Leptospirosis A27.9

Acute, febrile, phasic spirochete infection (leptospirosis). Obligation to notify in case of proven disease! S.a.u. Infection Protection Act.

Miscellaneous leptospires. All pathogenic leptospires are grouped under the name Leptospira interrogans with different subtypes (2000 serotypes, 23 serovars). Severe forms of leptospirosis are usually caused by Leptospira icterohaemorrhagica.

incubation period 2-30 days.

Then sudden onset of headache and limb pain (often calf pain, myalgias), conjunctivitis (typical, meningismus and fleeting exanthema.

Severe feeling of illness, high fever and drowsiness for 5-10 days. After a short period of fever relief, organ manifestations with renewed fever, leptospiruria (> 90% of patients), jaundice , haemorrhagic diathesis, anaemia, internal organ involvement, meningitis.

Anicteric, mostly benign courses of the disease have been described much more frequently than the severe symptoms. In this case, serous meningitis (30-40% of patients) is often in the foreground. In uncomplicated cases, the patients develop fever after 7-10 days.

Severe courses with high mortality occur mainly in people over 50 years of age.

If untreated, the symptoms of the disease can last 3-4 weeks, but convalescence often takes several months.

Severe cases: Early antibiotic therapy with penicillin G in high dosage (starting within the first 48 hours). Thereafter, manifestation of leptospires in the internal organs without access to therapy. Penicillin G/ Benzylpenicillin: 10-20 million IU/day i.v. over 7-14 days. Cave! Risk of Herxheimer's reaction. Prophylaxis of the Herxheimer's reaction with prednisolone 40-60 mg/day for 10-14 days, gradual dosing.

Lighter cases: Tetracyclines (e.g. Achromycin) (only bacteriostatic effect): Adults 3-4 times/day 0.5-1.0 g p.o. Cave! Already existing liver or kidney damage is considered as contraindication.

In case of organ manifestations try haemodialysis.

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