Manag ement of Human Leptospirosis

Dr. Georgy K. Nainan DM FISN,

Organising Secretary, LeptoCON 2009

Leptospirosis a zoonotic disease had been on the increase for the last decade. This affects males, predominantly 20-40 age, more from the lower socioeconomic status with history of exposure to environment harboring leptospirae. From the clinical point of view it is important to differentiate leptospirosis from other febrile conditions, identify who will develop Multi Organ Dysfunction (MOD) and will progress into Multi Organ Failure (MOF). Viral fever is the commonest cause of fever and may mimic leptospirosis (lepto syndrome). Renal parenchymal involvement is more characteristic of lepto and Hanta virus infections. Main differential diagnosis in a patient with fever, thrombocytopenia, jaundice and urinary abnormalities will be enteric, malaria, other viral infections and septicemia. There are detectable and treatable conditions. Viral fever usually doesn’t produce significant liver and hepatic dysfunction. Some of the simple lab tests which may favour leptospirosis are severe thrombocytopenia (<30000) raised CPK more

than 600 (2 fold), liver transaminases increase less than fourfold, presence of urinary abnormalities like albuminuria, microhaematuria and leukocyturia. These are not confirmatory. High titre of IgM Elisa for Lepto Antibody or rise in titre is the commonly used test to support Human Leptospirosis.

 

Complications: Acute Renal Failure – oliguric & non oliguric;

 

Thrombocytopenia; Makedly raised CPK (Rhabdomyolysis); Hepatitis / Congestion; Encephalopathy – encephalitis / + metabolic encephalopathy; Haemorrhagic Alveolitis / Pneumonitis / ARDS; Myocarditis, Pancreatitis / Cholecystitis / Uveitis; Systemic Inflammatory Response Syndrome (SIRS)-

Capillary Leak; Refractory Hypotension.

 

TREATMENT - A variety of antimicrobial agents including pencillin, (antibiotic of choice), ampicilline doxycyclin, 3rd / 4th generation cephalosporins and quinalones are found to be affective both in vivo and invitro studies. Early antibiotic therapy has been shown to shorten the duration of illness. Simple analgesics, anti pyretics like acetaminophen, tepid spenging etc., are adequate for the myalgia and fever. NSAIDs are best avoided due to potential nephrotoxicity. Patients who have clinical suspecion based on the symptoms and with the lab parameters pointing to leptospirosis should be treated at the earliest. with 200 mgs of doxycyclin daily x 7 days. Once patient gets signs of organ dysfunction they should be admitted and treated with inj. Crystalline pencilline. Recommended dose is 15 lakhs 6 hourly IV after test dose. Quinolones and 3rd and 4th generation of cephaloporins have been clinically claimed to be beneficial and used to treat possible primary infective cause and to prevent secondary hospital acquired infections till culture and sensitivity results are available for guidance. With aggressive treatment mortality in Leptospirosis has come down.