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
- adenopatia
- 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
- pobreza/falta de saneamento
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
- biópsia renal
- biópsia pulmonar
- métodos de coloração
- aglutinação em látex
- Western Blot
- reação em cadeia da polimerase quantitativa
Emerging tests
- ensaios de fluxo lateral
- Citocinas
Treatment algorithm
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
Divulgaciones
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
Divulgaciones
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
Divulgaciones
SVS declares that he has no competing interests.
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Referencias
Artículos principales
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. Resumen
World Health Organization. Human leptospirosis: guidance for diagnosis, surveillance and control. Geneva: World Health Organization; 2003.Texto completo
Centers for Disease Control and Prevention: National Notifiable Diseases Surveillance System (NNDSS). Leptospirosis (Leptospira interrogans) 2013 case definition. Apr 2021 [internet publication].Texto completo
Artículos de referencia
Una lista completa de las fuentes a las que se hace referencia en este tema está disponible para los usuarios con acceso a todo BMJ Best Practice.
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Más DiferencialesGuías de práctica clínica
- CDC Yellow Book: health information for international travel - leptospirosis
- National leptospirosis service
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