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General Information:
-Leptospirosis is a tropical infectious disease that is also endemic in the US. (Estimated 16% seroprevalence in inner city Baltimore!)
-The spirochete is spread through animal urine and can survive in water or soil for weeks.
-Risk factors: rural exposure to animal urine (farming, adventure sports) or urban exposure to rat urine.
-Infection is acquired through breaks in the skin or mucus membranes
-Outbreaks are often seen following rain or floods.
Clinical Presentation:
-Non-specific febrile illness (usually not diagnosed in these cases)
-If untreated, 5-10% progress to jaundice, renal failure, thrombocytopenia, hemorrhage, and respiratory failure.
Diagnosis:
- Primarily based on clinical presentation and history
- Paired serum sent to CDC (the acute serum sample should be drawn in the ED)
Treatment:
- Doxycycline, Ceftriaxone and Penicillin are all effective
Bottom Line:
Consider and treat for Leptospirosis in patients with possible exposure animal urine (especially after a flood) who present in extremis with renal failure, jaundice, and thrombocytopenia.
University of Maryland Section of Global Emergency Health
Author: Andi Tenner, MD, MPH
References
Center for Disease Control. (2012) Leptospirosis. Retrieved January 1, 2013 from http://www.cdc.gov/leptospirosis/infection/index.html.
Childs JE, Schwartz BS, Ksiazek TG, et al. Risk Factors Associated with Antibodies to Leptospires in Inner-city Residents of Baltimore: A Protective Role for Cats. Am J Public Health. 1992;82:597-599.
Leung J, Schiffer J. Feverish, Jaundiced. Am J Med. 2009;122:129-131.