Leptospirosis history and symptoms

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Venkata Sivakrishna Kumar Pulivarthi M.B.B.S [2]

Overview

Clinical symptoms of leptospirosis are very wide, with mild anicteric presentation at one end to severe leptospirosis with severe jaundice and multiple organ involvement. Classic presentation of leptospirosis is a biphasic illness, and the onset of Symptoms within 2–30 days (incubation period) of exposure to the bacteria. Serious symptoms may manifest earlier on Days 4–6 of the illness depending on the type of pathogen and host immunological status.

Symptoms

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

Common Symtoms

• Fever
• Headache
• Myalgia
• Nausea & vomitings
• Jaundice
• Conjunctival suffusion a pathognomic of leptospirosis

Other Symptoms

• Chills
• Red eyes
• Abdominal pain
• Diarrhea
• Rash

Acute Phase

• Also known as Septicemic phase or leptospiremic phase.
• Begins abruptly
• Bacteria are present in the blood and CSF of the patient
• Characterized by wide spectrum of nonspecific signs and symptoms such as fever, chills, headache and conjunctival suffusion making it very difficult to diagnose.
• Associate with severe myalgia
• Other less common findings include: Photophobia, lymphadenopathy, abdominal pain, nausea, vomiting, a transient rash, sore throat, coughing or chest pain
• Characterestic of this phase also includes: Mild form of leptospirosis in ~90% cases which lasts several days to a week, followed by a brief remission, during which the temperature drops and the symptoms disappear

Immune phase

• It is also known as leptospiruric phase.
• Circulating (IgM) antibodies are produced and leptospires are present in the urine
• Characterestic findings that differentiate from other febrile illnesses are myalgia and conjunctival suffusion.
• Myalgia often involves in calf muscles, less commonly involves abdominal and para-spinal muscles.

Anicteric leptospirosis

• More common but serious illness is uncommon
• Most of cases present either subclinical or of very mild severity
• Few cases present with a febrile illness of sudden onset
• Other symptoms include chills, headache (severe with retro-orbital pain and photophobia), myalgia, abdominal pain, conjunctival suffusion, and skin rash (transient and last <24 hours)
• May progress to aseptic meningitis in ≤25% of patients and more common in younger age group than the patients with icteric leptospirosis
• Mortality is very less when compared to icteric leptospirosis

Icteric leptospirosis

• Rapidly progressive and severe form of leptospirosis(Weil's disease)
• In the severe form of leptospirosis renal failure, hepatic failure and pulmonary haemorrhage can occur and associate with Icterohaemorrhagiae.
• Less common form of leptospirosis with incidence of 5%-10%
• Jaundice is not associate with hepatocellular injury, eventually LFT returns to normal after recovery
• High mortality rate with a range of 5%-15%

Acute phase	Immune phase
Also known as Septicemic phase Begins abruptly Characterized by nonspecific signs such as fever, chills, headache and conjunctival suffusion Associate with severe myalgia Other less common findings include: Photophobia, lymphadenopathy, abdominal pain, nausea, vomiting, a transient rash, sore throat, coughing or chest pain Characterestic of this phase also includes: symptoms lasts several days to a week, which is followed by a brief remission, during which the temperature drops and the symptoms disappear	Anicteric leptospirosis	Icteric leptospirosis
	More common but serious illness is uncommon Most of cases present either subclinical or of very mild severity Few cases present with a febrile illness of sudden onset Other symptoms include chills, headache (severe with retro-orbital pain and photophobia), myalgia, abdominal pain, conjunctival suffusion, and skin rash (transient and last <24 hours) May progress to aseptic meningitis in ≤25% of patients and more common in younger age group than the patients with icteric leptospirosis Mortality is very less when compared to icteric leptospirosis	Rapidly progressive and severe form of leptospirosis Less common form of leptospirosis with incidence of 5%-10% Jaundice is not associate with hepatocellular injury, eventually LFT returns to normal after recovery High mortality rate with a range of 5%-15%