Treatment and prevention of leptospirosis
- Nick Day, DM, FRCP
Nick Day, DM, FRCP
- Professor of Tropical Medicine
- University of Oxford
- Section Editors
- Stephen B Calderwood, MD
Stephen B Calderwood, MD
- Editor-in-Chief — Infectious Diseases
- Section Editor — Bacterial Infections
- Professor of Medicine (Microbiology and Immunobiology)
- Harvard Medical School
- Morven S Edwards, MD
Morven S Edwards, MD
- Section Editor — Pediatric Infectious Diseases
- Professor of Pediatrics
- Baylor College of Medicine
Leptospirosis is a zoonosis caused by the spirochetes of the genus Leptospira. Synonyms include Weil's disease, Weil-Vasiliev disease, Swineherd's disease, rice-field fever, waterborne fever, nanukayami fever, cane-cutter fever, swamp fever, mud fever, Stuttgart disease, and Canicola fever.
The treatment and prevention of leptospirosis will be presented here. The epidemiology, microbiology, clinical manifestations, and diagnosis of this disease are discussed separately. (See "Epidemiology, microbiology, clinical manifestations, and diagnosis of leptospirosis".)
Most cases of leptospirosis are self-limited in the absence of antimicrobial therapy, although a proportion of patients do develop severe complications with significant morbidity and mortality. In general, if the illness is severe enough to come to clinical attention and the diagnosis is recognized, antibiotic therapy should be administered.
In the setting of severe illness due to leptospirosis, supportive care with renal replacement therapy, ventilatory support, and blood products may also be required . In general, such management is the same as organ failure due to other causes of sepsis. In one Brazilian study of patients with complications of leptospirosis including acute respiratory distress syndrome (ARDS) and acute kidney injury (AKI), daily hemodialysis was associated with significantly lower mortality than alternate-day dialysis . Hypokalemia is common in non-oliguric AKI associated with leptospirosis and should be corrected . Recovery of renal function after the acute period is generally rapid and complete [4-6]. For patients with ARDS, low net fluid intake to prevent pulmonary hemorrhage and lung-protective ventilation practices are appropriate. (See "Renal replacement therapy (dialysis) in acute kidney injury in adults: Indications, timing, and dialysis dose" and "Mechanical ventilation of adults in acute respiratory distress syndrome".)
Clinical approach — Symptomatic patients presenting for medical attention should receive antimicrobial therapy to shorten the duration of illness and reduce shedding of organisms in the urine. We suggest the following approach, which varies with the clinical presentation.
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