ID - Lepto Flashcards
How does leptospirosis present?
Initially non-specific symptoms of fever, lethargy and may get gastrointestinal upset.
Most infections are self resolving but a small percentage (10%) progress to disease which needs treatment and/or organ support.
Typically complications include:
- AKI
- hepatitis and jaundice
- pulmonary involvement/pulmonary haemorrhage/ARDS
- Weil’s disease (severe form)
Other complications include
- CNS - headaches, photophobia, meningitis
- GI - N&V, abdo pain, pancreatitis
What are your differentials of someone presenting with jaundice and AKI?
Divided into pre-existing liver disease and non-preexisting liver disease.
Pre-existing liver disease:
- HRS
- SBP
- Any cause of AKI on CLD: NSAIDs, loop diuretics, ACEi, steroids, UTI, sepsis
No pre-existing liver disease:
- Viral infection: EBV, CMV, viral hepatitides, HIV
- bacterial infection/sepsis
- Fungal infection with hepatic toxicity from antifungals
- Autoimmune hepatitis
- obstructive biliary disease
- Extra luminal IBD complications
- Pregnancy
- vasculitis
What is the recommended management for leptospirosis in critical care?
- Resuscitate ABCDE approach, correcting abnormalities as they are found
- Supportive care: Fluid resuscitation, renal support, ventilatory support.
- Send microbiological cultures, urine, blood, sputum +/- CSF
- IgM antibodies (present from day 7-10)
- Antibiotics once confirmed:
i) IV Penicillin G (oral doxycycline may be used in milder disease
ii) Amoxicillin and azithromycin used in pregnancy.
iii) Often 3rd gen cephalosporins (ceftriaxone) used in ITU
Watch for Jarisch-Herxheimer reaction (worsening of fever, chills, muscle pains and headache)
What details from a patients history might make you suspicious that a patient has leptospirosis?
- returning traveller from developing countries with high rainfall, poor sanitation, staying in rural tropical areas
- interaction with rodents or rodent infected water
