Summary

• Zoonosis transmitted by direct or indirect contact with urine of infected animals. Other sources of exposure include blood, fluids, or tissues of parturition of infected animals.
• Associated with occupational exposure and water sports. Endemic worldwide, higher rates in tropical areas during rainy season and temperate regions during late summer. Outbreaks have been associated with flooding and natural disasters.
• Diagnosis requires a high index of suspicion based on clinical presentation associated with epidemiological exposure. Affected individuals can present with an extensive spectrum of clinical manifestations ranging from subclinical illness in approximately 90% of cases to renal and hepatic failure and pulmonary haemorrhages.
• Disease presents in 2 phases, the acute/initial phase (sudden onset of fever, headaches, myalgia, and conjunctival suffusion) and the immune phase (additional pulmonary symptoms, arrhythmias, and potential for organ failure).
• Treatment includes benzylpenicillin or amoxicillin and/or doxycycline along with supportive therapy. Alternative therapeutic agents include ceftriaxone, cefotaxime, and azithromycin.
• In general, the prognosis in patients with mild disease is favourable; however, patients affected by severe disease carry a poor prognosis.