Leptospirosis

Exam Cram

• Leptospirosis is a spirocete infection associated with rats urine

• High risk:  farmer cleaning sewage, camping & swimming next to fresh water

• Presentation: vomiting, fever, haemoptysis, hypotension, hepatitis & coagulopathy

• Management: IV benzyl penicillin

Also called Weil's Disease

Outline 

Background

• Leptospirosis is a spirochete, that can exhibit the Jarisch Herxheimer (JH) reaction upon treatment

• Found in rat's urine

Assessment

History

• Story of recent exposure to rat's urine: 

  • Camping, 

  • Cleaning sewage

  • Freshwater swimming

• Acute onset: severe vomiting, myalgia, headache

• Bruised skin, bleeding gums

Examination

• Febrile, hypotensive, tachycardic

• Jaundice

• RUQ tenderness

Investigations

• Transaminitis- hepatocellular LFT derangement

• Raised PT and APTT

• CXR- pulmonary haemorrhage

• PCR- urinary or blood for leptospirosis

Diagnosis

Diagnostic criteria: blood/ urine PCR + symptoms

Differentials: bacterial sepsis

Management

1. Doxycycline (mild)

2. Ceftriaxone (severe)

Also Benzylpenicillin 

References and Resources

Page written in 2024.