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Leptospirosis

Last reviewed: 16 Aug 2025
Last updated: 09 Aug 2023

Summary

Definition

History and exam

Key diagnostic factors

  • high remittent fever
  • headache
  • myalgia
  • conjunctival suffusion
  • muscle tenderness
Full details

Other diagnostic factors

  • 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
  • morbilliform rash
Full details

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
  • poor living conditions/lack of sanitation
Full details

Diagnostic tests

1st tests to order

  • CBC 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
  • chest x-ray
  • LFTs
  • conjugated bilirubin
  • metabolic profile
  • serum pancreatic enzymes
  • CSF analysis
Full details

Tests to consider

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

Pruebas emergentes

  • lateral flow assays
  • cytokines

Algoritmo de tratamiento

Agudo

mild disease

moderate to severe disease

Colaboradores

Autores

John Fournier, MD

Clinical Fellow

Infectious Disease Section

Yale School of Medicine

New Haven

CT

Divulgaciones

JF declares that he has no competing interests.

Albert I. Ko, MD

Professor of Epidemiology and Medicine

Department Chair

Epidemiology of Microbial Diseases

Yale School of Public Health

New Haven

CT

Divulgaciones

AIK serves as an expert panel member for the Reckitt Global Hygiene Institute and a Board of Directors member for the American Society of Tropical Medicine. He has received grants from Zoetis and has patents which have been awarded and submitted for use in developing diagnostics and vaccines for leptospirosis.

Agradecimientos

Dr John Fournier and Dr Albert I. Ko would like to gratefully acknowledge Dr Nilmarie Guzman, a previous contributor to this topic.

Divulgaciones

NG declares that she has no competing interests.

Revisores por pares

Carmen Isache, MD

Assistant Professor of Medicine

Infectious Disease Division

University of Florida College of Medicine

Jacksonville

FL

Divulgaciones

CI declares that she has no competing interests.

Andreas Jansen, MD, DTM

Scientific Officer

Robert Koch Institute

Department for Infectious Disease Epidemiology

Gastrointestinal Infections

Zoonoses and Tropical Infections Unit

Berlin

Germany

Divulgaciones

AJ declares that he has no competing interests.

Sean V. Shadomy, DVM, MPH

Epidemiologist

Bacterial Zoonoses Branch

DFBMD/NCZVED/CCID

Centers for Disease Control and Prevention

Atlanta

GA

Divulgaciones

SVS declares that he has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

Referencias

Nuestros equipos internos de evidencia y editoriales colaboran con colaboradores expertos internacionales y revisores pares para garantizar que brindemos acceso a la información más clínicamente relevante posible.

Artículos principales

Levett P. Leptospirosis. In: Mandell, Douglas, and Bennett's principles and practice of infectious diseases. 6th ed. Philadelphia, PA: Churchill Livingstone; 2006:2495-500.

Vijayachari P, Sugunan AP, Shriram AN. Leptospirosis: an emerging global, public health problem. J Biosci. 2008 Nov;33(4):557-69. Resumen

World Health Organization. Human leptospirosis: guidance for diagnosis, surveillance and control. Geneva: World Health Organization; 2003.Texto completo

Centers for Disease Control and Prevention: National Notifiable Diseases Surveillance System (NNDSS). Leptospirosis (Leptospira interrogans) 2013 case definition. Apr 2021 [internet publication].Texto completo

Artículos de referencia

Una lista completa de las fuentes a las que se hace referencia en este tema está disponible para los usuarios con acceso a todo BMJ Best Practice.
  • Leptospirosis images
  • Diferenciales

    • Hantavirus cardiopulmonary syndrome
    • Dengue fever
    • Malaria infection
    Más Diferenciales
  • Guías de práctica clínica

    • CDC Yellow Book: health information for international travel - leptospirosis
    • Fever in returned travellers presenting in the United Kingdom: recommendations for investigation and initial management
    Más Guías de práctica clínica
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