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LEPTOSPIROSIS

30/12/10

Leptospirosis, caused mainly by the spirochete Leptospira interrogans, is a zoonosis that is common in tropical and subtropical climates. It infects wild and domestic animals, particularly rodents, and the organism is excreted in their urine. Transmission to humans occurs when leptospires enter through abraded skin, mucous membranes, or conjunctiva following contact with urine-contaminated soil or water. Exposure to the organism is either occupational (gardening, farming) or recreational (swimming, rafting, crossing streams).

Leptospirosis may occur as two clinically distinguishable syndromes. The more common syndrome (85-90% of cases) is anicteric leptospirosis, which manifests as a biphasic illness. After an incubation period of 7 to 12 days (range, 2-20 days), the initial septicemic phase is characterized by the abrupt onset of high fevers, headaches, and myalgias. Conjunctival suffusion, muscle tenderness, a maculopapular skin rash, and hepatosplenomegaly may also be noted. After 4 to 7 days, defervescence occurs. Two to 3 days later, during the secondary immune phase, leptospires disappear from the blood and cerebrospinal fluid, but circulating antibodies may cause immune-mediated aseptic menigitis, uveitis, or chorioretinitis. Icteric leptospirosis, or Weil’s syndrome, is less common (5-10%) and may be characterized by hepatic, renal, and vascular dysfunction. Fever, jaundice, and azotemia typically develop, and hypotension due to vascular collapse may ensue. The diagnosis is usually established retrospectively by serologic tests. Blood, urine, and cerebrospinal fluid can be obtained for culture. Empiric therapy with doxycycline or penicillin should be initiated if the diagnosis is considered.

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LEPTOSPIROSISLeptospirosis, caused mainly by the spirochete Leptospira interrogans, is a zoonosis that is common in tropical and subtropical climates. It infects wild and domestic animals, particularly rodents, and the organism is excreted in their urine. Transmission to humans occurs when leptospires enter through abraded skin, mucous membranes, or conjunctiva following contact with urine-contaminated soil or water. Exposure to the organism is either occupational (gardening, farming) or recreational (swimming, rafting, crossing streams).Leptospirosis may occur as two clinically distinguishable syndromes. The more common syndrome (85-90% of cases) is anicteric leptospirosis, which manifests as a biphasic illness. After an incubation period of 7 to 12 days (range, 2-20 days), the initial septicemic phase is characterized by the abrupt onset of high fevers, headaches, and myalgias. Conjunctival suffusion, muscle tenderness, a maculopapular skin rash, and hepatosplenomegaly may also be noted. After 4 to 7 days, defervescence occurs. Two to 3 days later, during the secondary immune phase, leptospires disappear from the blood and cerebrospinal fluid, but circulating antibodies may cause immune-mediated aseptic menigitis, uveitis, or chorioretinitis. Icteric leptospirosis, or Weil’s syndrome, is less common (5-10%) and may be characterized by hepatic, renal, and vascular dysfunction. Fever, jaundice, and azotemia typically develop, and hypotension due to vascular collapse may ensue. The diagnosis is usually established retrospectively by serologic tests. Blood, urine, and cerebrospinal fluid can be obtained for culture. Empiric therapy with doxycycline or penicillin should be initiated if the diagnosis is considered.*204/348/5*

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30/12/10

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