10/28/2015

LeptospirosisTreatment&Management:ApproachConsiderations,DietandActivity,Transfer

LeptospirosisTreatment&Management
Author:SandraGGompf,MD,FACP,FIDSAChiefEditor:MichaelStuartBronze,MDmore...
Updated:Apr14,2015

ApproachConsiderations
Antimicrobialtherapyisindicatedforthesevereformofleptospirosis,butitsuseis
controversialforthemildformofleptospirosis.ACochraneReviewfound
insufficientevidencetoadvocatefororagainsttheuseofantibioticsinthetherapy
forleptospirosis. [42]
Ifantibioticsareused,theyshouldbeinitiatedassoonasthediagnosisof
leptospirosisisconsideredandshouldbecontinuedforafullcoursedespiteinitial
serologicresults,becausemostpatientsarediagnosedonlythroughacuteand
convalescenttesting.Earlytreatmenthasbeenshowntoofferthebestclinical
outcomesresultsfromcontrolledstudiesoftreatmentduringtheimmunephase
haveyieldedmixedresults. [43,44]
Mildleptospirosisistreatedwithdoxycycline,ampicillin,oramoxicillin.Forsevere
leptospirosis,intravenouspenicillinGhaslongbeenthedrugofchoice,although
thethirdgenerationcephalosporinscefotaximeandceftriaxonehavebecomewidely
used.Alternativeregimensareampicillin,amoxicillin,orerythromycin.Severalother
antibioticsmaybeusefulforexample,brothmicrodilutiontestinghasshown
sensitivitytomacrolides,fluoroquinolones,andcarbapenems[45]butclinical
experiencewiththeseagentsismorelimited.
Severecasesofleptospirosiscanaffectanyorgansystemandcanleadto
multiorganfailure.Supportivetherapyandcarefulmanagementofrenal,hepatic,
hematologic,andcentralnervoussystemcomplicationsareimportant.
Patientsshouldbemanagedinamonitoredsettingbecausetheirconditioncan
rapidlyprogresstocardiovascularcollapseandshock.Accesstomechanical
ventilationandairwayprotectionshouldbeavailableintheeventofrespiratory
compromise.Continuouscardiacmonitoringshouldbeattainedarrhythmias,
includingventriculartachycardiaandprematureventricularcontractions,aswellas
atrialfibrillation,flutter,andtachycardia,canoccur.
Renalfunctionshouldbeevaluatedcarefullyanddialysisconsideredincasesof
renalfailure.Inmostcases,therenaldamageisreversibleifthepatientsurvives
theacuteillness.Afewcasesintheliteraturehavereportedthatplasmaexchange,
corticosteroids,andintravenousimmunoglobulinmaybebeneficialinselected
patientsinwhomconventionaltherapydoesnotelicitaresponse. [46,47,48]
Corticosteroidtherapywithhighdosepulsedmethylprednisolone(30mg/kg/d,notto
exceed1500mghasbeenusedsuccessfullytotreatpatientswithleptospiralrenal
failurewithoutdialysis.Thisapproachmayhaveanimportantroleinareasofthe
worldwithlimitedresourceswheredialysistreatmentisunavailableandwould
involvelengthymedicaltransport.Theuseofrenaldosedopamineinconjunction
withsteroidsordiureticshasalsobeendescribed. [23]
Pulsedosesteroidsmayalsoplayaroleinthemanagementofseverepulmonary
disease. [49,47]PatientswithWeilsyndromemayneedtransfusionsofwholeblood,
platelets,orboth.Ophthalmicdropsofmydriaticsandcorticosteroidshavebeen
usedforreliefofocularsymptoms. [50]
Patientswithseverediseaseshouldremainhospitalizeduntiladequateresolutionof
organfailureandclinicalinfection.Outpatientfollowupmayincludeanassessment
ofrenalfunctiontoensureongoingreversalofanydamage.Acardiacassessment
maybeindicatedinpatientswithsymptomssuggestiveofheartinvolvement.

DietandActivity
Inmildcases,patientsshouldbeencouragedtomaintainadequatefluidintaketo
avoidvolumedepletion.Inmoreseverecases,dietsappropriatefortheclinical
pictureshouldbeordered(eg,electrolyteandproteinrestrictionincasesofrenal
insufficiency).Patientswithhypotensionorclinicalshockshouldnotbefedenterally
untiladequateperfusionisrestored.
Patientswithseverediseaseshouldbeplacedonbedrestuntiladequately
resuscitatedandtreated.Thosewithmilddiseasecanpursueactivityastolerated.

