Last reviewed: November 2017
Last updated: February  2017

Summary

Definition

History and exam

Key diagnostic factors

  • contact (direct or indirect) with urine of infected animals
  • residence in or travel to endemic area or area recently affected by natural disaster
  • high remittent fever
  • headache
  • myalgia
  • conjunctival suffusion
  • muscle tenderness

Other diagnostic factors

  • male sex
  • 7 to 14 day incubation period
  • chills or rigors
  • abdominal pain
  • nausea or vomiting
  • diarrhea
  • asthenia
  • anorexia
  • photophobia
  • eye pain
  • neck stiffness
  • cough
  • dyspnea
  • chest pain
  • hemoptysis
  • oliguria or polyuria
  • cardiac arrhythmias
  • lymphadenopathy
  • splenomegaly
  • hepatomegaly
  • jaundice
  • adenopathy
  • mental status changes
  • maculopapular rash

Risk factors

  • contact (direct or indirect) with urine of infected animals
  • residence in or travel to an endemic area
  • residence in or travel to an area with recent flooding
  • involvement in water sports

Diagnostic investigations

1st investigations to order

  • CBC and differential
  • urinalysis
  • darkfield examination
  • blood culture
  • CSF culture
  • ECG
  • microscopic agglutination test (MAT)
  • ELISA (IgM antibodies)
  • PCR assay
  • CXR
  • LFTs
  • conjugated bilirubin
  • metabolic profile
  • pancreatic enzymes
  • CSF analysis
Full details

Investigations to consider

  • urine culture
  • renal biopsy
  • lung biopsy
  • staining methods
  • latex agglutination
  • western blot
  • quantitative PCR
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

Assistant Professor of Medicine

Infectious Diseases Division

University of Florida College of Medicine

Jacksonville

FL

Disclosures

NG declares that she has no competing interests.

Peer reviewers VIEW ALL

Assistant Professor of Medicine

Infectious Disease Division

University of Florida College of Medicine

Jacksonville

FL

Disclosures

CI declares that she has no competing interests.

Scientific Officer

Robert Koch Institute

Department for Infectious Disease Epidemiology

Gastrointestinal Infections

Zoonoses and Tropical Infections Unit

Berlin

Germany

Disclosures

AJ declares that he has no competing interests.

Epidemiologist

Bacterial Zoonoses Branch

DFBMD/NCZVED/CCID

Centers for Disease Control and Prevention

Atlanta

GA

Disclosures

SVS declares that he has no competing interests.

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