Patients with severe disease should remain hospitalized until adequate resolution of organ failure and clinical infection. Trans R Soc Trop Med Hyg. What is the treatment for leptospirosis? You will need antibiotics as the treatment for leptospirosis. Michael Stuart Bronze, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Medical Association, Association of Professors of Medicine, Infectious Diseases Society of America, Oklahoma State Medical Association, Southern Society for Clinical InvestigationDisclosure: Nothing to disclose. National Research Council. Am J Trop Med Hyg. If leptospirosis is suspected on the basis of the clinical presentation and risk factors for recent exposure, empirical antibiotics should be given early and continued for at least seven days. Treatment with Treatment of Leptospirosis in Horses If your horse is diagnosed with Leptospirosis, it is important for the person caring for him to wear gloves and a face shield. Shaked Y, Shpilberg O, Samra D, Samra Y. Leptospirosis in pregnancy and its effect on the fetus: case report and review. 1990 Jul. Clinician's suspicion of leptospirosis as a differential diagnosis accompanied by clinical features such as, fever, vomiting, thrombocytopenia, and neutrophilic leukocytosis AND treatment with antibiotics specifically prescribed for treatment of leptospirosis. Judith Green-McKenzie, MD, MPH, FACP, FACOEM is a member of the following medical societies: American College of Physicians, American College of Preventive Medicine, National Medical Association, American College of Occupational and Environmental MedicineDisclosure: Nothing to disclose. Transplant Proc. Leptospirosis is re-emerging as a result of increased international travel and climate changes elicited by global warming. [Medline]. J Wildl Dis. From the Centers for Disease Control and Prevention. 2007 Feb. 11(1):142-8. June 9, 2015; Accessed: June 13, 2018. The role of prophylaxis in children has not been adequately studied. [Medline]. 78(9):1136-47. Antibiotic treatment (doxycycline [Vibramycin, Oracea, Adoxa, Atridox], penicillin) is most effective when initiated early in the course of the illness. 2011 Oct. 15(10):e710-5. Please confirm that you would like to log out of Medscape. 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. Other public health measures include identification of contaminated water supplies, rodent control, prohibition of swimming in lakes or streams where risk of infection may be high, and informing people of risk when they are involved in recreational activities. http://whqlibdoc.who.int/hq/2003/WHO_CDS_CSR_EPH_2002.23.pdf, https://www.cdc.gov/leptospirosis/features/adventure-racing.html, https://www.cdc.gov/leptospirosis/pets/prevention/index.html, https://www.cdc.gov/leptospirosis/exposure/hurricanes-leptospirosis.html, American College of Physicians-American Society of Internal Medicine, American College of Occupational and Environmental Medicine, Southern Society for Clinical Investigation, American Society of Tropical Medicine and Hygiene, Alliance for the Prudent Use of Antibiotics, American Association for the Advancement of Science, American Association of University Professors, American Clinical and Climatological Association, Association for Professionals in Infection Control and Epidemiology, Infectious Disease Society for Obstetrics and Gynecology, Southwestern Association of Clinical Microbiology. Supportive care In the setting of severe illness due to leptospirosis, supportive care with renal replacement therapy, ventilatory support, and blood products may also be required [ 1 ]. Doxycycline versus azithromycin for treatment of leptospirosis and scrub typhus. Hawaii: Communicable Disease Report. Tripler Army Medical Center. Dall'Antonia M, Sluga G, Whitfield S, Teall A, Wilson P, Krah D. Leptospirosis pulmonary haemorrhage: a diagnostic challenge. Wang Z, Jin L, Wegrzyn A. Leptospirosis vaccines. 2011 Nov. 85(5):905-8. Clin Microbiol Rev. [Medline]. The antibiotics most frequently used are a penicillin antibiotic (amoxicillin or ampicillin) or doxycycline. Vaccines exist for animals and humans but are not necessarily available in all areas. From the Centers for Disease Control and Prevention. Patients with suspected or confirmed leptospirosis should receive a combination of [Medline]. Int J Syst Evol Microbiol. A nephrologist should be alerted early in the course because the need for dialysis may develop rapidly. [Medline]. 