Transfer
Transfertoafacilitywithanappropriatelevelofcareshouldbeconsideredin
patientswithseveredisease.Leptospirosishasaregionalepidemiologywithhigh
incidenceofcasesinremoteregionsthatofferlimitedmedicalcare.Although
transportingpatientswithseverediseasetoappropriatemedicalcentersis
preferred,militaryphysicianswhohavetreatedpatientsfromWesternPacific
islandsavertedtheneedfortransoceanictransportfordialysisbyadministering
highdosesteroids. [38,37]

Consultations
Inseverecasesofleptospirosis,severalspecialtyconsultationsmayaidinproper
patientmanagement.Aninfectiousdiseasespecialistmayassistindifferentiating

http://emedicine.medscape.com/article/220563treatment

1/6

10/28/2015

LeptospirosisTreatment&Management:ApproachConsiderations,DietandActivity,Transfer

leptospirosisfromdiseaseswithsimilarpresentationsbutthatmayhavesignificantly
differenttreatments.Anephrologistshouldbealertedearlyinthecoursebecause
theneedfordialysismaydeveloprapidly.Ifavailable,criticalcarespecialistsmay
bebestpreparedtomanagepatientswithaffectedmultiplesystems.
Forassistancewithlaboratorydiagnosis,theCentersforDiseaseControland
Prevention(CDC)ortheWorldHealthOrganization(WHO)canaidtheclinicianin
obtainingsamplesandorderingtests.

Deterrence/Prevention
Preventionofleptospirosisisdifficultbecausetheorganismhasnotbeeneradicated
fromwildanimals,whichconstantlyinfectdomesticanimals.Importantcontrol
measuresincludecontroloflivestockinfectionwithgoodsanitation,immunization,
andproperveterinarycare.
Preventinginfectedanimalsfromurinatinginwaterswherehumanshavecontact,
disinfectingcontaminatedworkareas,providingworkereducation,practicinggood
personalhygiene,andusingpersonalprotectiveequipment(PPE)whenhandling
infectedanimalsortissuesareimportantactionsforpreventionofthedisease.
ExamplesofPPEincludeglovesandfaceshieldsforveterinariansandrubberboots
forsewerworkersandagriculturalworkerswhowadeinrodenturinecontaminated
water.
Publichealthmeasuresincludeinvestigationofcasesinanefforttodetectcommon
sourceoutbreaksandimplementationofappropriatecontrolmeasurestoprevent
furthercases.Otherpublichealthmeasuresincludeidentificationofcontaminated
watersupplies,rodentcontrol,prohibitionofswimminginstreamswhereriskof
infectionmaybehigh,andinformingpeopleofriskwhentheyareinvolvedin
recreationalactivities.
VaccinesareofferedtohighriskworkersinsomeEuropeanandAsiancountries
(eg,riceworkersinItaly).Humanvaccinesareserovarspecificandmustbe
repeatedyearly.Theyareassociatedwithpainfulswelling,especiallyafter
revaccination.VaccinesarenotusedintheUnitedStates.
However,renalinfectionandpersistentleptospiruriacanoccurinimmunizeddogs.
Humaninfectionhasoccurredfromasymptomaticimmunizeddogsthatstillshed
leptospiresintheirurine.Also,theseanimalvaccinesareserovarspecificandthus
areusefulonlywhereoneorafewserovarsarepresent.Hence,thevaccinegiven
shouldcontaintheserovarsknowntobeprevalentinthearea.
Doxycycline,inthedoseof200mgeveryweek,hasdemonstratedefficacyof95%
againstleptospirosisandmayhelppreventthediseaseinexposedadults. [51,52]
Thisregimenisrecommendedforthosewithshorttermexposureandisnotfor
repeatedorlongtermexposure.Theroleofprophylaxisinchildrenhasnotbeen
adequatelystudied.
Medication

