Leptospirosis (Weil’s disease) is an infectious zoonoses caused by the spirochaete bacteria from the genus Leptospira. Human infection occurs via contact with infected animals or soil or with water that has been contaminated by the urine of infected animals. It is responsbile for other 50 000 deaths per year worldwide. In many countries, this is a notifiable disease.
The Leptospira bacteria colonize the kidneys of infected mammals (eg rats, other wildlife, pigs, horses and pets) and are released through urine into the environment.
Clinical Features:
Typically an abrupt onset 7 to 14 days after exposure with a range in severity of a headache, fever, vomiting, diarrhoea, abdominal pain and muscles aches (eg leg muscle tenderness) and sometimes a rash,
Later in more severe cases develop red eye, haemoptysis, jaundice, meningitis.
Diagnosis: clinical features and laboratory tests for the IgM antibodies using an enzyme-linked immunosorbent assay (ELISA); microscopic agglutination test (MAT).
The diagnosis can be missed due to the non-specific nature of the clinical presentation and the overlap of the symptoms with other febrile illnesses. Differential diagnosis: influenza, pneumonia, dengue, Zika virus infection, Ross River virus, malaria, enteric fever, rickettsiosis, typhoid, Q fever, viral hepatitis, pyelonephritis and meningitis, fever of unknown origin
With no treatment, Leptospirosis can result in kidney disease (jaundice), meningitis, liver failure, respiratory distress, and in 5–10% cases it is fatal.
Management:
Doxycycline, azithromycin, ampicillin or amoxicillin early
Followed by benzylpenicillin IV
Public health measures to prevent and restrict spread (eg protective equipment when working with potentially infected animals; hand washing).
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