- most important source of transmission to humans are rats, dogs, cattle and pigs
- flooding is a major risk for epidemic severe disease. Military training, outdoor athletic activities and adventure travel have led to recognised outbreaks and spradic cases of leptospirosis
- Leptospires infect humans through the mucosa or macerated, punctured or abraded skin
- incubation period averages 5-14 days
- leptospirosis is classically described as biphasic
~ leptospiremic phase: acute fever lasts for 3-10 days (blood culture postive up to day 4 of illness)
~ immune phase : fever not responsive to antibiotic but leptospires can be isolated from urine
- conjunctival suffusion, pharyngeal edema without exudate, muscle tenderness (esp calves), rash, jaundice or signs of meningism
- Weil's disease is characterised by jaundice, acute renal failure, hypotension and hemorrhage (usually pulmonary), aseptic meningitis, cholecystitis, acute abdomen and pancreatitis
- diagnosis is by serologic assay
- treatment: oral doxycycline 100mg bd for mild infection, IV penicillin G 1.5 mega unit QID for severe infection
- chemoprophylaxis: oral doxycycline 200mg once a week
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