ContributorInformationandDisclosures
Author
SandraGGompf,MD,FACP,FIDSAAssociateProfessorofInfectiousDiseasesandInternationalMedicine,
UniversityofSouthFloridaCollegeofMedicineChief,InfectiousDiseasesSection,Director,Occupational
HealthandInfectionControlPrograms,JamesAHaleyVeteransHospital
SandraGGompf,MD,FACP,FIDSAisamemberofthefollowingmedicalsocieties:AmericanCollegeof
Physicians,InfectiousDiseasesSocietyofAmerica
Disclosure:Nothingtodisclose.
Coauthor(s)
JudithGreenMcKenzie,MD,MPH,FACP,FACOEMAssociateProfessor,DirectorofClinicalPractice,
OccupationalMedicineResidencyDirector,UniversityofPennsylvaniaSchoolofMedicine
JudithGreenMcKenzie,MD,MPH,FACP,FACOEMisamemberofthefollowingmedicalsocieties:American
CollegeofPhysicians,AmericanCollegeofPreventiveMedicine,NationalMedicalAssociation,American
CollegeofOccupationalandEnvironmentalMedicine
Disclosure:Nothingtodisclose.
AnaPaulaVelez,MDAssistantProfessorofMedicine,DivisionofInfectiousDiseaseandInternational
Medicine,UniversityofSouthFloridaCollegeofMedicineandJamesAHaleyVeteransAffairsMedicalCenter
AttendingPhysician,MoffittCancerCenter
AnaPaulaVelez,MDisamemberofthefollowingmedicalsocieties:AmericanCollegeofPhysiciansAmerican
SocietyofInternalMedicine,AmericanMedicalAssociation,InfectiousDiseasesSocietyofAmerica
Disclosure:Nothingtodisclose.
ChiefEditor
MichaelStuartBronze,MDDavidRossBoydProfessorandChairman,DepartmentofMedicine,StewartG
WolfEndowedChairinInternalMedicine,DepartmentofMedicine,UniversityofOklahomaHealthScience
CenterMasteroftheAmericanCollegeofPhysiciansFellow,InfectiousDiseasesSocietyofAmerica
MichaelStuartBronze,MDisamemberofthefollowingmedicalsocieties:AlphaOmegaAlpha,American
MedicalAssociation,OklahomaStateMedicalAssociation,SouthernSocietyforClinicalInvestigation,
AssociationofProfessorsofMedicine,AmericanCollegeofPhysicians,InfectiousDiseasesSocietyofAmerica
Disclosure:Nothingtodisclose.
Acknowledgements
DeniseDemers,MD,FAAPAssistantProfessorofPediatrics,UniformedServicesUniversityoftheHealth
SciencesAttendingPhysician,DivisionofPediatricInfectiousDiseases,DepartmentofPediatrics,TriplerArmy
MedicalCenter

http://emedicine.medscape.com/article/220563treatment

2/6

10/28/2015

LeptospirosisTreatment&Management:ApproachConsiderations,DietandActivity,Transfer

