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Leptospirosis

Alternative Names: Weil disease; Icterohemorrhagic fever; Swineherd's disease; Rice-field fever; Cane-cutter fever; Swamp fever; Mud fever; Hemorrhagic jaundice; Stuttgart disease; Canicola fever Symptoms: Incubation period of 2 to 26 days (average 10 days) Abrupt onset of fever, rigors, myalgias, and headache in 75 to 100% of patients Dry cough (25-35% of cases) Nausea, vomiting, and diarrhea (50% of cases) Less common symptoms include joint aches, bone pain, sore throat, and abdominal pain Conjunctivitis Approximately 7 to 40% of patients may have muscle tenderness, an enlarged spleen or liver, enlarged lymph glands, sore throat, muscle rigidity, abnormal lung sounds, or skin rash Signs and tests: White blood cell (WBC) counts are generally less than 10,000. Urinalysis frequently is abnormal. Elevated creatine kinase is found in approximately 50% of patients. About 40% of patients have minimal to moderate elevations of liver enzymes. Diagnosis is most frequently made by serologic (antibody) testing. Bacteria is best visualized by dark field microscopy, silver stain, or fluorescent microscopy. Unlike Treponema pallidum, Leptospira can be grown from blood, urine, and CSF. It is slow growing and the laboratory needs to be notified. Isolation of the organism from the blood is successful in 50% of cases. Urine cultures become positive during the second week of the illness and remain so for up to 30 days.

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