Nejm 1984;310:524

Cause:Leptospira sp.(many)

Pathophys:Biphasic illness; Weil's disease is the 2nd, immune phase with rash, hepatitis, renal failure, myocarditis, uveitis

Usually in young adults in warm seasons, from contact with or ingestion of water contaminated with animal urine or directly with the animals themselves: dogs, rats (causing urban epidemic foci—Ann IM 1996;125:794), cattle, pigs, frogs, squirrels, other wild animals, etc; worldwide

Sx: 2- to 26-d incubation period (average = 10 d); abrupt onset of “flu syndrome”; malaise; headache often severe; fever; nausea, vomiting, diarrhea (50%); dry cough; jaundice, though not always clinical

Si:Icterus, fever, purpura and other rashes, tender organomegaly, conjunctivitis, severe muscle tenderness; r/o dengue, adenovirus, toxic shock, rubella, rubeola, Kawasaki’s

2-5% mortality without rx, rest eventually resolve

Weil's disease or syndrome: elevated bilirubin and BUN, anemia, uveitis, hemorrhages, aseptic meningitis with mental status changes

Myocarditis, renal failure, hepatic failure, meningitis

Lab:

Bact:Culture of urine up to 6-8 wk after onset, or acute CSF or blood on special media from CDC at 30°C × 6 wk; or guinea pig (not rodent) injection causes icterus in 3-12 d

Chem:CPK, bilirubin, BUN (25%), LFTs all increased

CSF:Aseptic meningitis pattern

Hem:ESR low, r/o brucellosis, trichinosis, psittacosis (Petersdorf 1971), CHF

Serol:Agglutinin titer >1/25

Urine:Rbc's

Rx:

Prevent w doxycyline 100 mg po bid × 1 wk (Ann IM 1984;100:696; Nejm 1984;310:497) if likely exposed

of disease (Lancet 1988;1:433): 1st tetracycline 2-4 gm qd, or doxycycline as above; 2nd, penicillin