Disclosure:Nothingtodisclose.
JuanDDiaz,DOFellowinInfectiousDiseases,UniversityofSouthFloridaCollegeofMedicine,TampaGeneral
Hospital,andJamesAHaleyVeteransHospital
Disclosure:Nothingtodisclose.
JosephDomachowske,MDProfessorofPediatrics,MicrobiologyandImmunology,DepartmentofPediatrics,
DivisionofInfectiousDiseases,StateUniversityofNewYorkUpstateMedicalUniversity
JosephDomachowske,MDisamemberofthefollowingmedicalsocieties:AlphaOmegaAlpha,American
AcademyofPediatrics,AmericanSocietyforMicrobiology,InfectiousDiseasesSocietyofAmerica,Pediatric
InfectiousDiseasesSociety,andPhiBetaKappa
Disclosure:Nothingtodisclose.
PatrickWHickey,MD,FAAPAssistantProfessorofPediatricsandPreventiveMedicine,UniformedServices
UniversityoftheHealthSciencesConsultingStaff,DepartmentofPediatrics,DivisionofPediatricInfectious
Disease,WalterReedArmyMedicalCenter
PatrickWHickey,MD,FAAPisamemberofthefollowingmedicalsocieties:AlphaOmegaAlpha,American
AcademyofPediatrics,AmericanSocietyofTropicalMedicineandHygiene,InfectiousDiseasesSocietyof
America,InternationalSocietyofTravelMedicine,andPediatricInfectiousDiseasesSociety
Disclosure:Nothingtodisclose.
EdmondAHookerII,MD,DrPH,FAAEMAssistantProfessor,DepartmentofEmergencyMedicine,University
ofCincinnatiCollegeofMedicineAssociateProfessor,DepartmentofHealthServicesAdministration,Xavier
University
EdmondAHookerII,MD,DrPH,FAAEMisamemberofthefollowingmedicalsocieties:AmericanAcademyof
EmergencyMedicine,AmericanPublicHealthAssociation,SocietyforAcademicEmergencyMedicine,and
SouthernMedicalAssociation
Disclosure:Nothingtodisclose.
MatthewRJezior,MDFellow,DepartmentofCardiology,WalterReedMedicalCenter
Disclosure:Nothingtodisclose.
MariaDMileno,MDAssociateProfessorofMedicine,DivisionofInfectiousDiseases,TheWarrenAlpert
MedicalSchoolofBrownUniversity
MariaDMileno,MDisamemberofthefollowingmedicalsocieties:AlphaOmegaAlpha,AmericanCollegeof
Physicians,AmericanSocietyofTropicalMedicineandHygiene,InfectiousDiseasesSocietyofAmerica,
InternationalSocietyofTravelMedicine,andSigmaXi
Disclosure:Nothingtodisclose.
JosephTMorris,MDChiefofInfectiousDiseaseService,MadiganArmyMedicalCenterAssistantProfessor,
DepartmentofInternalMedicine,UniformedServicesUniversityoftheHealthSciences
Disclosure:Nothingtodisclose.
GaryJNoel,MDProfessor,DepartmentofPediatrics,WeillCornellMedicalCollegeAttendingPediatrician,
NewYorkPresbyterianHospital
GaryJNoel,MDisamemberofthefollowingmedicalsocieties:PediatricInfectiousDiseasesSociety
Disclosure:Nothingtodisclose.
CecilyKPeterson,MDProgramDirector,ClinicalFaculty,DepartmentofMedicine,MadiganArmyMedical
Center
Disclosure:Nothingtodisclose.
CharlesVSanders,MDEdgarHullProfessorandChairman,DepartmentofInternalMedicine,Professorof
Microbiology,ImmunologyandParasitology,LouisianaStateUniversitySchoolofMedicineatNewOrleans
MedicalDirector,MedicineHospitalCenter,CharityHospitalandMedicalCenterofLouisianaatNewOrleans
ConsultingStaff,OchsnerMedicalCenter
CharlesVSanders,MDisamemberofthefollowingmedicalsocieties:AllianceforthePrudentUseof
Antibiotics,AlphaOmegaAlpha,AmericanAssociationfortheAdvancementofScience,AmericanAssociation
ofUniversityProfessors,AmericanClinicalandClimatologicalAssociation,AmericanCollegeofPhysician
Executives,AmericanCollegeofPhysicians,AmericanFederationforMedicalResearch,AmericanFoundation
forAIDSResearch,AmericanGeriatricsSociety,AmericanLungAssociation,AmericanMedicalAssociation,
AmericanSocietyforMicrobiology,AmericanThoracicSociety,AmericanVenerealDiseaseAssociation,
AssociationforProfessionalsinInfectionControlandEpidemiology,AssociationofAmericanMedicalColleges,
AssociationofAmericanPhysicians,AssociationofProfessorsofMedicine,InfectiousDiseaseSocietyfor
ObstetricsandGynecology,InfectiousDiseasesSocietyofAmerica,LouisianaStateMedicalSociety,Orleans
ParishMedicalSociety,RoyalSocietyofMedicine,SigmaXi,SocietyofGeneralInternalMedicine,
SoutheasternClinicalClub,SouthernMedicalAssociation,SouthernSocietyforClinicalInvestigation,and
SouthwesternAssociationofClinicalMicrobiology
Disclosure:Nothingtodisclose.
WilliamHShoff,MD,DTM&HDirector,PENNTravelMedicineAssociateProfessor,DepartmentofEmergency
Medicine,HospitaloftheUniversityofPennsylvania,UniversityofPennsylvaniaSchoolofMedicine
WilliamHShoff,MD,DTM&Hisamemberofthefollowingmedicalsocieties:AmericanCollegeofPhysicians,
AmericanSocietyofTropicalMedicineandHygiene,InternationalSocietyofTravelMedicine,Societyfor
AcademicEmergencyMedicine,andWildernessMedicalSociety
Disclosure:Nothingtodisclose.
RussellWSteele,MDHead,DivisionofPediatricInfectiousDiseases,OchsnerChildren'sHealthCenter
ClinicalProfessor,DepartmentofPediatrics,TulaneUniversitySchoolofMedicine
RussellWSteele,MDisamemberofthefollowingmedicalsocieties:AmericanAcademyofPediatrics,
AmericanAssociationofImmunologists,AmericanPediatricSociety,AmericanSocietyforMicrobiology,
InfectiousDiseasesSocietyofAmerica,LouisianaStateMedicalSociety,PediatricInfectiousDiseasesSociety,

http://emedicine.medscape.com/article/220563treatment

3/6

10/28/2015

LeptospirosisTreatment&Management:ApproachConsiderations,DietandActivity,Transfer

