Leptospirosis

Last reviewed: 27 Apr 2022
Last updated: 27 May 2020

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
More key diagnostic factors

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
  • maculopapular rash
Other diagnostic factors

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
More risk factors

Diagnostic investigations

1st investigations to order

  • CBC and differential
  • urinalysis
  • microscopic agglutination test (MAT)
  • enzyme-linked immunosorbent assay (ELISA)
  • polymerase chain rection (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

INITIAL

at high risk of exposure

ACUTE

mild disease

moderate to severe disease

Contributors

Authors

Nilmarie Guzman, MD

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

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.

  • Leptospirosis images
  • Differentials

    • Hantavirus cardiopulmonary syndrome
    • Dengue fever
    • Malaria infection
    More Differentials
  • Guidelines

    • Health information for international travel (Yellow Book): leptospirosis
    • Fever in returned travellers presenting in the United Kingdom: recommendations for investigation and initial management
    More Guidelines
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