Leptospirosis

Last Updated: 2020-06-01

Author(s): -

  • Landouzy 1883.
  • Mathieu 1886.
  • Weil 1886.

Weil's disease, canicola fever (human), rice paddy leptospirosis, Stuttgart dog epidemic, pork keeper disease, Japanese autumn fever, pea picker disease, Leptospirosis icterohaemorrhagica, swine herder disease.

Reportable infection with Leptospira interrogans, which is characterized by recurrent fever attacks.

  • Mainly affected: farmers, miners and hunters.
  • Worldwide distribution.
  • Pathogen: Leptospira interrogans.
  • Incubation period: 1-2 weeks.
  • L. interrogans attacks the kidney tissue of infected animals. In contact with urine or urine-contaminated water (diving, swimming, etc.) or soil, contaminated fruits or animals, Leptospira penetrate the human organism through skin lesions.
  • The various serotypes (2000 serotypes, 23 serovars) all show the same clinical picture.
  • Typical are febrile temperatures for 5-10 days (but can also last up to 4 weeks), reduced general condition, chills, cephalgias, myalgias (especially calf pain), diarrhoea (former Ford Bragg fever, note: US-Army base in North Carolina, where the disease was frequently observed).
  • After about 7 days, the temperature normalizes with subsequent renewed fever attacks (these repeat several times in total).
  • CNS involvement (30-40% have serous meningitis), eyes (conjunctivitis), lungs (dyspnoea), liver (icterus) and kidneys (acute renal failure) possible.
  • Morbiliform and scarlatiniform exanthema.
  • Typical are dolent pretibial plaques during the first fever phase.
  • Purpura in the context of haemolytic anaemia.
  • Occupational history, leisure time history, travel history.
  • Clinical features.
  • Blood culture.
  • If necessary, cerebrospinal fluid puncture.
  • Bacterial examination of urine (leptospiruria (> 90% of patients)).
  • Serological antibody detection (microagglutination test).
  • Doxycycline p.o. 200 mg 1x/ week.
  • Vaccination
  • Only available for dogs, but not for humans.
  • Mostly healing under antibiotic therapy after 2-6 weeks.
  • Letality can be up to 40%, with older patients being particularly affected.
  • Doxycycline p.o. 100 mg 2x a day for 7 days.

In severe cases:

  • PenicillinG intravenously 1.5 Mio 4x a day for 7 days.
    • Alternative: Ceftriaxone intravenously 2g 1x a day.
    • Alternative: Cefotaxim intravenously 1g 4x a day for 7 days.
    • Alternative: Doxycycline intravenously 200 mg 1x a day

For severe pulmonary forms additionally:

  • Methylprednisolone 1g intravenously for 3 days, then 1 mg/kg bw/d further.
  1. Enwonwu CO. Infectious oral necrosis (cancrum oris) in Nigerian children: a review. Community Dent Oral Epidemiol 1985;13:190-4. 
  2.  Shenoy VV, Nagar VS, Chowdhury AA, Bhalgat PS , Juvale NI. Pulmonary leptospirosis: an excellent response to bolus methylprednisolone. Postgrad Med J 2006;82:602-6. 
  3.  Haake DA , Levett PN. Leptospirosis in humans. Curr Top Microbiol Immunol 2015;387:65-97. 
  4.  de Vries SG, Visser BJ, Nagel IM, Goris MG, Hartskeerl RA , Grobusch MP. Leptospirosis in Sub-Saharan Africa: a systematic review. Int J Infect Dis 2014;28:47-64. 
  5.  Schuller S, Francey T, Hartmann K, Hugonnard M, Kohn B, Nally JE et al. European consensus statement on leptospirosis in dogs and cats. J Small Anim Pract 2015;56:159-79. 
  6.  RKI - RKI-Ratgeber für Ärzte - Leptospirose. (2016). Rki.de. Retrieved 24 May 2016, from https://www.rki.de/DE/Content/Infekt/EpidBull/Merkblaetter/Ratgeber_Leptospirose.html#doc6823762bodyText9