SocietyforPediatricResearch,andSouthernMedicalAssociation
Disclosure:Nothingtodisclose.
FranciscoTalavera,PharmD,PhDAdjunctAssistantProfessor,UniversityofNebraskaMedicalCenterCollege
ofPharmacyEditorinChief,MedscapeDrugReference
Disclosure:MedscapeSalaryEmployment
Jeter(Jay)PritchardTaylorIII,MDComplianceOfficer,AttendingPhysician,EmergencyMedicineResidency,
DepartmentofEmergencyMedicine,PalmettoHealthRichland,UniversityofSouthCarolinaSchoolofMedicine
MedicalDirector,DepartmentofEmergencyMedicine,PalmettoHealthBaptist
Jeter(Jay)PritchardTaylorIII,MDisamemberofthefollowingmedicalsocieties:AmericanAcademyof
EmergencyMedicine,AmericanCollegeofEmergencyPhysicians,AmericanMedicalAssociation,andSociety
forAcademicEmergencyMedicine
Disclosure:Nothingtodisclose.
MaryLWindle,PharmDAdjunctAssociateProfessor,UniversityofNebraskaMedicalCenterCollegeof
PharmacyEditorinChief,MedscapeDrugReference
Disclosure:Nothingtodisclose.

References
1. PalaniappanRU,RamanujamS,ChangYF.Leptospirosis:pathogenesis,immunity,anddiagnosis.Curr
OpinInfectDis.2007Jun.20(3):28492.[Medline].
2. YangCW.LeptospirosisinTaiwananunderestimatedinfectiousdisease.ChangGungMedJ.2007Mar
Apr.30(2):10915.[Medline].
3. GithekoAK,LindsaySW,ConfalonieriUE,PatzJA.Climatechangeandvectorbornediseases:aregional
analysis.BullWorldHealthOrgan.2000.78(9):113647.[Medline].[FullText].
4. NationalResearchCouncil.AdvancingtheScienceofClimateChange.Washington,DC:TheNational
AcademiesPress2010.
5. CDC.FromtheCentersforDiseaseControlandPrevention.Update:outbreakofacutefebrileillness
amongathletesparticipatinginEcoChallengeSabah2000Borneo,Malaysia,2000.JAMA.2001Feb14.
285(6):72830.[Medline].
6. CDC.Update:leptospirosisandunexplainedacutefebrileillnessamongathletesparticipatingintriathlons
IllinoisandWisconsin,1998.MMWRMorbMortalWklyRep.1998Aug21.47(32):6736.[Medline].
7. CDC.OutbreakofleptospirosisamongwhitewaterraftersCostaRica,1996.MMWRMorbMortalWkly
Rep.1997Jun27.46(25):5779.[Medline].
8. RadlC,MllerM,RevillaFernandezS,KarnerZuserS,deMartinA,SchauerU,etal.Outbreakof
leptospirosisamongtriathlonparticipantsinLangau,Austria,2010.WienKlinWochenschr.2011Dec.
123(2324):7515.[Medline].
9. CDC.FromtheCentersforDiseaseControlandPrevention.Outbreakofacutefebrileillnessand
pulmonaryhemorrhageNicaragua,1995.JAMA.1995Dec6.274(21):1668.[Medline].
10. GaynorK,KatzAR,ParkSY,NakataM,ClarkTA,EfflerPV.LeptospirosisonOahu:anoutbreak
associatedwithfloodingofauniversitycampus.AmJTropMedHyg.2007May.76(5):8825.[Medline].
11. SocolovschiC,AngelakisE,RenvoisA,FournierPE,MariJL,DavoustB,etal.Strikes,flooding,rats,
andleptospirosisinMarseille,France.IntJInfectDis.2011Oct.15(10):e7105.[Medline].
12. LevettPN.Leptospirosis.ClinMicrobiolRev.2001Apr.14(2):296326.[Medline].[FullText].
13. InadaR,IdoY,HokiR.Theetiology,modeofinfection,andspecifictherapyofWeil'sdisease
(spirochaetosisicterohaemorrhagica.JExperMed.1916.23:377402.
14. GILLESPIERW,RYNOJ.Epidemiologyofleptospirosis.AmJPublicHealthNationsHealth.1963Jun.
53:9505.[Medline].[FullText].
15. HeiseyGB,NimmanityaS,KarnchanachetaneeC,TingpalapongM,SamransamruajkitS,HansukjariyaP,
etal.EpidemiologyandcharacterizationofleptospirosisatanurbanandprovincialsiteinThailand.
SoutheastAsianJTropMedPublicHealth.1988Jun.19(2):31722.[Medline].
16. SMITHDJ,SELFHR.ObservationsonthesurvivalofLeptospiraaustralisAinsoilandwater.JHyg
(Lond).1955Dec.53(4):43644.[Medline].[FullText].
17. CacciapuotiB,CiceroniL,MaffeiC,DiStanislaoF,StrusiP,CalegariL,etal.Awaterborneoutbreakof
leptospirosis.AmJEpidemiol.1987Sep.126(3):53545.[Medline].
18. ChakurkarG,VaideeswarP,PanditSP,DivateSA.Cardiovascularlesionsinleptospirosis:anautopsy
study.JInfect.2008Mar.56(3):197203.[Medline].
19. ChierakulW,TientadakulP,SuputtamongkolY,WuthiekanunV,PhimdaK,LimpaiboonR,etal.
Activationofthecoagulationcascadeinpatientswithleptospirosis.ClinInfectDis.2008Jan15.46(2):254
60.[Medline].
20. WagenaarJF,GorisMG,SakundarnoMS,GasemMH,MairuhuAT,deKruifMD,etal.Whatroledo
coagulationdisordersplayinthepathogenesisofleptospirosis?.TropMedIntHealth.2007Jan.12(1):111
22.[Medline].
21. SmytheL,AdlerB,HartskeerlRA,GallowayRL,TurenneCY,LevettPN.ClassificationofLeptospira
genomospecies1,3,4and5asLeptospiraalstoniisp.nov.,Leptospiravanthieliisp.nov.,Leptospira
terpstraesp.nov.andLeptospirayanagawaesp.nov.,respectively.IntJSystEvolMicrobiol.2013May.
63:185962.[Medline].
22. USDepartmentofHealthandHumanServices.Summaryofnotifiablediseases,UnitedStates1995.
MMWRMorbMortalWklyRep.1996Oct25.44(53):187.[Medline].
23. MalaniJ,PryorJ,LusanguliraK.LeptospirosisinPohnpei(19861995):acaseseriesontheuseof

