Disease: Leptospirosis

    Leptospirosis facts

    • Leptospirosis is an infectious disease that can occur in humans and animals worldwide.
    • A spirochete, Leptospira interrogans, causes leptospirosis.
    • High risk factors include close association with animals and the water and soil they may contaminate with infected urine.
    • Symptoms and signs of leptospirosis are highly variable and range from no symptoms to nonspecific symptoms including high fever, chills, headache, abdominal symptoms to Weil's disease with organ dysfunction.
    • Definitive diagnosis is done by isolating the bacteria from the patient; serological tests are also available.
    • There are antibiotics that are effective in treating leptospirosis.
    • Most people infected with Leptospira interrogans bacteria have a good prognosis; a few have a more guarded prognosis.
    • Vaccines are available for humans and animals in some countries; there is no vaccine available commercially for humans in the U.S.; available vaccines are very limited because they usually only protect well against a single serovar. Doxycycline (Vibramycin, Oracea, Adoxa, Atridox) has been used as a short-term prophylactic treatment to protect some humans from leptospirosis.

    What is leptospirosis?

    Leptospirosis is a disease caused by bacteria (Leptospira interrogans) that produce a wide range of symptoms that may occur in phases; some patients may develop kidney or liver failure, respiratory failure, meningitis, or even death. The disease is spread by the urine of infected animals (many species, both domesticated and wild); the bacteria can survive in the water and soil for months. The disease is most common in temperate and tropical climates. The infecting bacteria occur worldwide.

    What causes leptospirosis?

    The cause of leptospirosis is bacteria, Leptospira interrogans, a Gram-negative spirochete (spiral-shaped bacteria). The bacteria infect many types of animals (many wild animals, rodents, dogs, cats, pigs, horses, cattle, for example) that subsequently contaminate water, soil, and crops when they urinate because the bacteria are present in urine. The bacteria then infect humans when they invade through breaks in the skin or mucus membranes or when people ingest them. The bacteria multiply in the liver, kidneys, and central nervous system. Person-to-person transfer of this disease is rare.

    What are risk factors for leptospirosis?

    Risk factors include occupations that expose people to farm animals, wild animals, and to contaminated water and soil (farmers, slaughterhouse workers, veterinarians, miners, military personnel, disaster workers and victims, for example). People who participate in outdoor activities like camping or kayaking are also at higher risk for infection. Any exposure to sewage or animal waste increases risk of getting leptospirosis.

    What are leptospirosis symptoms and signs?

    Unfortunately, the symptoms and signs of leptospirosis are variable and are similar to those seen in many other diseases (dengue fever, hantavirus, brucellosis, malaria, and others). Symptoms can arise about two days to four weeks after exposure to the bacteria. Although some people have no symptoms, others may exhibit one or more of the following: high fever, chills, headache, muscle aches, abdominal pain, vomiting, diarrhea, jaundice, rash, and reddish eyes. These symptoms usually occur in the first phase of the infection, and when present, they often occur abruptly. Some patients resolve their symptoms and do not progress to the second phase; others may seem to briefly recover but relapse with more severe symptoms and organ damage. This is the second phase of leptospirosis, called Weil's disease.  If it's not treated, it may not resolve for several months. The death rate is about 1%-5%.

    How do physicians diagnose leptospirosis?

    Physicians make a presumptive diagnosis based on the patient's history and physical exam. Only specialized labs perform serological tests for leptospirosis; health-care professionals may perform definitive tests by isolating the bacteria from the patient (blood or CSF) or by a positive microscopic agglutination test (MAT). Other tests (ELISA, PCR, urine dipsticks) may provide additional evidence of infection. Patients with severe symptoms should be treated as confirmatory tests are time consuming.

    What is the treatment for leptospirosis?

    Although there is controversy about using antibiotics in the first phase of leptospirosis, antibiotics are recommended for treatment (penicillin G, ampicillin [Omnipen, Polycillin, Principen], amoxicillin [Amoxil, Dispermox (Discontinued), Trimox, Moxatag, Larotid], or erythromycin [E-Mycin, Eryc, Ery-Tab, PCE, Pediazole, Ilosone]) in patients with phase two or more severe symptoms. Some patients may require IV antibiotics and supportive hospital care.

