Last reviewed: June 2020
Last updated: May  2020

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
More 1st investigations to order

Investigations to consider

  • urine culture
  • renal biopsy
  • lung biopsy
  • staining methods
  • latex agglutination
  • western blot
  • quantitative PCR
More investigations to consider

Treatment algorithm

Contributors

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 reviewersVIEW 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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