http://emedicine.medscape.com/article/220563treatment

4/6

10/28/2015

LeptospirosisTreatment&Management:ApproachConsiderations,DietandActivity,Transfer

dopamine/steroidforWeil'ssyndrome.PacificHealthDialog.1996.3:15361.
24. SasakiDM,PangL,MinetteHP,WakidaCK,FujimotoWJ,ManeaSJ,etal.Activesurveillanceandrisk
factorsforleptospirosisinHawaii.AmJTropMedHyg.1993Jan.48(1):3543.[Medline].
25. KatzAR,BuchholzAE,HinsonK,ParkSY,EfflerPV.LeptospirosisinHawaii,USA,19992008.Emerg
InfectDis.2011Feb.17(2):2216.[Medline].[FullText].
26. DemersRY,ThiermannA,DemersP,FrankR.ExposuretoLeptospiraicterohaemorrhagiaeininnercity
andsuburbanchildren:aserologiccomparison.JFamPract.1983Dec.17(6):100711.[Medline].
27. ChildsJE,SchwartzBS,KsiazekTG,GrahamRR,LeDucJW,GlassGE.Riskfactorsassociatedwith
antibodiestoleptospiresininnercityresidentsofBaltimore:aprotectiveroleforcats.AmJPublicHealth.
1992Apr.82(4):5979.[Medline].[FullText].
28. TrevejoRT,RigauPrezJG,AshfordDA,McClureEM,JarqunGonzlezC,AmadorJJ,etal.Epidemic
leptospirosisassociatedwithpulmonaryhemorrhageNicaragua,1995.JInfectDis.1998Nov.178(5):1457
63.[Medline].
29. JacksonLA,KaufmannAF,AdamsWG,PhelpsMB,AndreasenC,LangkopCW,etal.Outbreakof
leptospirosisassociatedwithswimming.PediatrInfectDisJ.1993Jan.12(1):4854.[Medline].
30. DolhnikoffM,MauadT,BethlemEP,CarvalhoCR.Pathologyandpathophysiologyofpulmonary
manifestationsinleptospirosis.BrazJInfectDis.2007Feb.11(1):1428.[Medline].
31. Dall'AntoniaM,SlugaG,WhitfieldS,TeallA,WilsonP,KrahD.Leptospirosispulmonaryhaemorrhage:
adiagnosticchallenge.EmergMedJ.2008Jan.25(1):512.[Medline].
32. ShakedY,ShpilbergO,SamraD,SamraY.Leptospirosisinpregnancyanditseffectonthefetus:case
reportandreview.ClinInfectDis.1993Aug.17(2):2413.[Medline].
33. HawaiiDeptofHealth.CommunicableDiseaseSurveillance.Hawaii:CommunicableDiseaseReport.
Nov/Dec1999.15.
34. ElBouazzaouiA,HouariN,ArikaA,BelhoucineI,BoukattaB,SbaiH,etal.Facialpalsyassociatedwith
leptospirosis.EurAnnOtorhinolaryngolHeadNeckDis.2011Nov.128(5):2757.[Medline].
35. PeterG,NarasimhaH.Acalculouscholecystitis:ararepresentationofleptospirosisprogressingtoWeil's
disease.AsianPacJTropMed.2011Dec.4(12):10078.[Medline].
36. PappachanJM,MathewS,ThomasB,RenjiniK,ScariaCK,ShuklaJ.Theincidenceandclinical
characteristicsoftheimmunephaseeyediseaseintreatedcasesofhumanleptospirosis.IndianJMedSci.
2007Aug.61(8):4417.[Medline].
37. PersonDA,BurnettMW.Leptospirosis.TriplerArmyMedicalCenter.MedicalSurveillanceMonthlyReport.
1996.2:78.[FullText].
38. PersonDA.LeptospirosisinthePacific.::.TriplerArmyMedicalCenter.MedicalSurveillanceMonthly
Report.1998.4:1214.[FullText].
