2 min read - Leptospirosis

It is a very common infection seen in all parts of Sri Lanka.

Image result for leptospira interrogans
USUAL PRESENTATION is with abrupt onset fever with marked myalgia and headache.

Main differential diagnoses to be considered are,

  • Dengue fever
  • Typhus fever
  • Hanta virus infection
In many patients conjunctival suffusion and occasionally conjunctival haemorrhages can be seen.

Major life threatening complications include
Related image
  • Weil's disease (Jaundice with acute renal failure)
  • Pulmonary haemorrhages.
  • Acute respiratory distress syndrome
  • Myocarditis
  • DIC
MCQ points
  • Hypokalemia is a well known feature
  • ALT > AST (This is in contrast to dengue)
  • Thrombocytopenia is common
  • Some can develop aseptic meningitis
DIAGNOSIS of leptospirosis is mostly done serologically. Antibody tests have to be done after 5 days of illness.
  • Microscopic agglutination test (MAT) is the reference investigation. (Available in Medical research institute - MRI Colombo)
    • Image result for leptospirosis pulmonary hemorrhage
    Pulmonary haemorrhages
  • ELISA is available in most of the private laboratories.
MANAGEMENT
  • Never forget to fill up the notification form
  • Always take cultures before starting antibiotics
  • Commonly used antibiotics are
    • Oral doxycycline
    • Intravenous ceftriaxone/cefotaxime
    • Intravenous penicillin
  • Monitor
    • Vital parameters
    • LOOK FOR APPEARANCE OF DYSPNOEA AND LUNG SIGNS
      • Why? Better manage in an ICU
    • HEMOGLOBIN LEVEL AND PLATELET COUNT
      • Transfuse if Hb < 7
      • Transfuse platelets if < 50
    • URINE OUTPUT
    • Renal functions
      • AKI might require careful fluid balance, management of electrolytes and in some occasions dialysis

      • Liver functions
      • Electrolytes
        • Hypokalemia and hyponatremia are common
        • In AKI they can develop hyperkalemia
      • INR
        • If elevated may need FFP for correction
    • Early admission to intensive care units is recommended if the patient has lung signs or infiltrates in chest Xray.
    • Intravenous high dose corticosteroids can be used in selected patients.


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