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
- Pneumonia or other common cause of sepsis
- Dengue (viral infection) or malaria - consider in travellers fever)
- Ascending cholangitis (easily missed)
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