Leptospirosis Follow-up

  • Author: Sandra G Gompf, MD, FACP, FIDSA; Chief Editor: Burke A Cunha, MD   more...
 
Updated: Apr 17, 2012
 

Further Inpatient Care

  • Patients with severe disease should remain in a hospitalized setting until adequate resolution of organ failure and clinical infection.
Next

Further Outpatient Care

  • Outpatient follow-up may include an assessment of renal function to ensure ongoing reversal of any damage.
  • A cardiac assessment may be indicated in patients with symptoms suggestive of heart involvement.
Previous
Next

Transfer

  • Transfer to a facility with an appropriate level of care should be considered in patients with severe disease.
Previous
Next

Deterrence/Prevention

  • Avoiding or reducing contact with potentially affected animals and contaminated soil or water is the most effective deterrence. Persons at risk of occupational exposure should wear protective garments, including footwear, gloves, and eye protection. Strict attention to hygiene and sanitation is important; rodent control, decontamination of affected surfaces, and control of livestock infection are examples.
  • Leptospirosis vaccines have been investigated in humans and animals; however, the response has been disappointing in clinical application, and the search for a reliable vaccine continues.[17]
  • Internationally, certain workers at high risk, such as rice farmers in Asia or miners in Poland, have used immunizations that are specific to the serovars endemic to the local area.
  • Vaccination of humans is not performed in the United States. Immunization of livestock and peridomestic animals is performed, either to prevent the spread of leptospires to other animals or for prevention of human disease.
  • Chemoprophylaxis has been shown to be effective in persons with potential risk for exposure, such as military troops traveling to endemic areas or vacationers engaging in aquatic recreation. Doxycycline 250 mg administered orally once a week is shown to be highly efficacious. However, it is not recommended in persons with long-term or repeated exposure.
Previous
Next

Complications

  • Complications originate either from the natural history of the disease or the treatment.
Previous
Next

Prognosis

  • The prognosis in patients with mild infection is very good. More severe cases portend a much poorer outcome.
Previous
Next

Patient Education

  • Government officials, public health workers, and health care workers should educate all populations at risk about proper preventative measures.
Previous
 
Contributor Information and Disclosures
Author

Sandra G Gompf, MD, FACP, FIDSA  Associate Professor of Infectious Diseases and International Medicine, University of South Florida College of Medicine; Chief, Infectious Diseases Section, Director, Occupational Health and Infection Control Programs, James A Haley Veterans Hospital

Sandra G Gompf, MD, FACP, FIDSA is a member of the following medical societies: American College of Physicians and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Coauthor(s)

Ana Paula Velez  MD, Assistant Professor of Medicine, Division of Infectious Disease and International Medicine, University of South Florida College of Medicine and James A Haley Veterans Affairs Medical Center; Attending Physician, Moffitt Cancer Center

Ana Paula Velez is a member of the following medical societies: American College of Physicians-American Society of Internal Medicine, American Medical Association, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Specialty Editor Board

Maria D Mileno, MD  Associate Professor of Medicine, Division of Infectious Diseases, The Warren Alpert Medical School of Brown University

Maria D Mileno, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, International Society of Travel Medicine, and Sigma Xi

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Charles V Sanders, MD  Edgar Hull Professor and Chairman, Department of Internal Medicine, Professor of Microbiology, Immunology and Parasitology, Louisiana State University School of Medicine at New Orleans; Medical Director, Medicine Hospital Center, Charity Hospital and Medical Center of Louisiana at New Orleans; Consulting Staff, Ochsner Medical Center

Charles V Sanders, MD is a member of the following medical societies: Alliance for the Prudent Use of Antibiotics, Alpha Omega Alpha, American Association for the Advancement of Science, American Association of University Professors, American Clinical and Climatological Association, American College of Physician Executives, American College of Physicians, American Federation for Medical Research, American Foundation for AIDS Research, American Geriatrics Society, American Lung Association, American Medical Association, American Society for Microbiology, American Thoracic Society, American Venereal Disease Association, Association for Professionals in Infection Control and Epidemiology, Association of American Medical Colleges, Association of American Physicians, Association of Professors of Medicine, Infectious Disease Society for Obstetrics and Gynecology, Infectious Diseases Society of America, Louisiana State Medical Society, Orleans Parish Medical Society, Royal Society of Medicine, Sigma Xi, Society of General Internal Medicine, Southeastern Clinical Club, Southern Medical Association, Southern Society for Clinical Investigation, and Southwestern Association of Clinical Microbiology

Disclosure: Nothing to disclose.

