See [AJGP 2018 - leptospirosis](https://www1.racgp.org.au/ajgp/2018/march/leptospirosis) > - conjunctival involvement + myalgia pathognomonic of leptospirosis > - notifiable condition > - abx 7 day treatment: **doxycycline** 100mg BD (2mg/kg child > 8 yo) OR **ben pen** 1.2g (50mg/kg kids) IV Q6H or **ceftriaxone** 1g (child >1 month 50mg/kg) IV od - Leptospirosis is a blood infection caused by the bacteria *Leptospira* that can infect humans, dogs, rodents and many other wild and domesticated animals. - *from urine of infected animals* - outbreaks after rainfall and flooding (eg in QLD, NT) - found in tropical areas - **Signs and symptoms** can range from none to mild (headaches, muscle pains, and fevers) to severe (bleeding in the lungs or meningitis). - ==*Weil's disease*==, the acute, severe form of leptospirosis, causes the infected individual to become **jaundiced** (skin and eyes become yellow), develop **kidney failure**, and **bleed**. - Bleeding from the lungs associated with leptospirosis is known as *severe pulmonary haemorrhage syndrome* # features - abrupt onset feaver - headache - myalgias - **conjunctival involvement** - severe redness and oedema of conjunctivae - usually no exudate - this + myalgia pathognomonic of leptospirosis - photosensitivity - nausea/vomiting - CSF pleocytes also present in 25% # icteric leptospirosis (Weil's disease) - 5-10% of leptospirosis cases - multisystem, rapidly progressive disease - **jaundice** - elevated bilirubin, but transaminases only mod increase - hepatic function normalises after recovery - **haemorrhage** - thrombocytopaenia in 50% of cases - **AKI** - +/- pulm involvement - couh - *pulm haemorrhage* - [[ARDS]] - cardiac involvement common - ECG changes ## prognosis - 5-15% mortality # Diagnosis - direct microscopy and PCR of body fluid (urine preferred) - culture: blood or CSF, may take several weeks to become positive, low sensitivity - screening with macroscopic slide agglutination test # Treatment - generally supportive - abx not required in mild cases