Leptospirosis

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

Morbus Weil, canicola fever (human), rice field leptospirosis, Stuttgart dog disease, pig herding disease, Japanese autumn fever, pea picker's disease, leptospirosis icterohaemorrhagica, swine herding disease.

Notifiable infection with Leptospira interrogans, which is characterised by recurrent episodes of fever.

• Mostly agricultural workers, miners and hunters are affected.
• Wide spread.

• Pathogen: Leptospira interrogans.
• Incubation period: 1–2 weeks.
• L. interrogans infects the kidney tissue of infected animals. In contact with urine or urine-contaminated water (diving, swimming, etc.) or soil, contaminated fruits or animals, the Leptospira penetrate the human organism through skin lesions.

• The various serotypes (2000 serotypes, 23 serovars) all show the same clinical picture. Thus, the distinction is not of clinical relevance.
• Typical are febrile temperatures for 5-10 days (but can also last up to 4 weeks), red. AZ, chills, cephalgia, myalgia (especially calf pain), diarrhoea (formerly Ford Bragg fever, note: US Army base in North Carolina, where the disease was frequently observed).
• After about 7 days, the temperature returns to normal, followed by renewed febrile episodes (these are repeated several times).
• Involvement of CNS (30-40% have serous meningitis), eyes (conjunctivitis), lungs (dyspnoea), liver (jaundice) and kidneys (acute renal failure) possible. 
• Morbiliform and scarlatiniform exanthema.
• Dolente pretibial plaques are typical in the context of the first fever phase. 
• Purpura in the context of haemolytic anaemia.

• Occupational history, recreational history, travel history.
• Clinical.
• Blood culture.
• If necessary, cerebrospinal fluid puncture.
• Bact. examination of urine (leptospiruria (> 90% of pat.).
• 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.
• Lethality can be up to 40%, with mainly elderly patients affected.

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