Most people are infected through contact with contaminated soil or water during outdoor activities.
Fever, headache, and other symptoms occur in two phases, separated by a few days.
A severe, potentially fatal form damages many organs, including the liver and kidneys.
Detecting antibodies against the bacteria in blood or identifying the bacteria in a sample taken from infected tissue confirms the diagnosis.
Infections are treated with antibiotics and, if severe, sometimes with fluids given intravenously and dialysis.
(See also Overview of Bacteria Overview of Bacteria Bacteria are microscopic, single-celled organisms. They are among the earliest known life forms on earth. There are thousands of different kinds of bacteria, and they live in every conceivable... read more .)
Leptospirosis occurs in many wild and domestic animals, including rats, mice, and dogs, and farm animals such as cattle, horses, sheep, goats, and pigs. Some animals act as carriers and pass the bacteria in their urine. Others become ill and die. People acquire these infections directly through contact with infected animals or indirectly through soil or water contaminated by urine from an infected animal.
Leptospirosis is an occupational disease of farmers and sewer and slaughterhouse workers. However, in the United States, most people become infected during outdoor activities when they come in contact with contaminated soil or fresh water, particularly while swimming or wading. Outside the United States, outbreaks have occurred after heavy rainfall or freshwater flooding. Leptospira can survive for several weeks to months in sources of fresh water (such as lakes and ponds). However, they can survive for only a few hours in salt water.
The 100 to 200 infections reported every year in the United States occur mainly in the late summer and early fall. Because mild leptospirosis typically causes vague, flu-like symptoms that go away on their own, many infections are probably unreported.
Symptoms of Leptospirosis
In about 90% of infected people, leptospirosis symptoms are not serious. In the rest, the disorder involves many organs. This potentially fatal form of leptospirosis is called Weil syndrome Weil syndrome Leptospirosis is a potentially serious infection caused by Leptospira, which are spiral-shaped bacteria called spirochetes. Most people are infected through contact with contaminated... read more .
Leptospirosis usually occurs in two phases:
First phase (septicemic phase): About 5 to 14 days after infection occurs, fever, headache, sore throat, severe muscle aches in the calves and back, and chills occur suddenly. The eyes usually become very red on the third or fourth day. Some people cough, occasionally bringing up blood, and have chest pain. Most people recover within about 1 week.
Second phase (immune phase): In some people, symptoms return a few days later. They result from inflammation caused by the immune system as it eliminates the bacteria from the body. The fever returns, and the tissues covering the brain and spinal cord (meninges) may become inflamed. This inflammation (meningitis Acute Bacterial Meningitis Acute bacterial meningitis is rapidly developing inflammation of the layers of tissue that cover the brain and spinal cord (meninges) and of the fluid-filled space between the meninges (subarachnoid... read more ) causes a stiff neck and headache. The lungs can be severely damaged.
If leptospirosis develops during pregnancy, the risk of miscarriage Miscarriage A miscarriage is the loss of a fetus before 20 weeks of pregnancy. Miscarriages may occur because of a problem in the fetus (such as a genetic disorder or birth defect) or in the woman (such... read more is increased.
Weil syndrome
Weil syndrome can occur during the second phase. It causes fever, jaundice Jaundice in Adults In jaundice, the skin and whites of the eyes look yellow. Jaundice occurs when there is too much bilirubin (a yellow pigment) in the blood—a condition called hyperbilirubinemia. (See also Overview... read more 
(yellowish discoloration of the skin and whites of the eyes that is caused by liver damage), kidney failure, and a tendency to bleed. People may have nosebleeds or cough up blood, or bleeding may occur within tissues in the skin, lungs, and, less commonly, digestive tract. Anemia can develop. Although the liver and kidneys are the organs most commonly affected, the lungs and heart may also be severely affected.
People who do not develop jaundice recover. About 5 to 10% of people with jaundice die, and this percentage is higher in those over age 60. Risk of death is higher if changes in mental function, kidney failure, respiratory failure, and internal bleeding occur.
Diagnosis of Leptospirosis
Culture of blood and urine samples or sometimes a sample of cerebrospinal fluid (obtained by spinal tap)
Blood tests for leptospirosis antibodies or genetic material
Doctors suspect leptospirosis when characteristic symptoms occur in people who have traveled to an area where an outbreak is occurring.
To confirm the diagnosis of leptospirosis, doctors take a sample of blood and urine. These samples are analyzed.
If people have symptoms of meningitis, doctors do a spinal tap Spinal Tap Diagnostic procedures may be needed to confirm a diagnosis suggested by the medical history and neurologic examination. Imaging tests commonly used to diagnose nervous system (neurologic) disorders... read more 
(lumbar puncture) to obtain a sample of the fluid that surrounds the brain and spinal cord (cerebrospinal fluid).
Usually, several samples are taken over several weeks. These samples are sent to a laboratory to grow (culture) the bacteria.
Identifying the bacteria in cultures or, more commonly, detecting antibodies against the bacteria in blood confirms the diagnosis. The polymerase chain reaction (PCR) technique Polymerase chain reaction (PCR) Genetic diagnostic technologies are scientific methods that are used to understand and evaluate an organism's genes. (See also Genes and Chromosomes.) Genes are segments of deoxyribonucleic... read more , which produces many copies of a gene, may be used. It helps doctors diagnose leptospirosis quickly.
Prevention of Leptospirosis
The antibiotic doxycycline can prevent leptospirosis. It is given by mouth once a week to people who are likely to be exposed to the bacteria—for example, people who live in or travel to an area where an outbreak of leptospirosis is occurring.
Treatment of Leptospirosis
Antibiotics
For Weil syndrome, possibly blood transfusions and hemodialysis
Mild infections are treated with antibiotics, such as amoxicillin, ampicillin, and doxycycline, given by mouth.
For severe infections, antibiotics such as penicillin, ampicillin, or ceftriaxone are given by vein (intravenously). Fluids containing salts may also be given.
People with severe infection (Weil syndrome) may need blood transfusions and, if they have kidney failure, they may need hemodialysis Hemodialysis Dialysis is an artificial process for removing waste products and excess fluids from the body, a process that is needed when the kidneys are not functioning properly. There are a number of reasons... read more 
.
People with the infection do not have to be isolated, but care must be taken when handling and disposing of their urine.
More Information
The following English-language resource may be useful. Please note that THE MANUAL is not responsible for the content of this resource.
Centers for Disease Control and Prevention (CDC): Leptospirosis: Comprehensive information about leptospirosis, including links for risk, prevention in people, and prevention in pets
Drugs Mentioned In This Article
| Generic Name | Select Brand Names |
|---|---|
doxycycline |
Acticlate, Adoxa, Adoxa Pak, Avidoxy, Doryx, Doxal, Doxy 100, LYMEPAK, Mondoxyne NL, Monodox, Morgidox 1x, Morgidox 2x , Okebo, Oracea, Oraxyl, Periostat, TARGADOX, Vibramycin, Vibra-Tabs |
amoxicillin |
Amoxil, Dispermox, Moxatag, Moxilin , Sumox, Trimox |
ampicillin |
Principen |
ceftriaxone |
Ceftrisol Plus, Rocephin |
