Leptospirosis classification
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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
Classification
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.[1]
- 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: 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.[2]
- Myalgia often involves in calf muscles, less commonly involves abdominal and para-spinal 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
- 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
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.[3]
- 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%
References
- ↑ Bal AM (2005). "Unusual clinical manifestations of leptospirosis". J Postgrad Med. 51 (3): 179–83. PMID 16333189.
- ↑ Forbes AE, Zochowski WJ, Dubrey SW, Sivaprakasam V (2012). "Leptospirosis and Weil's disease in the UK". QJM. 105 (12): 1151–62. doi:10.1093/qjmed/hcs145. PMID 22843698.
- ↑ Katz AR, Ansdell VE, Effler PV, Middleton CR, Sasaki DM (2001). "Assessment of the clinical presentation and treatment of 353 cases of laboratory-confirmed leptospirosis in Hawaii, 1974-1998". Clin Infect Dis. 33 (11): 1834–41. doi:10.1086/324084. PMID 11692294.