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World J Clin Infect Dis. Nov 25, 2016; 6(4): 61-66
Published online Nov 25, 2016. doi: 10.5495/wjcid.v6.i4.61
Leptospirosis: A clinical review of evidence based diagnosis, treatment and prevention
Alison B Lane, Michael M Dore
Alison B Lane, Walter Reed National Military Medical Center, Bethesda, MD 20899, United States
Michael M Dore, Department of Medicine, Naval Hospital Guam, Guam, CA 96910, United States
Author contributions: All authors participated equally in the writing of the manuscript.
Conflict-of-interest statement: None. The identification of specific products or scientific instrumentation are considered an integral part of the scientific endeavor and does not constitute endorsement or implied endorsement on the part of the author, DoD, or any component agency. The views expressed in this article are those of the author and do not reflect the official policy of the Department of the Navy, Department of Defense, or United States Government.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Michael M Dore, MD, Department of Medicine, Naval Hospital Guam, PSC 4555 Box 208, FPO AP 96540, Guam, CA 96910, United States. michael.m.dore.mil@mail.mil
Telephone: +1-671-3449202 Fax: +1-671-3449010
Received: August 21, 2016
Peer-review started: August 23, 2016
First decision: September 28, 2016
Revised: October 8, 2016
Accepted: October 22, 2016
Article in press: October 24, 2016
Published online: November 25, 2016
Processing time: 91 Days and 22.5 Hours
Abstract

Leptospirosis is a zoonotic disease with worldwide distribution and increasing prevalence. Infection is caused by the spirochete Leptospira, with common exposure being contaminated fresh water. Most infections are asymptomatic, but symptoms range from a mild, self-limiting, non-specific febrile illness to fulminant respiratory and renal failure with a high mortality rate. The combination of jaundice, renal failure, and hemorrhage is known as Weil’s disease and is the most characteristic pattern associated with severe leptospirosis. Clinical suspicion alone may be enough to warrant empiric antibiotic treatment in many cases. Serological methods are the most commonly used means of confirming a diagnosis of leptospirosis. The “gold standard” is the microscopic agglutination test. Typical treatment for mild causes is oral doxycycline, though azithromycin and oral penicillins are reasonable alternatives. Intravenous penicillin G has long been the standard of care for severe cases though limited studies show no benefit compared to third generation cephalosporins. We review the clinical presentation, diagnosis, treatment and prevention of leptospirosis.

Keywords: Leptospirosis; Tropical diseases; Infectious disease

Core tip: Leptospirosis is a zoonotic disease with worldwide distribution and increasing prevalence. Infection is caused by the spirochete Leptospira, with common exposure being contaminated fresh water. Most infections are asymptomatic, but symptoms range from a mild, self-limiting, non-specific febrile illness to fulminant respiratory and renal failure with a high mortality rate. Typical treatment for mild cases is oral doxycycline, though azithromycin and oral penicillins are reasonable alternatives. Intravenous penicillin G has long been the standard of care for severe cases though limited studies show no benefit compared to third generation cephalosporins. We review the clinical presentation, diagnosis, and treatment of leptospirosis.