Summary
Definition
History and exam
Key diagnostic factors
- presence of risk factors
- high remittent fever
- headache
- myalgia
- conjunctival suffusion
- muscle tenderness
Other diagnostic factors
- chills or rigors
- abdominal pain
- nausea or vomiting
- diarrhoea
- asthaenia
- anorexia
- photophobia
- eye pain
- neck stiffness
- cough
- dyspnoea
- chest pain
- haemoptysis
- 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
- FBC and differential
- urinalysis
- microscopic agglutination test (MAT)
- enzyme-linked immunosorbent assay (ELISA)
- polymerase chain reaction (PCR)
- darkfield examination
- blood culture
- cerebrospinal fluid (CSF) culture
- ECG
- CXR
- LFTs
- conjugated bilirubin
- metabolic profile
- serum pancreatic enzymes
- CSF analysis
Investigations to consider
- urine culture
- renal biopsy
- lung biopsy
- staining methods
- latex agglutination
- western blot
- quantitative PCR
Treatment algorithm
Contributors
Authors
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
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.
Use of this content is subject to our disclaimer