Leptospirosis Differential Diagnoses

Updated: Jul 08, 2021
  • Author: Sandra G Gompf, MD, FACP, FIDSA; Chief Editor: Michael Stuart Bronze, MD  more...
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Diagnostic Considerations

The differential diagnosis of leptospirosis is confoundingly broad. The flulike illness that characterizes mild cases may resemble a benign viral syndrome, while more severe cases may resemble meningitis or sepsis. Dengue, in particular, and chikungunya often overlap in territory with leptospirosis, and more than one infection may be present.

Recognizing and addressing the differential diagnoses when evaluating a patient suspected of having leptospirosis is critical. Missing other life-threatening illnesses, such as bacterial meningitis, acute toxin-induced hepatitis, pancreatitis, cholangitis, or Goodpasture disease, can be devastating, particularly because each of those diseases has a specific and entirely different necessary therapy. In addition, delayed treatment for severe leptospirosis may negatively affect patient outcome.

A possible key to correct diagnosis is a thorough history focusing on the patient's travel history, activities, and exposure to animals. Case clusters, if present, may suggest a common exposure.

Other problems to be considered may include the following:

  • Enteric fever
  • Infantile polyarteritis nodosa
  • Kawasaki disease
  • Primary HIV infection
  • Typhoid fever
  • Yellow fever
  • Mononucleosis
  • Cholecystitis
  • Pancreatitis and pancreatic pseudocyst