Summary
Definition
History and exam
Key diagnostic factors
- presença de fatores de risco
- febre alta remitente
- cefaleia
- mialgia
- sufusão conjuntival
- Sensibilidade muscular
Other diagnostic factors
- calafrios
- dor abdominal
- náuseas ou vômitos
- diarreia
- astenia
- anorexia
- fotofobia
- dor ocular
- rigidez de nuca
- tosse
- dispneia
- dor torácica
- hemoptise
- oligúria ou poliúria
- arritmia cardíaca
- linfadenopatia
- esplenomegalia
- hepatomegalia
- icterícia
- linfadenopatia
- alterações do estado mental
- Erupção cutânea morbiliforme
Risk factors
- contato (direto ou indireto) com a urina de animais infectados
- residência em/ou viagem para uma área endêmica
- residência em/ou viagem para uma área com enchente recente
- envolvimento em esportes aquáticos ou de aventura
- habitações precárias ou acesso inadequado a saneamento básico
Diagnostic tests
1st tests to order
- hemograma completo e diferencial
- urinálise
- teste de aglutinação microscópica
- ensaio de imunoadsorção enzimática (ELISA)
- reação em cadeia da polimerase
- exame de campo escuro
- hemocultura
- cultura do líquido cefalorraquidiano (LCR)
- eletrocardiograma (ECG)
- radiografia torácica
- TFHs
- bilirrubina conjugada
- perfil metabólico
- enzimas pancreáticas séricas
- análise do líquido cefalorraquidiano (LCR)
Tests to consider
- urocultura
- ultrassonografia abdominal
- biópsia renal
- biópsia pulmonar
- métodos de coloração
- Ensaio de hemaglutinação indireta
- aglutinação em látex
- western blot
- reação em cadeia da polimerase quantitativa
- ensaios de fluxo lateral
Emerging tests
- Citocinas
Treatment algorithm
doença leve
doença moderada a grave
Contributors
Authors
Molly Erin Fleece, MD, FIDSA
Associate Professor
Division of Infectious Diseases
Department of Medicine
University of Alabama at Birmingham
Birmingham, AL
Disclosures
MEF declares that she has no competing interests.
Stefania Carmona, MD
Assistant Professor
Division of Infectious Diseases
Department of Medicine
University of Alabama at Birmingham
Birmingham, AL
Disclosures
SC has received a professional services fee as an author of the Merck Manual Professional Version and the Merck Manual Consumer Version - Arboviruses, Arenaviridae, and Filoviridae chapters.
Acknowledgements
Dr Molly Erin Fleece and Dr Stefania Carmona would like to gratefully acknowledge Dr John Fournier, Dr Albert I. Ko, and Dr Nilmarie Guzman, previous contributors to this topic.
Disclosures
AIK has been reimbursed for participation in the Research Advisory and Advocacy Committee for the Reckitt Global Hygiene Institute. JF and NG declare that they have 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.
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.
References
Key articles
Vijayachari P, Sugunan AP, Shriram AN. Leptospirosis: an emerging global, public health problem. J Biosci. 2008 Nov;33(4):557-69. Abstract
Centers for Disease Control and Prevention. CDC Yellow Book 2026: health information for international travel. Section 4: travel-associated infections and diseases - leptospirosis. Apr 2025 [internet publication].Full text
World Health Organization. Human leptospirosis: guidance for diagnosis, surveillance and control. Geneva: World Health Organization; 2003.Full text
Centers for Disease Control and Prevention. Leptospirosis: clinical overview of leptospirosis. Feb 2026 [internet publication].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.
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