Eleftherios Mylonakis, MD  Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital

Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD  Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital

Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of eMedicine gratefully acknowledge the contributions of previous coauthors Juan D Diaz, DO; Matthew R Jezior, MD; Cecily K Peterson, MD; and Joseph T Morris, MD, to the development and writing of this article.

References

  1. Yang CW. Leptospirosis in Taiwan--an underestimated infectious disease. Chang Gung Med J. Mar-Apr 2007;30(2):109-15. [Medline].

  2. Chierakul W, Tientadakul P, Suputtamongkol Y, et al. Activation of the coagulation cascade in patients with leptospirosis. Clin Infect Dis. Jan 15 2008;46(2):254-60. [Medline].

  3. Wagenaar JF, Goris MG, Sakundarno MS, et al. What role do coagulation disorders play in the pathogenesis of leptospirosis?. Trop Med Int Health. Jan 2007;12(1):111-22. [Medline].

  4. Katz AR, Buchholz AE, Hinson K, Park SY, Effler PV. Leptospirosis in hawaii, USA, 1999-2008. Emerg Infect Dis. Feb 2011;17(2):221-6. [Medline].

  5. Gaspari R, Annetta MG, Cavaliere F, et al. Unusual presentation of leptospirosis in the late stage of pregnancy. Minerva Anestesiol. Jul-Aug 2007;73(7-8):429-32. [Medline].

  6. Khosravi M, Bastani B. Acute renal failure due to leptospirosis in a renal transplant recipient: a brief review of the literature. Transplant Proc. May 2007;39(4):1263-6. [Medline].

  7. Pappachan JM, Mathew S, Thomas B, et al. The incidence and clinical characteristics of the immune phase eye disease in treated cases of human leptospirosis. Indian J Med Sci. Aug 2007;61(8):441-7. [Medline].

  8. Dolhnikoff M, Mauad T, Bethlem EP, et al. Pathology and pathophysiology of pulmonary manifestations in leptospirosis. Braz J Infect Dis. Feb 2007;11(1):142-8. [Medline].

  9. Dall'Antonia M, Sluga G, Whitfield S, et al. Leptospirosis pulmonary haemorrhage: a diagnostic challenge. Emerg Med J. Jan 2008;25(1):51-2. [Medline].

  10. Spichler A, Spichler E, Moock M, et al. Acute pancreatitis in fatal anicteric leptospirosis. Am J Trop Med Hyg. May 2007;76(5):886-7. [Medline].

  11. Khositseth S, Sudjaritjan N, Tananchai P, et al. Renal magnesium wasting and tubular dysfunction in leptospirosis. Nephrol Dial Transplant. Mar 2008;23(3):952-8. [Medline].

  12. Chakurkar G, Vaideeswar P, Pandit SP, et al. Cardiovascular lesions in leptospirosis: an autopsy study. J Infect. Mar 2008;56(3):197-203. [Medline].

  13. Brett-Major DM, Coldren R. Antibiotics for leptospirosis. Cochrane Database Syst Rev. Feb 15 2012;2:CD008264. [Medline].

  14. Dursun B, Bostan F, Artac M, et al. Severe pulmonary haemorrhage accompanying hepatorenal failure in fulminant leptospirosis. Int J Clin Pract. Jan 2007;61(1):164-7. [Medline].

  15. Shenoy VV, Nagar VS, Chowdhury AA, Bhalgat PS, Juvale NI. Pulmonary leptospirosis: an excellent response to bolus methylprednisolone. Postgrad Med J. Sep 2006;82(971):602-6. [Medline]. [Full Text].

