Leptospirosis

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Retrieved

2021-01-23

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Orphanet

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Leptospirosis is an anthropozoonosis caused by spiral-shaped bacteria belonging to the genus Leptospira. Leptospirosis is a widespread zoonosis with a worldwide distribution and has emerged as a major public health problem in developing countries in South-East Asia and South America.

Epidemiology

Estimations from the World Health Organization (WHO) indicate that over 500,000 cases of severe leptospirosis are thought to occur each year, with a mortality rate of over 10%. However, the incidence in Europe is much lower with less than 500 cases being diagnosed per year in each European country.

Clinical description

Initial signs of infection include fever associated with shivering and pain (myalgia, headaches and abdominal pain). The disease progresses over several days with severity varying from flu-like symptoms to rapidly life-threatening multisystem failure, with the most characteristic manifestation being hepatonephritis. Marked jaundice, renal insufficiency, neurologic signs, respiratory involvement, myocarditis, painful hepatomegaly with splenomegaly, and bleeding may also occur. Laboratory investigations reveal polynuclear hyperleucocytosis, cholestasis that is in some cases severe and isolated (without or with only limited cytolysis), and occasionally rhabdomyolysis and thrombopenia.

Etiology

Animal hosts (generally rodents) excrete leptospires in their urine. Humans become infected through skin or mucosal contact with contaminated soft water. The incubation period lasts around 10 days.

Diagnostic methods

The diagnosis relies on analysis of blood cultures grown on specific EMJH media. Isolation of strains from urine is problematic and can only be performed from fresh samples. PCR analysis of blood or urine samples (fresh or formalin-fixed) can be used to detect leptospire DNA and allows early diagnosis within the first week following disease onset. However, leptospirosis is often diagnosed late, due to its wide spectrum of symptoms, ranging from a flu-like syndrome to renal failure.

Differential diagnosis

The symptoms mimic the clinical presentations of many other diseases, including dengue fever and malaria.

Management and treatment

Leptospira remain sensitive to penicillin G and therefore treatment is based on administration of antibiotics. Antibiotic therapy is beneficial but must be administered in the early stage of the disease. Disease prevention revolves around eradication of rodents and the use of proper precautions. In some countries, such as France, a vaccine is also available but is reserved for those in at-risk professions, such as sewerage workers.