doxycycline or Clarithromycin if well.
  • IV Cefotaxime or IV Amoxicillin (Erythromycin if Pen. allergy) if unwell.
  • Early renal team involvement if ARF.
  • Ophthalmology if eye signs prominent.


References


Content By Dr Íomhar O' Sullivan 19/12/2019. Last review Dr ÍOS 10/06/21.