39. SpichlerA,SpichlerE,MoockM,VinetzJM,LeakeJA.Acutepancreatitisinfatalanictericleptospirosis.
AmJTropMedHyg.2007May.76(5):8867.[Medline].
40. WorldHealthOrganization.Humanleptospirosis:guidancefordiagnosis,surveillanceandcontrol.Available
athttp://whqlibdoc.who.int/hq/2003/WHO_CDS_CSR_EPH_2002.23.pdf.Accessed:April24,2014.
41. VasconcellosFA,CoutinhoML,daSilvaEF,FernandesCP,MonteLG,SeyffertN,etal.Testingdifferent
antigencaptureELISAformatsfordetectionofLeptospiraspp.inhumanbloodserum.TransRSocTrop
MedHyg.2010Apr.104(4):25964.[Medline].
42. BrettMajorDM,ColdrenR.Antibioticsforleptospirosis.CochraneDatabaseSystRev.2012Feb15.
2:CD008264.[Medline].
43. WattG,PadreLP,TuazonML,CalubaquibC,SantiagoE,RanoaCP,etal.Placebocontrolledtrialof
intravenouspenicillinforsevereandlateleptospirosis.Lancet.1988Feb27.1(8583):4335.[Medline].
44. CostaE,LopesAA,SacramentoE,CostaYA,MatosED,LopesMB,etal.Penicillinatthelatestageof
leptospirosis:arandomizedcontrolledtrial.RevInstMedTropSaoPaulo.2003MayJun.45(3):1415.
[Medline].
45. MurrayCK,HospenthalDR.Determinationofsusceptibilitiesof26Leptospirasp.serovarsto24
antimicrobialagentsbyabrothmicrodilutiontechnique.AntimicrobAgentsChemother.2004Oct.
48(10):40025.[Medline].[FullText].
46. DursunB,BostanF,ArtacM,VaranHI,SuleymanlarG.Severepulmonaryhaemorrhageaccompanying
hepatorenalfailureinfulminantleptospirosis.IntJClinPract.2007Jan.61(1):1647.[Medline].
47. ShenoyVV,NagarVS,ChowdhuryAA,BhalgatPS,JuvaleNI.Pulmonaryleptospirosis:anexcellent
responsetobolusmethylprednisolone.PostgradMedJ.2006Sep.82(971):6026.[Medline].[FullText].
48. MeaudreE,AsencioY,MontcriolA,MartinaudC,GraffinB,PalmierB,etal.[Immunomodulationin
severeleptospirosiswithmultipleorganfailure:plasmaexchange,intravenousimmunoglobulinor
corticosteroids?].AnnFrAnesthReanim.2008Feb.27(2):1726.[Medline].
49. TrivediSV,ChavdaRK,WadiaPZ,ShethV,BhagadePN,TrivediSP,etal.Theroleofglucocorticoid
pulsetherapyinpulmonaryinvolvementinleptospirosis.JAssocPhysiciansIndia.2001Sep.49:9013.
[Medline].
50. MartinsMG,MatosKT,daSilvaMV,deAbreuMT.Ocularmanifestationsintheacutephaseof
leptospirosis.OculImmunolInflamm.1998Jun.6(2):759.[Medline].
51. TakafujiET,KirkpatrickJW,MillerRN,KarwackiJJ,KelleyPW,GrayMR,etal.Anefficacytrialof
doxycyclinechemoprophylaxisagainstleptospirosis.NEnglJMed.1984Feb23.310(8):497500.
[Medline].
52. [Guideline]GuidugliF,CastroAA,AtallahAN.Antibioticsforpreventingleptospirosis.CochraneDatabase
SystRev.2000.CD001305.[Medline].
53. AgampodiSB,MatthiasMA,MorenoAC,VinetzJM.Utilityofquantitativepolymerasechainreactionin
leptospirosisdiagnosis:associationoflevelofleptospiremiaandclinicalmanifestationsinSriLanka.Clin
InfectDis.2012May.54(9):124955.[Medline].[FullText].