  16. Meaudre E, Asencio Y, Montcriol A, et al. [Immunomodulation in severe leptospirosis with multiple organ failure: plasma exchange, intravenous immunoglobulin or corticosteroids?]. Ann Fr Anesth Reanim. Feb 2008;27(2):172-6. [Medline].

  17. Wang Z, Jin L, Wegrzyn A. Leptospirosis vaccines. Microb Cell Fact. Dec 11 2007;6:39. [Medline]. [Full Text].

  18. Boyer AS, Runyan RB. TGFbeta Type III and TGFbeta Type II receptors have distinct activities during epithelial-mesenchymal cell transformation in the embryonic heart. Dev Dyn. Aug 2001;221(4):454-9. [Medline].

  19. Centers for Disease Control and Prevention. Brief report: Leptospirosis after flooding of a university campus--Hawaii, 2004. MMWR Morb Mortal Wkly Rep. Feb 10 2006;55(5):125-7. [Medline]. [Full Text].

  20. Centers for Disease Control and Prevention. Outbreak of leptospirosis among white-water rafters--Costa Rica, 1996. MMWR Morb Mortal Wkly Rep. Jun 27 1997;46(25):577-9. [Medline]. [Full Text].

  21. Cox TE, Smythe LD, Leung LK. Flying foxes as carriers of pathogenic Leptospira species. J Wildl Dis. Oct 2005;41(4):753-7. [Medline].

  22. Dall'Antonia M, Sluga G, Whitfield S, et al. Leptospirosis pulmonary haemorrhage: a diagnostic challenge. Emerg Med J. Jan 2008;25(1):51-2. [Medline].

  23. Doudier B, Garcia S, Quennee V, et al. Prognostic factors associated with severe leptospirosis. Clin Microbiol Infect. Apr 2006;12(4):299-300. [Medline].

  24. Faine S. Leptospira and Leptospirosis. Boca Raton: CRC Press Inc; 1994.

  25. Farr RW. Leptospirosis. Clin Infect Dis. Jul 1995;21(1):1-6; quiz 7-8. [Medline].

  26. Masuzawa T, Okamoto Y, Une Y, et al. Leptospirosis in squirrels imported from United States to Japan. Emerg Infect Dis. Jul 2006;12(7):1153-5. [Medline]. [Full Text].

  27. Moore GE, Guptill LF, Glickman NW, et al. Canine leptospirosis, United States, 2002-2004. Emerg Infect Dis. Mar 2006;12(3):501-3. [Medline].

  28. O'Neil KM, Rickman LS, Lazarus AA. Pulmonary manifestations of leptospirosis. Rev Infect Dis. Jul-Aug 1991;13(4):705-9. [Medline].

  29. Sanford JP. Leptospirosis. In: Harrison's Principles of Internal Medicine. 13th ed. New York, NY: McGraw-Hill, Inc; 740-3.

  30. Sejvar J, Bancroft E, Winthrop K, et al. Leptospirosis in "Eco-Challenge" athletes, Malaysian Borneo, 2000. Emerg Infect Dis. Jun 2003;9(6):702-7. [Medline]. [Full Text].

  31. Speelman P. Leptospirosis. In: Harrison's Principle of Internal Medicine. 14th ed. New York, NY: McGraw-Hill, Inc; 1036-38.

  32. Tappero J, Ashford D, Perkins N. Leptospira species (Leptospirosis). In: Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. Philadelphia, Pa: Churchill Livingstone; 2000:2495-500.

 
Previous
Next
 
Darkfield microscopy of leptospiral microscopic agglutination test. (This image is in the public domain and thus free of any copyright restrictions. Courtesy of the Centers for Disease Control/Mrs. M. Gatton)
A scanning electron micrograph depicting Leptospira atop a 0.1-µm polycarbonate filter. (This image is in the public domain and thus free of any copyright restrictions. Courtesy of the Centers for Disease Control/Rob Weyant)
Silver stain, liver, fatal human leptospirosis. (This image is in the public domain and thus free of any copyright restrictions. Courtesy of the Centers for Disease Control/Dr. Martin Hicklin)
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.