20(3):284-92. nov. and Leptospira yanagawae sp. Severe cases of leptospirosis can affect any organ system and can lead to multiorgan failure. Those with mild disease can pursue activity as tolerated. Mild leptospirosis responds very well to treatment with antibiotics and most people will make a full recovery within a week. The optimal antimicrobial treatment for this disease has not been established. TREATMENT. Leptospirosis has a regional epidemiology with high incidence of cases in remote regions that offer limited medical care. 1(8583):433-5. J Hyg (Lond). It is generally accepted that antibiotic therapy must be initiated as soon as possible, preferably during the first 5 days of the appearance of symptoms. Most people with severe leptospirosis will require admission to hospital so the functions of their body can be supported while the underlying infection is treated with injections of [Medline]. If available, critical care specialists may be best prepared to manage patients with affected multiple systems. News, encoded search term (Leptospirosis) and Leptospirosis, UK COVID-19 Update: Booster Jabs, GPs' 'Breaking Point', 'Healthy' BMI Range Risks, Malaria Resistant to Artemisinin Emerging in Africa. 1998. [Medline]. 2004 Oct. 48(10):4002-5. Takafuji ET, Kirkpatrick JW, Miller RN, Karwacki JJ, Kelley PW, Gray MR, et al. Inada R, Ido Y, Hoki R. The etiology, mode of infection, and specific therapy of Weil's disease (spirochaetosis icterohaemorrhagica. Leptospirosis is treatable with antibiotics. Vasconcellos FA, Coutinho ML, da Silva EF, Fernandes CP, Monte LG, Seyffert N, et al. Trans R Soc Trop Med Hyg. 3:153-61. J Infect Dis. 1955 Dec. 53(4):436-44. [Full Text]. Benzylpenicillin is recommended as the first-line treatment, with [Medline]. Unusual presentation of leptospirosis in the late stage of pregnancy. [38, 37]. Katz AR, Buchholz AE, Hinson K, Park SY, Effler PV. eyes, mouth) with: freshwater or moist soil contaminated with urine of an infected animal (indirect contact); This approach may have be beneficial in resource-poor areas where dialysis is unavailable and would involve lengthy medical transport. Intravenous penicillin (1.5 MU every 6 hours) is a drug of choice for patients with severe leptospirosis, and ceftriaxone was shown to be equally effective (1 g IV, once daily). 2007 Aug. 61(8):441-7. Renal function should be evaluated carefully and dialysis considered in cases of renal failure. [45] but clinical experience with these agents is more limited. Epidemiology of leptospirosis. 2008 Jan. 25(1):51-2. Southeast Asian J Trop Med Public Health. 2001 Feb 14. [Medline]. [Medline]. Activation of the coagulation cascade in patients with leptospirosis. What role do coagulation disorders play in the pathogenesis of leptospirosis?. Ann Fr Anesth Reanim. Brett-Major DM, Coldren R. Antibiotics for leptospirosis. [Medline]. Severe liver manifestations and kidney damage and even failure resulting from the infection may require intensive medical care and sometimes dialysis treatment. [Medline]. Most vaccines in use for several decades are thus killed whole-cell bacterin vaccines. A few cases in the literature have reported that plasma exchange, corticosteroids, and intravenous immunoglobulin may be beneficial in selected patients in whom conventional therapy does not elicit a response. 2012 May. It is transmitted to humans by contact through skin lesions or mucous membranes (e.g. Human leptospirosis: guidance for diagnosis, surveillance and control. Katz AR, Manea SJ, Sasaki DM. 285(6):728-30. [23], Pulse-dose steroids may also play a role early in the management of severe pulmonary disease. [Medline]. Most cases involve flu-like symptoms (fever, chills, muscle aches, headaches). A waterborne outbreak of leptospirosis. [Guideline] Guidugli F, Castro AA, Atallah AN. Once Leptospira bacteria get into the body, they spread to many types of tissues. Transfer to a facility with an appropriate level of care should be considered in patients with severe disease. 