http://emedicine.medscape.com/article/220563treatment

5/6

10/28/2015

LeptospirosisTreatment&Management:ApproachConsiderations,DietandActivity,Transfer

54. AREANVM.Thepathologicanatomyandpathogenesisoffatalhumanleptospirosis(Weil'sdisease).AmJ
Pathol.1962Apr.40:393423.[Medline].[FullText].
55. BarkinRM,GuckianJC,GlosserJW.Infectionbyleptospiraballum:alaboratoryassociatedcase.South
MedJ.1974Feb.67(2):155passim.[Medline].
56. EverardCO,BennettS,EdwardsCN,NicholsonGD,HassellTA,CarringtonDG,etal.Aninvestigationof
someriskfactorsforsevereleptospirosisonBarbados.JTropMedHyg.1992Feb.95(1):1322.[Medline].
57. GaspariR,AnnettaMG,CavaliereF,PallaviciniF,GrilloR,ContiG,etal.Unusualpresentationof
leptospirosisinthelatestageofpregnancy.MinervaAnestesiol.2007JulAug.73(78):42932.[Medline].
58. HarrisBM,BlatzPJ,HinkleMK,McCallS,BeckiusML,MendeK,etal.Invitroandinvivoactivityoffirst
generationcephalosporinsagainstLeptospira.AmJTropMedHyg.2011Nov.85(5):9058.[Medline].[Full
Text].
59. KatzAR,ManeaSJ,SasakiDM.LeptospirosisonKauai:investigationofacommonsourcewaterborne
outbreak.AmJPublicHealth.1991Oct.81(10):13102.[Medline].[FullText].
60. KhositsethS,SudjaritjanN,TananchaiP,OngajyuthS,SitprijaV,ThongboonkerdV.Renalmagnesium
wastingandtubulardysfunctioninleptospirosis.NephrolDialTransplant.2008Mar.23(3):9528.[Medline].
61. KhosraviM,BastaniB.Acuterenalfailureduetoleptospirosisinarenaltransplantrecipient:abriefreview
oftheliterature.TransplantProc.2007May.39(4):12636.[Medline].
62. LettieriC,MoonJ,HickeyP,GrayM,BergB,HospenthalD.PrevalenceofleptospiraantibodiesinU.S.
ArmybloodbankdonorsinHawaii.MilMed.2004Sep.169(9):68790.[Medline].
63. MusgraveJE,PersonDA.Acuterenalfailureinchildrenduetoleptospirosis.PacHealthDialog.1996.
3:2001.
64. PhimdaK,HoontrakulS,SuttinontC,ChareonwatS,LosuwanalukK,ChueasuwanchaiS,etal.
Doxycyclineversusazithromycinfortreatmentofleptospirosisandscrubtyphus.AntimicrobAgents
Chemother.2007Sep.51(9):325963.[Medline].[FullText].
65. WangZ,JinL,WegrzynA.Leptospirosisvaccines.MicrobCellFact.2007Dec11.6:39.[Medline].[Full
Text].
66. WattG,PadreLP,TuazonM,CalubaquibC.Skeletalandcardiacmuscleinvolvementinsevere,late
leptospirosis.JInfectDis.1990Jul.162(1):2669.[Medline].

MedscapeReference2011WebMD,LLC

http://emedicine.medscape.com/article/220563treatment

6/6