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
- morbilliform 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
- poor living conditions/lack of sanitation
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
- chest x-ray
- 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
Emerging tests
- lateral flow assays
- cytokines
Treatment algorithm
mild disease
moderate to severe disease
Contributors
Authors
John Fournier, MD
Clinical Fellow
Infectious Disease Section
Yale School of Medicine
New Haven
CT
Disclosures
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
Disclosures
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.
Acknowledgements
Dr John Fournier and Dr Albert I. Ko would like to gratefully acknowledge Dr Nilmarie Guzman, a previous contributor to this topic.
Disclosures
NG declares that she has no competing interests.
Peer reviewers
Carmen Isache, MD
Assistant Professor of Medicine
Infectious Disease Division
University of Florida College of Medicine
Jacksonville
FL
Disclosures
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
Disclosures
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
Disclosures
SVS declares that he has no competing interests.
References
Key articles
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. Abstract
World Health Organization. Human leptospirosis: guidance for diagnosis, surveillance and control. Geneva: World Health Organization; 2003.Full text
Centers for Disease Control and Prevention: National Notifiable Diseases Surveillance System (NNDSS). Leptospirosis (Leptospira interrogans) 2013 case definition. Apr 2021 [internet publication].Full text
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Hantavirus cardiopulmonary syndrome
- Dengue fever
- Malaria infection
More DifferentialsGuidelines
- CDC Yellow Book: health information for international travel - leptospirosis
- National leptospirosis service
More Guidelines
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