    For those clinicians who choose to treat phase-one patients, the choice of antibiotics includes the above; many choose to treat with doxycycline, however.

    What is the prognosis of leptospirosis?

    Overall, the prognosis of leptospirosis is good; many become infected and spontaneously recover without treatment. However, the prognosis decreases as the symptoms increase; people with Weil's disease may have a prognosis ranging from good to poor, depending on their response to treatments. Pregnant women who become infected have a high rate of fetal mortality, especially if they acquire the disease early in pregnancy.

    What causes leptospirosis?

    The cause of leptospirosis is bacteria, Leptospira interrogans, a Gram-negative spirochete (spiral-shaped bacteria). The bacteria infect many types of animals (many wild animals, rodents, dogs, cats, pigs, horses, cattle, for example) that subsequently contaminate water, soil, and crops when they urinate because the bacteria are present in urine. The bacteria then infect humans when they invade through breaks in the skin or mucus membranes or when people ingest them. The bacteria multiply in the liver, kidneys, and central nervous system. Person-to-person transfer of this disease is rare.

    What are risk factors for leptospirosis?

    Risk factors include occupations that expose people to farm animals, wild animals, and to contaminated water and soil (farmers, slaughterhouse workers, veterinarians, miners, military personnel, disaster workers and victims, for example). People who participate in outdoor activities like camping or kayaking are also at higher risk for infection. Any exposure to sewage or animal waste increases risk of getting leptospirosis.

    What are leptospirosis symptoms and signs?

    Unfortunately, the symptoms and signs of leptospirosis are variable and are similar to those seen in many other diseases (dengue fever, hantavirus, brucellosis, malaria, and others). Symptoms can arise about two days to four weeks after exposure to the bacteria. Although some people have no symptoms, others may exhibit one or more of the following: high fever, chills, headache, muscle aches, abdominal pain, vomiting, diarrhea, jaundice, rash, and reddish eyes. These symptoms usually occur in the first phase of the infection, and when present, they often occur abruptly. Some patients resolve their symptoms and do not progress to the second phase; others may seem to briefly recover but relapse with more severe symptoms and organ damage. This is the second phase of leptospirosis, called Weil's disease.  If it's not treated, it may not resolve for several months. The death rate is about 1%-5%.

    How do physicians diagnose leptospirosis?

    Physicians make a presumptive diagnosis based on the patient's history and physical exam. Only specialized labs perform serological tests for leptospirosis; health-care professionals may perform definitive tests by isolating the bacteria from the patient (blood or CSF) or by a positive microscopic agglutination test (MAT). Other tests (ELISA, PCR, urine dipsticks) may provide additional evidence of infection. Patients with severe symptoms should be treated as confirmatory tests are time consuming.

    What is the treatment for leptospirosis?

    Although there is controversy about using antibiotics in the first phase of leptospirosis, antibiotics are recommended for treatment (penicillin G, ampicillin [Omnipen, Polycillin, Principen], amoxicillin [Amoxil, Dispermox (Discontinued), Trimox, Moxatag, Larotid], or erythromycin [E-Mycin, Eryc, Ery-Tab, PCE, Pediazole, Ilosone]) in patients with phase two or more severe symptoms. Some patients may require IV antibiotics and supportive hospital care.

    For those clinicians who choose to treat phase-one patients, the choice of antibiotics includes the above; many choose to treat with doxycycline, however.

    What is the prognosis of leptospirosis?

    Overall, the prognosis of leptospirosis is good; many become infected and spontaneously recover without treatment. However, the prognosis decreases as the symptoms increase; people with Weil's disease may have a prognosis ranging from good to poor, depending on their response to treatments. Pregnant women who become infected have a high rate of fetal mortality, especially if they acquire the disease early in pregnancy.

    Source: http://www.rxlist.com

    Physicians make a presumptive diagnosis based on the patient's history and physical exam. Only specialized labs perform serological tests for leptospirosis; health-care professionals may perform definitive tests by isolating the bacteria from the patient (blood or CSF) or by a positive microscopic agglutination test (MAT). Other tests (ELISA, PCR, urine dipsticks) may provide additional evidence of infection. Patients with severe symptoms should be treated as confirmatory tests are time consuming.

    Source: http://www.rxlist.com

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