Leptospirosis is a bacterial disease that affects humans and animals. It is caused by bacteria of the genusLeptospira.

In humans, it can cause a wide range of symptoms, some of which may be mistaken for other diseases. Some infected persons, however, may have no symptoms at all. Without treatment, Leptospirosis can lead to kidney damage, meningitis (inflammation of the membrane around the brain and spinal cord), liver failure, respiratory distress, and even death. The bacteria that cause leptospirosis are spread through the urine of infected animals, which can get into water or soil and can survive there for weeks to months. Many different kinds of wild and domestic animals carry the bacterium. These can include, but are not limited to:

Cattle Pigs Horses Dogs Rodents Wild animals

When these animals are infected, they may have no symptoms of the disease. Infected animals may continue to excrete the bacteria into the environment continuously or every once in a while for a few months up to several years. Humans can become infected through:

contact with urine (or other body fluids, except saliva) from infected animals contact with water, soil, or food contaminated with the urine of infected animals.

The bacteria can enter the body through skin or mucous membranes (eyes, nose, or mouth), especially if the skin is broken from a cut or scratch. Drinking contaminated water can also cause infection. Outbreaks of leptospirosis are usually caused by exposure to contaminated water, such as floodwaters. Person to person transmission is rare.

Signs and Symptoms

In humans, Leptospirosis can cause a wide range of symptoms, including:

High fever Headache Chills Muscle aches

Vomiting Jaundice (yellow skin and eyes) Red eyes Abdominal Pain Diarrhea Rash

Many of these symptoms can be mistaken for other diseases. In addition, some infected persons may have no symptoms at all. The time between a person's exposure to a contaminated source and becoming sick is 2 days to 4 weeks. Illness usually begins abruptly with fever and other symptoms. Leptospirosis may occur in two phases:

after the first phase (with fever, chills, headache, muscle aches, vomiting, or diarrhea) the patient may recover for a time but become ill again. if a second phase occurs, it is more severe; the person may have kidney or liver failure or meningitis. This phase is also called Weil's disease.

The illness lasts from a few days to 3 weeks or longer. Without treatment, recovery may take several months. Leptospirosis occurs worldwide, but is most common in temperate or tropical climates. It is an occupational hazard for many people who work outdoors or with animals, such as:

farmers mine workers sewer workers slaughterhouse workers veterinarians and animal caretakers fish workers dairy farmers military personnel

The disease has also been associated with swimming, wading, kayaking, and rafting in contaminated lakes and rivers. As such, it is a recreational hazard for campers or those who participate in outdoor sports. The risk is likely greater for those who participate in these activities in tropical or temperate climates. In addition, incidence of Leptospirosis infection among urban children appears to be increasing.

Treatment
Leptospirosis is treated with antibiotics, such as doxycycline or penicillin, which should be given early in the course of the disease. Intravenous antibiotics may be required for persons with more severe symptoms. Persons with symptoms suggestive of leptospirosis should contact a health care provider.

Prevention
The risk of acquiring leptospirosis can be greatly reduced by not swimming or wading in water that might be contaminated with animal urine, or eliminating contact with potentially infected animals. Protective clothing or footwear should be worn by those exposed to contaminated water or soil because of their job or recreational activities.

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Technical Information
Clinical Features
Symptoms include fever, headache, chills, muscle aches, vomiting, jaundice, anemia, and sometimes a rash. The incubation period is usually 7 days, with a range of 2-29 days. If not treated, the patient could develop kidney damage, meningitis, liver failure, and respiratory distress. In rare cases, death occurs.

Etiologic Agent
Leptospires are long, thin, motile spirochetes. They may be free-living or associated with animal hosts and survive well in fresh water, soil, and mud in tropical areas. Organisms are antigenically complex, with over 200 known pathogenic serologic variants. Although certain geographic regions contain specific leptospiral serovars and species, the serologic characterization of an isolate is not an absolute predictor of its species designation.

Sequelae
Clinical course is highly variable. The serious icteric form (Weil's disease) is not common, but hemorrhage, hepatomegaly, pulmonary hemorrhage, ARDS, and jaundice are among the severe features. Case fatality rate is 1 to 5%.

Surveillance
Despite not being a reportable disease, leptospirosis has been reported in numerous states. To better identify leptospirosis in high-risk areas, active surveillance will be necessary.

Incidence and Trends

It is estimated that 100-200 Leptospirosis cases are identified annually in the United States. About 50% of cases occur in Hawaii. The largest recorded U.S. outbreak occurred in 1998, when 775 people were exposed to the disease. Of these, 110 became infected. Although incidence in the United States is relatively low, leptospirosis is considered to be the most widespread zoonotic disease in the world. Significant increases in incidence have been reported from Peru and Ecuador following heavy rainfall and flooding in the spring of 1998. Thailand has also reported a rapid increase in incidence between 1995 and 2000.

The incubation period of Leptospirosis is anything between two to 20 days (with a range of 10 days). The time between a persons exposure to a contaminated source and becoming sick is two days to four weeks. Illness usually begins abruptly with fever and other symptoms. Leptospirosis may occur in two phases, after the first phase, with fever, chills, headache, muscle aches, vomiting or diarrhea, the patient may recover for a time but become ill again. If a second phase occurs, it is more severe, the person may have kidney or liver failure or meningitis. The illness lasts from a few days to three weeks or longer. Without treatment, recovery may take several months.

Leptospirosis may follow a biphasic course

Septicemic phase (with a duration of 4 to 7 days): Linterrogans dissemination in blood, cerebrospinal fluid (CSF) and most tissues. Clinically, its characterized by extensive vasculitis. Immune phase (with a duration of 10 to 30 days): The leptospira disappear from the blood and CSF, remaining intermittently in the urine and aqueous humor. Clinically, its characterized by multisystemic manifestations.

There are two types of infections which can occur:

Anicteric Leptospirosis (90% of cases) A) Septic phase (3 to 7 days) Abrupt onset with high fever and chills. Muscle aches, commonly involving muscles of the calf. Headache (associated with retrobulbar pain). Abdominal pain. Nausea. Vomiting. Diarrhea. B) Immune phase (0 to 30 days) may or may not occur Aseptic meningitis Conjunctival hemorrhage is a very common cause of a bloody, non painful eye. In a subconjunctival hemorrhage, a small blood vessel breaks in the sclera, the white of the eye. The hemorrhage looks frightening, but is not dangerous in the least. This type of condition causes no change in vision and is not associated with discharge. The redness of the hemorrhage will usually resolve over several weeks. Rash. Cough. Bloodstained sputum. Pulmonary infiltrates. Acalculous cholecystitis (common in children) gall bladder wall thickening. Icteric Leptospiroses (5 to 10% of cases) A) Septic phase (3 to 7 days) Symptoms similar to anicteric form. B) Immune phase (7 to 30) Reddish jaundice (jaundice + conjunctival + cutaneous vasculites). Renal failure. Increase serum creatinine, with normal or decreased levels of serum potassium. Hemorrhagic manifestations: gastrointestinal and pulmonary hemorrhage. Myocarditis inflammation or degeneration of the heart muscle.

Pulmonary involvement. Hepatomegaly liver enlargement.

Leptospirosis: Diagnostic Tests

The list of diagnostic tests mentioned in various sources as used in the diagnosis ofLeptospirosis includes: Blood culture Urine culture CSF culture

Mode of Transmission of Leptospirosis

It can be transmitted by: Contact of skin, especially if abraded, or of mucous membranes with water, moist soil or vegetation contaminated with urine of infected animals. Direct contact with urine or tissues of infected animals. Inhalation of droplet, aerosols of contaminated urine.