History and exam
Key diagnostic factors
common
presence of risk factors
Key risk factors include contact (direct or indirect) with urine of infected animals, residence in or travel to endemic area (tropical regions during the rainy season and during late summer in temperate regions) or area recently affected by natural disaster (e.g., flooding), and involvement in water sports.
headache
Present during acute/initial phase.
myalgia
Present in lower extremities, most likely in calf muscles, pathognomonic of leptospirosis.
Present during acute/initial phase.
conjunctival suffusion
Bilateral, pathognomonic of leptospirosis.
Present during acute/initial and immune phases.
muscle tenderness
Localised in the calves and possibly in the paraspinal muscles.
Present during acute/initial and immune phases.
Other diagnostic factors
common
chills or rigors
Present during acute/initial phase.
abdominal pain
Present during acute/initial phase.
nausea or vomiting
Present during acute/initial phase.
diarrhoea
Present during acute/initial phase.
asthaenia
Present during acute/initial phase.
anorexia
Present during acute/initial phase.
photophobia
Present during acute/initial and immune phases.
eye pain
Present during acute/initial and immune phases.
neck stiffness
Sign of aseptic meningitis.
Present during immune phase.
uncommon
cough
Pulmonary symptom present during immune phase.
dyspnoea
Pulmonary symptom present during immune phase.
chest pain
Pulmonary symptom present during immune phase.
haemoptysis
Pulmonary symptom present during immune phase.
oliguria or polyuria
Acute renal failure presenting with polyuria and hypokalaemia is commonly observed in severe cases during the immune phase.
The presence of oliguria represents a poor prognostic factor.
cardiac arrhythmias
Present during immune phase.
lymphadenopathy
Present during acute/initial phase.
splenomegaly
Present during acute/initial and immune phases.
hepatomegaly
Present during acute/initial and immune phases.
jaundice
Present during immune phase.
adenopathy
Present during acute/initial and immune phases.
mental status changes
Can include confusion, hallucinations, aggressive behaviour, and delirium.
Present during immune phase, but occurs rarely.
morbilliform rash
Non-pruritic rash lasting 1 or 2 days.
Present during acute/initial phase, but occurs rarely.
Risk factors
strong
contact (direct or indirect) with urine of infected animals
Leptospira are maintained in nature by chronic renal infection in carrier animals. The animal reservoirs that are likely to account for the majority of leptospirosis are rats, cattle, dogs, and other peridomestic small mammals.[27] Once infected, these animals will excrete leptospires in their urine for the remainder of their lives.
Groups at high risk for infection include rural subsistence farmers, urban slum dwellers, veterinarians and animal handlers, military personnel, and miners.[21][27] Indirect contact with urine occurs as a result of exposure to water and soil that is contaminated with leptospires.[2]
residence in or travel to an endemic area
Leptospirosis has been identified in both rural and urban areas worldwide; however, the highest incidence of infection has been documented in tropical regions during the rainy season and during late summer in temperate regions.[1][7] In the US, about 50% of reported cases are in Puerto Rico, with the second highest incidence in Hawaii.[22]Leptospira can survive for weeks or months in a warm and humid environment, particularly in water and wet soil.[2][7] Travellers represent a growing population at risk.[32]
residence in or travel to an area with recent flooding
involvement in water sports
poor living conditions/lack of sanitation
Poor living conditions including dirt floors, proximity to sewage and open sewers, and lack of sanitation may increase the risk of infection.[36]
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