Leptospirosis history and symptoms

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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

Clinical symptoms of leptospirosis are very wide, with mild anicteric presentation at one end to severe leptospirosis with severe jaundice and multiple organ involvement. Classic presentation of leptospirosis is a biphasic illness, and the onset of Symptoms within 2–30 days (incubation period) of exposure to the bacteria. Serious symptoms may manifest earlier on Days 4–6 of the illness depending on the type of pathogen and host immunological status.

Symptoms

In humans, Leptospirosis can cause a wide range of symptoms, including:

Common Symtoms

• Fever: Moderate to severe fever with chills.
• Myalgia: Characterestic of leptospirosis due to involvement of calf, abdominal & lumbosacral muscles.
• Red eyes
• Headache: usually throbbing or retro-orbital headache not relieved by analgesics
• Cough & chest pain seen in patients involving lungs
• Nausea and vomiting
• Jaundice

Other Symptoms

• Abdominal pain
• Diarrhea
• Rash

Clinical Presentation

Acute Phase

• Also known as Septicemic phase or leptospiremic phase.
• Begins abruptly.
• Bacteria are present in the blood and CSF of the patient.
• Characterized by wide spectrum of nonspecific signs and symptoms such as fever, chills, headache and conjunctival suffusion making it very difficult to diagnose.
• Associated with severe myalgia.
• Other less common findings include: Photophobia, lymphadenopathy, abdominal pain, nausea, vomiting, a transient rash, sore throat, coughing or chest pain.
• Characterestic of this phase also includes: Mild form of leptospirosis in ~90% cases which lasts several days to a week, followed by a brief remission, during which the temperature drops and the symptoms disappear.

Immune phase

• It is also known as leptospiruric phase.
• Circulating (IgM) antibodies are produced and leptospires are present in the urine
• Characterestic findings that differentiate from other febrile illnesses are myalgia and conjunctival suffusion.
• Myalgia often involves in calf muscles, less commonly involves abdominal and paraspinal muscles.

Anicteric leptospirosis

• More common but serious illness is uncommon.
• Most of cases present either subclinical or of very mild severity.
• Few cases present with a febrile illness of sudden onset.
• May progress to aseptic meningitis in ≤25% of patients and more common in younger age group than the patients with icteric leptospirosis.
• Mortality is very less when compared to icteric leptospirosis

Icteric leptospirosis

• Rapidly progressive and severe form of leptospirosis(Weil's disease).
• In the severe form of leptospirosis renal failure, hepatic failure and pulmonary haemorrhage can occur and associate with Icterohaemorrhagiae.
• Less common form of leptospirosis with incidence of 5%-10%.
• Jaundice is not associate with hepatocellular injury, eventually LFT returns to normal after recovery.
• High mortality rate with a range of 5%-15%.

Severe leptospirosis

Sever form of leptospirosis with organ failure including liver and kidney involvement is known as Weil's disease.

• Hepatic: Mild to severe form of jaundice developed within 4-7 days after the initial clinical presentation that can progress to hepatic failure or hepatic encephalopathy.
• Renal: Very common presentation involving kidneys is acute interstitial nephritis, with cola colored urine, oliguria or anuria.
• Pulmonary: Milder form of leptospirosis presents with cough, chest pain and blood tinged sputum, where as in severe form present with cough, hemoptysis, rapidly increasing breathlessness which may lead to respiratory failure and death. Hemorrhagic pneumonitis with interstitial and intra alveolar hemorrhage is the commonest cause of death in leptospirosis with case fatality rate of 0%-15%.
• Cardiovascualar: Arrhythmias present with syncope and palpitations.
• Nervous system: Meningitis, encephalitis, focal defecits, spasticity, paralysis, peripheral neuropathies, nerve palsies and radiculopathies.

Acute phase	Immune phase
	It is also known as leptospiruric phase. Circulating (IgM) antibodies are produced and leptospires are present in the urine Characterestic findings that differentiate from other febrile illnesses are myalgia and conjunctival suffusion. Myalgia often involves in calf muscles, less commonly involves abdominal and paraspinal muscles.
Also known as Septicemic phase. Begins abruptly. Characterized by nonspecific signs such as fever, chills, headache and conjunctival suffusion. Associate with severe myalgia. Other less common findings include: Photophobia, lymphadenopathy, abdominal pain, nausea, vomiting, a transient rash, sore throat, coughing or chest pain. Characterestic of this phase also includes: symptoms lasts several days to a week, which is followed by a brief remission, during which the temperature drops and the symptoms disappear.	Anicteric leptospirosis	Icteric leptospirosis	Severe leptospirosis
	More common but serious illness is uncommon. Most of cases present either subclinical or of very mild severity. Few cases present with a febrile illness of sudden onset. Other symptoms include chills, headache (severe with retro-orbital pain and photophobia), myalgia, abdominal pain, conjunctival suffusion, and skin rash (transient and last <24 hours). May progress to aseptic meningitis in ≤25% of patients and more common in younger age group than the patients with icteric leptospirosis. Mortality is very less when compared to icteric leptospirosis.	Rapidly progressive and severe form of leptospirosis Less common form of leptospirosis with incidence of 5%-10%. Jaundice is not associate with hepatocellular injury, eventually LFT returns to normal after recovery. High mortality rate with a range of 5%-15%.	Sever form of leptospirosis with organ failure including liver and kidney involvement is known as Weil's disease. Hepatic: Mild to severe form of jaundice developed within 4-7 days after the initial clinical presentation that can progress to hepatic failure or hepatic encephalopathy. Renal: Very common presentation involving kidneys is acute interstitial nephritis, with cola colored urine, oliguria or anuria. Pulmonary: Milder form of leptospirosis presents with cough, chest pain and blood tinged sputum, where as in severe form present with cough, hemoptysis, rapidly increasing breathlessness which may lead to respiratory failure and death. Hemorrhagic pneumonitis with interstitial and intra alveolar hemorrhage is the commonest cause of death in leptospirosis with case fatality rate of 0%-15%. Cardiovascualar: Arrhythmias present with syncope and palpitations. Nervous system: Meningitis, encephalitis, focal defecits, spasticity, paralysis, peripheral neuropathies, nerve palsies and radiculopathies.