From the Guidelines
Leptospirosis is a bacterial infection that requires prompt antibiotic treatment, with oral doxycycline 100mg twice daily for 7 days recommended for mild cases and intravenous penicillin G or ceftriaxone for severe cases. The infection is caused by Leptospira bacteria and can range from mild flu-like illness to severe disease with multi-organ failure (Weil's disease) [ 1 ].
Mode of Transmission
The bacteria are excreted in the urine of infected animals, such as rats, dogs, cattle, and other domestic and wild animals, and humans acquire the infection through direct contact with urine or urine-contaminated water [ 1 ]. Risks include recreational sports, occupational animal or water exposure, and flooding.
Clinical Presentation
The clinical presentation of leptospirosis varies from mild flu-like symptoms to a severe illness characterized by hemorrhage, jaundice, and hepatorenal failure (Weil’s disease) [ 1 ]. The infection classically follows a biphasic course with an initial bacteremic phase with ‘flu-like’ symptoms lasting 4-7 days, followed 1-3 days later by an immune phase characterized by fever, myalgia, hepatorenal syndrome, and hemorrhage.
Treatment and Prevention
Treatment should begin as soon as leptospirosis is suspected, without waiting for laboratory confirmation, as early intervention improves outcomes [ 1 ]. Supportive care, including hydration, fever management, and monitoring for complications like kidney failure or respiratory distress, is essential. Prevention involves avoiding potentially contaminated water, wearing protective clothing in high-risk environments, and controlling rodent populations.
Key Points
- Leptospirosis requires prompt antibiotic treatment
- Oral doxycycline is recommended for mild cases, while intravenous penicillin G or ceftriaxone is preferred for severe cases
- The infection can range from mild flu-like illness to severe disease with multi-organ failure
- Early recognition and treatment are crucial for preventing serious complications [ 1 ].
From the Research
Overview of Leptospirosis
- Leptospirosis is a zoonotic disease that can cause significant morbidity and mortality worldwide 2, 3.
- The disease is caused by the bacterium Leptospira and can be transmitted through contact with contaminated water, soil, or animals 4.
Treatment of Leptospirosis
- The optimal antimicrobial treatment for leptospirosis has not been established, but various antibiotics such as penicillin, doxycycline, cefotaxime, and ceftriaxone have been used to treat the disease 2, 3.
- A meta-analysis found no significant difference in mortality between penicillin treatment and placebo, and no difference between penicillin and other antibiotics such as cephalosporins or doxycycline 3.
- A case report found that combined therapy with doxycycline and ceftriaxone was effective in treating leptospirosis 4.
Chemoprophylaxis of Leptospirosis
- Chemoprophylaxis regimens such as weekly doses of doxycycline have been assessed, but the evidence is limited and inconclusive 3.
- A single dose of doxycycline at exposure to flood water may have a beneficial effect in preventing symptomatic leptospirosis 3.
Jarisch-Herxheimer Reaction
- The Jarisch-Herxheimer reaction is a potential adverse event associated with antibiotic treatment of leptospirosis, but its true prevalence and impact are unknown 5.
- Large, well-designed studies are needed to investigate the incidence and severity of the Jarisch-Herxheimer reaction in leptospirosis patients 5.
Effectiveness of Current Antibiotics
- Current antibiotics such as penicillin, doxycycline, and ceftriaxone are still effective against most Leptospira strains, but continuous susceptibility testing and development of novel antibiotics are encouraged 6.
- Adverse reactions such as Jarisch-Herxheimer reactions can occur with current antibiotics, and natural resources such as plants and marine actinobacteria may be potential sources of new anti-leptospiral compounds 6.