Leptospirosis differential diagnosis

Leptospirosis Microchapters
Home
Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Leptospirosis from other Diseases
Epidemiology and Demographics
Risk Factors
Natural History, Complications and Prognosis
Diagnosis
History and Symptoms
Physical Examination
Laboratory Findings
Other Imaging Findings
Treatment
Medical Therapy
Surgery
Primary Prevention
Future or Investigational Therapies
Case Studies
Case #1
Leptospirosis differential diagnosis On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Leptospirosis differential diagnosis All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Leptospirosis differential diagnosis
CDC on Leptospirosis differential diagnosis
Leptospirosis differential diagnosis in the news
Blogs on Leptospirosis differential diagnosis
Directions to Hospitals Treating Leptospirosis
Risk calculators and risk factors for Leptospirosis differential diagnosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Venkata Sivakrishna Kumar Pulivarthi M.B.B.S [2]

Overview

Leptospirosis must be differentiated from other diseases that cause fever, diarrhea, nausea and vomiting, such as ebola, typhoid fever, malaria, yellow fever, shigellosis, and other enteric bacterial infections. Moderate to severe leptospirosis must be differentiated from dengue fever.

Differential diagnosis

Differential diagnosis list for leptospirosis is very large due to diverse symptomatics. For forms with middle to high severity, the list includes dengue fever and other hemorrhagic fevers, hepatitis of various etiologies, viral meningitis, malaria and typhoid fever. Light forms should be distinguished from influenza and other related viral diseases. Specific tests are a must for proper diagnosis of leptospirosis. Under circumstances of limited access (e.g., developing countries) to specific diagnostic means, close attention must be paid to anamnesis of the patient. Factors like certain dwelling areas, seasonality, contact with stagnant water (swimming, working on flooded meadows, etc) and/or rodents in the medical history support the leptospirosis hypothesis and serve as indications for specific tests (if available).

The table below summarizes the findings that differentiate Leptospirosis from other conditions that cause fever, diarrhea, nausea and vomiting:

Disease	Findings
Ebola	Presents with fever, chills vomiting, diarrhea, generalized pain or malaise, and sometimes internal and external bleeding, that follow an incubation period of 2-21 days.
Typhoid fever	Presents with fever, headache, rash, gastrointestinal symptoms, with lymphadenopathy, relative bradycardia, cough and leucopenia and sometimes sore throat. Blood and stool culture can confirm the presence of the causative bacteria.
Malaria	Presents with acute fever, headache and sometimes diarrhea (children). A blood smears must be examined for malaria parasites. The presence of parasites does not exclude a concurrent viral infection. An antimalarial should be prescribed as an empiric therapy.
Lassa fever	Disease onset is usually gradual, with fever, sore throat, cough, pharyngitis, and facial edema in the later stages. Inflammation and exudation of the pharynx and conjunctiva are common.
Yellow fever and other Flaviviridae	Present with hemorrhagic complications. Epidemiological investigation may reveal a pattern of disease transmission by an insect vector. Virus isolation and serological investigation serves to distinguish these viruses. Confirmed history of previous yellow fever vaccination will rule out yellow fever.
Shigellosis & other bacterial enteric infections	Presents with diarrhea, possibly bloody, accompanied by fever, nausea, and sometimes toxemia, vomiting, cramps, and tenesmus. Stools contain blood and mucous in a typical case. A search for possible sites of bacterial infection, together with cultures and blood smears, should be made. Presence of leucocytosis distinguishes bacterial infections from viral infections.
Dengue	Presence of atypical lymphocytosis in blood differentiate it from leptospirosis.
Others	Viral Hepatitis, rheumatic fever, typhus, and mononucleosis

Disease	Symptoms					Physical signs		Lab findings			Other findings
	Fever characterestic	Cough	Rash	Joint pain	Myalgia	Characterestic physical finding	Icterus	Leukocyte count	Plasma Creatine kinase	Confirmatory test
Leptospirosis	Fever last for 4-7 days, remission for 1-2 days and then relapse	✔	Present over legs, Hemorrhagic rash	✔	✔ (Severe myalgia is characteristic of leptospirosis)	Conjunctival suffusion	✔	High	Elevated	Microscopic agglutination test of urine	History of exposure to soil or water contaminated by infected rodents Recent history travel to tropical, sub tropical areas or humid areas
Dengue	Fever last for 1-2 days, remission for 1-2 days and then relapse for 1-2 days		Over legs and trunk Pruritic rash May be hemorrhagic	✔			X	Low		Serology showing positive IgM or IgG
Malaria	Fever present daily or on alternate day or every 3 days depending on Plasmodium sps.		No rash	X	✔		✔			Giemsa stained thick and thin blood smears
Ebola	✔
Influenza	✔	✔								Viral culture or PCR
Yellow fever	✔
Typhoid fever	✔					Rose spots				Blood or stool culture showing salmonella typhi sps.
Ricketsial fever											Recent history of tick bite
Viral hepatitis										Positive serology