Stages:
1st stage: Septicemic/ Leptospiremic Phase (4 – 7
days)
- onset of high remittent fever, chills, headache, anorexia,
nausea & vomiting, abdominal pain, joint pains, muscle
pains, myalgia, severe prostration, cough, respiratory
distress, bloody sputum.
2nd stage: Immune/ Toxic Phase (4 – 30 days)
- if severe, death may occur between the 9th & 16th day
2 types:
Anicteric (without jaundice) – return of fever of a lower
degree with rash, conjunctival injection, headache,
meningeal manifestations like disorientation, convulsions
& signs of meningeal irritations (with CSF finding
of aseptic meningitis)
Icteric (with jaundice) – Weil syndrome; hepatic & renal
manifestations: hemorrhage, hepatomegaly,
hyperbilirubinemia, oliguria, anuria with progressive renal
failure; shock, coma & congestive heart failure in severe
cases
3rd stage: Convalescence Phase
- Relapses may occur during 4th or 5th week
Pathognomonic Signs:
Leptospirosis — orange eyes
1. Usually asymptomatic
2. Low-grade afternoon fever
3.Night sweating
4.Loss of appetite
5. Weight loss
6. Easy fatigability – due
to increased oxygen
demand
7. Temporary amenorrhe
8. Productive dry cough
9. Hemoptysis
Drug of choice:
Medical Management:
• First-choice drug is oral doxycycline, starting within 48
hours of illness (starting antibiotics can lead to
a Jarisch-Herxheimer reaction).
• Oral amoxicillin, ampicillin and doxycycline are effective
in mild-to-moderate infections.
• Intravenous penicillin G is the drug of choice for
severely ill patients.
• A recent clinical trial showed that third-generation
cephalosporins are as effective as doxycycline and
penicillin in the treatment of acute disease.4
• Chloramphenicol is also active against Leptospira but
should be reserved for critically ill patients.
• Supportive care and treatment of the hypotension,
haemorrhage, renal failure and liver failure.
• Vitamin K should be administered for
hypoprothrombinaemia.
• Immunity to leptospirosis is incomplete and so
patients should be advised to adopt lifestyle changes to
avoid re-exposure if possible.
Nursing Management: