2 min read - Leptospirosis

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


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

• 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)



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.