2018 May. Here is your guide to stay safe this monsoon. CDC. 2007 Jun. No leptospirosis vaccine is available for human use in the United States, but there are vaccines for animals (pets and agricultural). [Full Text]. 2018 May 1. 2012 Feb 15. Kupferman T, Coffee MP, Eckhardt BJ. Leptospirosis is an infectious disease that can occur in humans and animals worldwide. 1993 Aug. 17(2):241-3. Leptospirosis among Returned Travelers: A GeoSentinel Site Survey and Multicenter Analysis-1997-2016. N Engl J Med. 162(1):266-9. Socolovschi C, Angelakis E, Renvois A, Fournier PE, Mari JL, Davoust B, et al. Braz J Infect Dis. Am J Trop Med Hyg. Peter G, Narasimha H. Acalculous cholecystitis: a rare presentation of leptospirosis progressing to Weil's disease. Am J Trop Med Hyg. In most cases, the renal damage is reversible if the patient survives the acute illness. Treatment of Leptospirosis in Dogs Renal failure and liver disease are treated with fluid therapy and other supportive measures to maintain normal fluid, electrolyte, and acid-base balance. Placebo-controlled trial of intravenous penicillin for severe and late leptospirosis. What is the treatment of leptospirosis? Am J Epidemiol. 46(25):577-9. [Medline]. Am J Trop Med Hyg. The mainstay of treatment for leptospirosis is antibiotic therapy. 2017 Dec. 97 (6):1679-1681. Public health measures include investigation of cases in an effort to detect common source outbreaks and implementation of appropriate control measures to prevent further cases. An investigation of some risk factors for severe leptospirosis on Barbados. 2007 May. 1993 Jan. 48(1):35-43. Important control measures include control of livestock infection with good sanitation, immunization, and proper veterinary care. Leptospirosis was reinstated as a Nationally Notifiable Disease in 2013. You'll need a subscription to access all of BMJ Best Practice. Most leptospiral cases resolve spontaneously. Levett PN. Antibiotics are the main treatment. [Full Text]. [Full Text]. Leptospirosis is a potentially fatal bacterial infection that can cause severe complications. Classification of Leptospira genomospecies 1, 3, 4 and 5 as Leptospira alstonii sp. Associated with occupational exposure, water sports, and flooding. As with other spirochetal diseases, antibiotic treatment of patients with leptospirosis may cause a Jarisch-Herxheimer reaction; however, this is rarely fatal. Leptospirosis is a zoonosis that affects many domestic and wild animals, mainly rodents (particularly rats) but also dogs and cattle, etc. 14(2):296-326. It passes from animals to humans through contaminated water, often in tropical areas. [Medline]. [Medline]. Judith Green-McKenzie, MD, MPH, FACP, FACOEMAssociate Professor, Director of Clinical Practice, Occupational Medicine Residency Director, University of Pennsylvania School of Medicine Because of the heterogeneity in Leptospira serovars that cause disease in different host species, different polyvalent vaccines are given depending on exposure type and geography. Minerva Anestesiol. Int J Infect Dis. Pulmonary leptospirosis: an excellent response to bolus methylprednisolone. 30(2):109-15. [Full Text]. Treatment For Leptospirosis In order to manage the signs and symptoms of the condition, effective antibiotic therapy can be applied as the treatment method. 46(2):254-60. Share cases and questions with Physicians on Medscape consult. GILLESPIE RW, RYNO J. [43, 44]. Supportive therapy and careful management of renal, hepatic, hematologic, and central nervous system complications are important. [51]. Jackson LA, Kaufmann AF, Adams WG, Phelps MB, Andreasen C, Langkop CW, et al. Go to The Berkey Product Page. Because of the presence of Leptospira carrier states in both cattle and wildlife, avoiding all exposure to leptospirosis is not possible for most beef cattle operations. Persons with symptoms suggestive of leptospirosis should contact a All material on this website is protected by copyright, Copyright 1994-2021 by WebMD LLC. CDC. [Medline]. [Full Text]. 