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Leptospirose

Последний просмотренный: 23 Sep 2025
Last updated: 09 Aug 2023

Резюме

Определение

History and exam

Key diagnostic factors

  • presença de fatores de risco
  • febre alta remitente
  • cefaleia
  • mialgia
  • sufusão conjuntival
  • Sensibilidade muscular
Full details

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
  • adenopatia
  • alterações do estado mental
  • Erupção cutânea morbiliforme
Full details

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
  • pobreza/falta de saneamento
Full details

Diagnostic investigations

1st investigations 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)
Full details

Investigations to consider

  • urocultura
  • biópsia renal
  • biópsia pulmonar
  • métodos de coloração
  • aglutinação em látex
  • Western Blot
  • reação em cadeia da polimerase quantitativa
Full details

Emerging tests

  • ensaios de fluxo lateral
  • Citocinas

Treatment algorithm

ACUTE

doença leve

doença moderada a grave

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.

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

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

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.
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  • Guidelines

    • CDC Yellow Book: health information for international travel - leptospirosis
    • National leptospirosis service
    More Guidelines
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