Leptospirosis Diagnosis and Management

Clinical Presentation

Leptospirosis presents as a biphasic illness characterized by fever, headache, chills, myalgia, conjunctival suffusion, and less frequently by meningitis, rash, jaundice, or renal insufficiency 1, 2, 3
The disease can be classified into two main clinical forms: mild to moderate (flu-like symptoms) and severe form (Weil's disease) characterized by hemorrhage, jaundice, and hepato-renal failure 4
The septicemic or bacteremic phase lasts 4-7 days with high fever, diffuse myalgias, headache, and conjunctival suffusion 4
Conjunctival suffusion is a suggestive clinical sign that should prompt consideration of leptospirosis 4

Confirmed diagnosis requires one of the following: isolation of Leptospira from a clinical specimen, fourfold or greater increase in Leptospira agglutination titer between acute and convalescent-phase serum specimens, or demonstration of Leptospira in a clinical specimen by immunofluorescence 1, 3
A single Leptospira agglutination titer of ≥200 in one or more serum specimens supports a probable case classification 1, 3

Probable case: A clinically compatible case with supportive serologic findings (Leptospira agglutination titer ≥200 in one or more serum specimens) 1, 3
Confirmed case: A clinically compatible case that is laboratory confirmed through isolation, serological conversion, or immunofluorescence 1, 3

Treatment for mild to moderate leptospirosis should be started as soon as possible with antibiotics such as penicillin or doxycycline 4
For severe leptospirosis (Weil's disease), treatment should be initiated immediately without waiting for laboratory confirmation 4
Avoid contact with urine from infected animals and contaminated water 4
Take precautions during water recreational activities, occupational exposure to animals or water, and during floods 4