47(32):673-6. Chierakul W, Tientadakul P, Suputtamongkol Y, Wuthiekanun V, Phimda K, Limpaiboon R, et al. Outbreak of leptospirosis among triathlon participants in Langau, Austria, 2010. Available at https://www.cdc.gov/leptospirosis/exposure/hurricanes-leptospirosis.html. Ocular manifestations in the acute phase of leptospirosis. 1984 Feb 23. It is caused by a bacteria spread by the urine of animals. Leptospirosis in ICU: A Retrospective Study of 134 Consecutive Admissions. [Medline]. Preve India's Dire COVID-19 Situation Likely to Worsen. Crit Care Med. Trevejo RT, Rigau-Prez JG, Ashford DA, McClure EM, Jarqun-Gonzlez C, Amador JJ, et al. Leptospirosis is a common zoonosis acquired by exposure to body fluids, to tissues of infected animals, or to contaminated soil or fresh water. Wagenaar JF, Goris MG, Sakundarno MS, Gasem MH, Mairuhu AT, de Kruif MD, et al. For severe leptospirosis, intravenous penicillin G has long been the drug of choice, although the third-generation cephalosporins cefotaxime and ceftriaxone have become widely used. Access to mechanical ventilation and airway protection should be available in the event of respiratory compromise. 2006 Sep. 82(971):602-6. Cochrane Database Syst Rev. Complications including pulmonary haemorrhage, jaundice, renal impairment, myocarditis, and uveitis are all possibilities. /viewarticle/948698 The incidence and clinical characteristics of the immune phase eye disease in treated cases of human leptospirosis. [Medline]. However, severe disease may rarely occur as exemplified in the case presented here. [Medline]. Although there is controversy about using antibiotics in the first phase of leptospirosis, antibiotics ( penicillin - penicillin G, ampicillin [Omnipen, Polycillin, Principen], amoxicillin [ Amoxil , Trimox , Moxatag , Larotid ], or erythromycin [E-Mycin, Eryc , Ery-Tab , PCE , Pediazole, Ilosone]) are recommended for treatment of patients with phase two or more severe symptoms. [Medline]. Usually, antimicrobial therapy with penicillin or derivatives (ampicillin, ticarcillin-clavulanic acid, amoxicillin), cephalosporins, erythromycin, enrofloxacin, ciprofloxacin, tetracycline or doxycycline achieves the best results. Eur Ann Otorhinolaryngol Head Neck Dis. 2018 Feb. 43:361-365. Leptospirosis, also called Weil's disease, is an infection you can get from animals. nov., Leptospira terpstrae sp. Testing different antigen capture ELISA formats for detection of Leptospira spp. Leptospirosis is treated with antibiotics, such as doxycycline or penicillin, which should be given early in the course of the disease. For advice on medication following a natural disaster or mass outbreak, click here. Person DA, Burnett MW. Harris BM, Blatz PJ, Hinkle MK, McCall S, Beckius ML, Mende K, et al. Trivedi SV, Chavda RK, Wadia PZ, Sheth V, Bhagade PN, Trivedi SP, et al. Prevention of leptospirosis is difficult because the organism cannot be eradicated from wild animal reservoirs, which constantly infect domestic animals. The role of glucocorticoid pulse therapy in pulmonary involvement in leptospirosis. Clinical Review, You are being redirected to Demers RY, Thiermann A, Demers P, Frank R. Exposure to Leptospira icterohaemorrhagiae in inner-city and suburban children: a serologic comparison. 1987 Sep. 126(3):535-45. Leptospirosis. Indian J Med Sci. 6:39. This website also contains material copyrighted by 3rd parties. Treatment 1 week before service and 2 weeks before farrowing has been found to be most satisfactory in preventing reproductive losses. Courtesy of the Centers for Disease Control/Dr. Upon administration, antibiotics immediately inhibit multiplication and replication of the organism, thereby rapidly decreasing the chances of fatal complications. Doxycycline, in the dose of 200 mg every week, has demonstrated efficacy of 95% against leptospirosis and may help prevent the disease in exposed adults. [Medline]. South Med J. [Medline]. Third-generation cephalosporins and quinolone antibiotics may also be effective. A subscription is required to access all the content in Best Practice. Patients with severe disease should be placed on bed rest until adequately resuscitated and treated. 