Leptospirosis A27.9

Landouzy, 1883; Mathieu, 1886; Weil, 1886

Acute, febrile, phased leptospirosis. Duty to report in case of proven illness! S.a.u. Infection Protection Act.

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

Worldwide, in Europe especially in Central and Eastern Europe. Incidence (Federal Republic of Germany): 20-50 diseases/year (higher estimated number of unreported cases).

The carriers of leptospires are rats, mice, dogs, pigs, horses and cattle. Inoculation mainly via pre-damaged skin. Transmission is also described by contaminated fruit, soil (urine of infected animals) or contact with contaminated waters (diving, swimming, canoeing).

Incubation period 7-14 days. Then sudden onset of headache and limb pain (often calf pain, myalgia), conjunctivitis (typical, meningismus and fleeting exanthema. Strong feeling of illness, fever and drowsiness for 5-10 days. After short-term defibrillation, organ manifestations with renewed fever, leptospiruria (> 90% of patients), jaundice , haemorrhagic diathesis, anaemia, involvement of internal organs, meningitis.

Significantly more frequently than the severely pronounced symptoms, anikteric, mostly benign courses of disease were described. Serous meningitis (30-40% of patients) is often the main symptom. Patients with uncomplicated courses of the disease develop fever after 7-10 days.

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

Untreated, the symptoms of the disease can last 3-4 weeks, but convalescence often lasts several months.

More than 80% of patients have leptospiruria! Pathogen detection in blood and cerebrospinal fluid (1st week), in urine (2nd week); IgM antibody detection (possible from about the 10th day of illness, e.g. with ELISA) or IgG antibody detection (≥ fourfold increase in titer in two samples).

Hepatorenal failure, ARDS, arrhythmia.

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.

Fatalities 10-40% (especially in older people), type-specific immunity after infection.

Active vaccination with killed pathogens in persons in endemic areas. For short-term stays in endemic areas chemoprophylaxis with doxycycline (e.g. supracycline) 2 times/day 100 mg p.o.

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