Leptospirosis history and symptoms: Difference between revisions

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Revision as of 18:58, 9 March 2017

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.^[1]

Symptoms

In humans, Leptospirosis can cause a wide range of symptoms, including:^[2]^[3]

Common Symtoms

Fever: Moderate to severe fever with chills.
Myalgia: Characterestic of leptospirosis due to involvement of calf, abdominal & lumbosacral muscles.
Red eyes
Headache: usually throbbing or retro-orbital headache not relieved by analgesics
Cough & chest pain seen in patients involving lungs
Nausea and vomiting
Jaundice

Other Symptoms

Clinical Presentation


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.	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.^[4] Myalgia often involves in calf muscles, less commonly involves abdominal and paraspinal muscles.
	Anicteric leptospirosis	Icteric leptospirosis	Severe 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%.	Sever form of leptospirosis with organ failure including liver and kidney involvement is known as Weil's disease. Hepatic: Mild to severe form of jaundice developed within 4-7 days after the initial clinical presentation that can progress to hepatic failure or hepatic encephalopathy. Renal: Very common presentation involving kidneys is acute interstitial nephritis, with cola colored urine, oliguria or anuria. Pulmonary: Milder form of leptospirosis presents with cough, chest pain and blood tinged sputum, where as in severe form present with cough, hemoptysis, rapidly increasing breathlessness which may lead to respiratory failure and death. Hemorrhagic pneumonitis with interstitial and intra alveolar hemorrhage is the commonest cause of death in leptospirosis with case fatality rate of 0%-15%. Cardiovascualar: Arrhythmias present with syncope and palpitations. Nervous system: Meningitis, encephalitis, focal defecits, spasticity, paralysis, peripheral neuropathies, nerve palsies and radiculopathies.

References

↑ Faine, S (1982). Guidelines for the control of leptospirosis. Geneva Albany, N.Y: World Health Organization Obtainable from WHO Publication Centre USA. ISBN 924170067X.
↑ Heath CW, Alexander AD, Galton MM (1965). "Leptospirosis in the United States. Analysis of 483 cases in man, 1949, 1961". N Engl J Med. 273 (17): 915-22 concl. doi:10.1056/NEJM196510212731706. PMID 5319290.
↑ Perrocheau A, Perolat P (1997). "Epidemiology of leptospirosis in New Caledonia (South Pacific): a one-year survey". Eur J Epidemiol. 13 (2): 161–7. PMID 9084999.
↑ Forbes AE, Zochowski WJ, Dubrey SW, Sivaprakasam V (2012). "Leptospirosis and Weil's disease in the UK". QJM. 105 (12): 1151–62. doi:10.1093/qjmed/hcs145. PMID 22843698.

[1] Faine, S (1982). Guidelines for the control of leptospirosis. Geneva Albany, N.Y: World Health Organization Obtainable from WHO Publication Centre USA. ISBN 924170067X.

[pmid5319290-2] Heath CW, Alexander AD, Galton MM (1965). "Leptospirosis in the United States. Analysis of 483 cases in man, 1949, 1961". N Engl J Med. 273 (17): 915-22 concl. doi:10.1056/NEJM196510212731706. PMID 5319290.

[pmid9084999-3] Perrocheau A, Perolat P (1997). "Epidemiology of leptospirosis in New Caledonia (South Pacific): a one-year survey". Eur J Epidemiol. 13 (2): 161–7. PMID 9084999.

[pmid22843698-4] Forbes AE, Zochowski WJ, Dubrey SW, Sivaprakasam V (2012). "Leptospirosis and Weil's disease in the UK". QJM. 105 (12): 1151–62. doi:10.1093/qjmed/hcs145. PMID 22843698.

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@@ Line 22: / Line 22: @@
 == Clinical Presentation ==
-===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.<ref name="pmid16333189">{{cite journal| author=Bal AM| title=Unusual clinical manifestations of leptospirosis. | journal=J Postgrad Med | year= 2005 | volume= 51 | issue= 3 | pages= 179-83 | pmid=16333189 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16333189  }} </ref>
-* Associated 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.<ref name="pmid22843698">{{cite journal| author=Forbes AE, Zochowski WJ, Dubrey SW, Sivaprakasam V| title=Leptospirosis and Weil's disease in the UK. | journal=QJM | year= 2012 | volume= 105 | issue= 12 | pages= 1151-62 | pmid=22843698 | doi=10.1093/qjmed/hcs145 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22843698  }} </ref>
-* Myalgia often involves in [[Calf muscle|calf]] muscles, less commonly involves abdominal and paraspinal 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.
-* 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.<ref name="pmid11692294">{{cite journal| author=Katz AR, Ansdell VE, Effler PV, Middleton CR, Sasaki DM| title=Assessment of the clinical presentation and treatment of 353 cases of laboratory-confirmed leptospirosis in Hawaii, 1974-1998. | journal=Clin Infect Dis | year= 2001 | volume= 33 | issue= 11 | pages= 1834-41 | pmid=11692294 | doi=10.1086/324084 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11692294  }} </ref>
-* Less common form of leptospirosis with incidence of 5%-10%.
-* Jaundice is not associate with hepatocellular injury, eventually [[Liver function tests|LFT]] returns to normal after recovery.
-* High mortality rate with a range of 5%-15%.
-==== Severe leptospirosis ====
-Sever form of leptospirosis with organ failure including  [[liver]] and [[kidney]] involvement  is known as [[Weil's disease]].
-* [[Hepatic]]: Mild to severe form of [[jaundice]] developed within 4-7 days after the initial clinical presentation that can progress to [[hepatic failure]] or [[hepatic encephalopathy]].
-* [[Renal]]: Very common presentation involving [[kidneys]] is [[acute interstitial nephritis]], with cola colored urine, [[oliguria]] or [[anuria]].
-* [[Pulmonary]]:  Milder form of leptospirosis presents with [[cough]], [[chest pain]] and blood tinged sputum, where as in severe form present with [[cough]], [[hemoptysis]], rapidly increasing [[breathlessness]] which may lead to [[respiratory failure]] and death. Hemorrhagic [[pneumonitis]] with [[interstitial]] and intra alveolar [[hemorrhage]] is the commonest cause of death in leptospirosis with case fatality rate of 0%-15%.
-* Cardiovascualar: [[Arrhythmias]] present with [[syncope]] and [[palpitations]].
-* [[Nervous system]]: [[Meningitis]],  [[encephalitis]], focal defecits, spasticity, paralysis, peripheral neuropathies, nerve palsies and radiculopathies.
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