2011 Feb. 17(2):221-6. Medical Surveillance Monthly Report. This price can increase significantly if your pet's disease is more severe. [Medline]. Spichler A, Spichler E, Moock M, Vinetz JM, Leake JA. In mild leptospirosis, antibiotic tablets may be all that is needed. Treatment 1 week before service and 2 weeks before farrowing has been found to be most satisfactory in preventing reproductive losses. JAMA. April 17, 2015; Accessed: June 13, 2018. 1992 Apr. Sasaki DM, Pang L, Minette HP, Wakida CK, Fujimoto WJ, Manea SJ, et al. Observations on the survival of Leptospira australis A in soil and water. In the severe form of the disease, liver and kidney func [49] As with severity of illness, response may vary depending on host immune factors or the particular virulence of the leptospire. 2007 Dec 11. Update: leptospirosis and unexplained acute febrile illness among athletes participating in triathlons--Illinois and Wisconsin, 1998. Clin Infect Dis. Meaudre E, Asencio Y, Montcriol A, Martinaud C, Graffin B, Palmier B, et al. 1993 Jan. 12(1):48-54. [Medline]. [Medline]. 2008 Mar. [Full Text]. J Trop Med Hyg. It's rare in the UK. 2008 Jan 15. Am J Public Health Nations Health. 1962 Apr. Malani J, Pryor J, Lusangulira K. Leptospirosis in Pohnpei (1986-1995): a case series on the use of dopamine/steroid for Weil's syndrome. [Medline]. Could It Happen Here? [Medline]. Large outbreaks of leptospirosis have occurred following excess rainfall or in tourists following exposure to fresh water during adventure activities. for: Medscape. Clin Infect Dis. The doctor needs to know how the patient is responding to antibiotic treatment. : ;:. Murray CK, Hospenthal DR. Curr Opin Infect Dis. [Medline]. Two blood tests (taken more than 2 weeks apart) are often required to make a diagnosis. (This image is in the public domain and thus free of any copyright restrictions. Pediatr Infect Dis J. Michael Stuart Bronze, MDDavid Ross Boyd Professor and Chairman, Department of Medicine, Stewart G Wolf Endowed Chair in Internal Medicine, Department of Medicine, University of Oklahoma Health Science Center; Master of the American College of Physicians; Fellow, Infectious Diseases Society of America; Fellow of the Royal College of Physicians, London Leptospirosis vaccines are also associated with significant adverse effects. Cacciapuoti B, Ciceroni L, Maffei C, Di Stanislao F, Strusi P, Calegari L, et al. [Medline]. 53:950-5. 1974 Feb. 67(2):155 passim. Chang Gung Med J. [Medline]. 4:12-14. Facial palsy associated with leptospirosis. 1995 Dec 6. 76(5):886-7. Examples of PPE include gloves and face shields for veterinarians and rubber boots for sewer workers and agricultural workers who wade in rodent urine- contaminated water. [Medline]. serovars to 24 antimicrobial agents by a broth microdilution technique. Available at https://www.cdc.gov/leptospirosis/pets/prevention/index.html. Case Report: A Cluster of Three Leptospirosis Cases in a New York City Abattoir and an Unusual Complication in the Index Case. Acute renal failure in children due to leptospirosis. Accessed: April 24, 2014. The treatment of leptospirosis involves high doses of antibiotics. [Full Text]. El Bouazzaoui A, Houari N, Arika A, Belhoucine I, Boukatta B, Sbai H, et al. Bull World Health Organ. [Medline]. Purpose of review: Leptospirosis is an important but often overlooked zoonotic disease that can cause significant morbidity and mortality. Thus, prevention is better to prevent these things from happening to you and your family. 1991 Oct. 81(10):1310-2. Leptospirosis in Hawaii, USA, 1999-2008. 1996. [Medline]. [Medline]. An infectious disease specialist may assist in differentiating leptospirosis from diseases with similar presentations but that may have significantly different treatments and in treating co-infections such as malaria, dengue, or others, depending on exposure history. 2007 May. phosphate binders. Adventure Racing and Leptospirosis. [Medline]. Lettieri C, Moon J, Hickey P, Gray M, Berg B, Hospenthal D. Prevalence of leptospira antibodies in U.S. Army blood bank donors in Hawaii. 1916. Risk factors associated with antibodies to leptospires in inner-city residents of Baltimore: a protective role for cats. Can We Confirm the Nocebo Effect of Statins and Muscle Pain? 1998 Jun. [Full Text]. Person DA. 39(4):1263-6. 