What is the treatment for Leptospirosis?

Treatment of Leptospirosis

Antibiotics should be started promptly upon suspicion of leptospirosis, with penicillin and tetracycline antibiotics being the most effective treatments during the bacteremic phase. 1

Clinical Presentation and Diagnosis

Leptospirosis presents with a spectrum of manifestations ranging from mild flu-like symptoms to severe disease (Weil's disease) characterized by:

• Biphasic illness pattern:

  • Initial bacteremic phase (4-7 days): Flu-like symptoms
  • Immune phase (1-3 days later): Characterized by fever, myalgia (especially calves), hepatorenal syndrome, and hemorrhage 1

• Key clinical findings:

  • Conjunctival suffusion (highly suggestive)
  • Jaundice (in severe cases)
  • Myalgia, particularly of calf muscles
  • Fever
  • Headache

• Laboratory findings:

  • Proteinuria and hematuria on urinalysis
  • Polymorphonuclear leukocytosis
  • Thrombocytopenia and anemia (if significant hemorrhage)
  • Elevated bilirubin with mild transaminase elevation
  • Renal function abnormalities 1

Treatment Algorithm

Mild Disease

• Generally self-limiting
• Antibiotics recommended:
  • Doxycycline (100 mg twice daily for 7 days) OR
  • Penicillin G (appropriate dosing based on weight)
  • Early administration reduces duration and severity of illness 2

Severe Disease (Weil's Disease)

• Characterized by jaundice, renal failure, hemorrhage
• Requires hospitalization and more aggressive management:
  • Intravenous antibiotics (ceftriaxone or penicillin G)
  • Supportive care for organ dysfunction
  • Renal or liver support may be required 1
  • Close monitoring for pulmonary complications (occurs in 20-70% of patients) 3

Special Considerations

Timing of Treatment

• Treatment should begin upon clinical suspicion without waiting for laboratory confirmation 1
• Early treatment is critical for reducing disease severity and duration 2

Sports and Activities

• Person-to-person spread is rare
• No restrictions from contact sports needed
• Risk is primarily from exposure to contaminated water during swimming, rafting, kayaking 1

Common Pitfalls and Caveats

1. Delayed diagnosis: Leptospirosis can mimic many other febrile illnesses, particularly dengue in endemic areas 2. Maintain high index of suspicion in patients with appropriate exposure history.

2. Late treatment: While a systematic review showed no benefit of antibiotics in established leptospirosis, most infectious disease specialists continue to recommend antibiotics even in later stages 1.

3. Inadequate monitoring: Patients with severe disease can deteriorate rapidly despite therapy. Monitor renal and liver function closely, as 5-10% of infected individuals develop severe disease with 5-15% mortality in severe cases 2, 4.

4. Exposure identification: Risk factors include recreational water sports, occupational animal exposure, flooding, and walking through contaminated water 1, 5. Identifying these exposures is crucial for early diagnosis.

5. Diagnostic challenges: Blood cultures should be taken within the first 5 days of onset (before antibiotics) and kept at room temperature before dispatch to reference laboratories 1.

By following this approach to treatment and being aware of the potential complications, clinicians can effectively manage leptospirosis and reduce the risk of severe outcomes.