54(9):1249-55. Outbreak of acute febrile illness and pulmonary hemorrhage--Nicaragua, 1995. Antimicrob Agents Chemother. What's Eating You: 12 Common Intestinal Parasites, Ebola Survivor May Have Started Latest Outbreak -- 5 Years Later, To Extract More Doses per Vial, Vaccinators Put Squeeze on FDA to Relax Vaccine Handling Advice, Fauci Worries About Possible Post-COVID 'Mental Health Pandemic', Five-Day Course of Oral Antiviral Appears to Stop SARS-CoV-2 in Its Tracks, CDC: Vaccinated People Can Gather Indoors Without Masks, Tropical Skin Conditions on the Rise, Difficult to Detect, High Temps May Up Risk of Deadly Tick-Borne Fever, Many Die From Snakebites Despite the Availability of Antivenom. Epidemiology and characterization of leptospirosis at an urban and provincial site in Thailand. Although transporting patients with severe disease to appropriate medical centers is preferred, military physicians who have treated patients from Western Pacific islands averted the need for transoceanic transport for dialysis by administering high-dose steroids. 274(21):1668. What is the treatment for leptospirosis? J Infect Dis. If you have a Best Practice personal account, your own subscription or have registered for a free trial, log in here: If your hospital, university, trust or other institution provides access to BMJ Best Practice through services such as OpenAthens or Shibboleth, log in via this button: If you have been provided an access code, you can register it here: For any urgent enquiries please contact our customer services team who are ready to help with any problems. US Department of Health and Human Services. 2001 Apr. [Medline]. How you get leptospirosis. [Medline]. [Medline]. Early initiation of hemodialysis or peritoneal dialysis considerably reduces mortality risk. Leptospirosis on Kauai: investigation of a common source waterborne outbreak. [Medline]. J Crit Care. [52, 53] This regimen is recommended for those with short-term exposure and is not for repeated or long-term exposure. Your feedback has been submitted successfully. 2018 May 14. 1996. [Medline]. CDC. Am J Public Health. Sandra G Gompf, MD, FACP, FIDSAProfessor of Infectious Disease and International Medicine, University of South Florida Morsani College of Medicine; Chief, Infectious Diseases Section, Director, Occupational Health and Infection Control Programs, James A Haley Veterans Hospital [Full Text]. Martin Hicklin). Antimicrobial therapy is indicated for the severe form of leptospirosis, but its use is controversial for the mild form of leptospirosis. Pedersen K, Anderson TD, Maison RM, Wiscomb GW, Pipas MJ, Sinnett DR, et al. Pac Health Dialog. Barkin RM, Guckian JC, Glosser JW. A Cochrane Review found insufficient evidence to advocate for or against the use of antibiotics in the therapy for leptospirosis. [50, 47] Patients with Weil syndrome may need transfusions of whole blood, platelets, or both. 2007 May. [Full Text]. 2001 Sep. 49:901-3. Everard CO, Bennett S, Edwards CN, Nicholson GD, Hassell TA, Carrington DG, et al. Delmas B, Jabot J, Chanareille P, Ferdynus C, Allyn J, Allou N, et al. [Medline]. [Medline]. 1992 Feb. 95(1):13-22. This review summarizes the most recent literature pertaining to the use of antimicrobial agents in the treatment of leptospirosis. For example, vaccines may be offered to high-risk workers in some European and Asian countries (eg, rice workers in Italy) but are not available to US short-term travelers to endemic areas. Mild leptospirosis is treated with doxycycline, ampicillin, or amoxicillin. Epidemic leptospirosis associated with pulmonary hemorrhage-Nicaragua, 1995. Am J Public Health. /viewarticle/914153 Efficacy Whether antimicrobials produce a beneficial effect in mild illness remains controversial [ 14-17 ]. For assistance with laboratory diagnosis, the Centers for Disease Control and Prevention (CDC) or the World Health Organization (WHO) can aid the clinician in obtaining samples and ordering tests. Your physician may recommend the following antibiotics to treat the mild symptoms of leptospirosis. Treatment and Prevention. Summary of notifiable diseases, United States 1995.