Task force advocates guidelines on leptospirosis management

Gabriel Angelo Sembrano, RN In 2010, the Leptospirosis Task Force composed of the Philippine Society of Nephrology, the Philippine Society for Microbiology and Infectious Diseases and the Philippine College of Chest Physicians released practice guidelines for leptospirosis outbreaks. These guidelines are important for emergency physicians in diagnosing and treating leptospirosis, said Dr. Richard Hizon, nephrologist with the National Kidney and Transplant Institute. In diagnosing leptospirosis, early recognition and prompt treatment must be prioritized so that further complications and fatal consequences can be prevented. According to Hizon, gathering extensive information during clinical assessment and epidemiologic history is considered to be more important than waiting for the results of laboratory work. The Task Force recommends that patients should be suspected with leptospirosis if they present with acute fever for at least two days, reside in a flooded area, and manifest at least two of the following symptoms: myalgia, calf tenderness, conjunctival suffusion, chills, abdominal pain, headache, jaundice or oliguria. He adds that categorization of the case to either mild, or moderate to severe is vital. Hizon explained that practitioners should be on the lookout for certain laboratory findings that serve as markers for severe leptospirosis. These are complete blood count, serum creatinine, liver function tests, bleeding parameters, serum potassium, arterial blood gas, chest radiograph and electrocardiogram. He pointed out that patients with stable vital signs, anicteric sclerae, good urine output, no evidence of meningismus or meningeal irritation, no signs of sepsis or jaundice, and no difficulty in breathing, are considered to have mild leptospirosis and are manageable at home with proper medications as prescribed by the physician. Moderate to severe cases are best managed in healthcare or hospital settings. They usually present with unstable vital signs, jaundice, abdominal pain, nausea, vomiting, diarrhea, oliguria or anuria, meningismus or meningeal irritation, sepsis, altered mental states, difficulty in breathing and hemoptysis.

Hizon mentioned that doxycycline is the drug of choice in managing leptospirosis. Alternative drugs include amoxicillin and azithromycin. For moderate to severe cases, the drug of choice is penicillin G; and alternative drugs may include parenteral ampicillin, third-generation cephalosporin and parenteral azithromycin dehydrate. Antibiotic therapy should be given for 7 days, except for azithromycin dihydrate which could be given for 3 days. Hizon stressed that kidneys are consistently involved in leptospirosis. Thus, indicated for emergency dialysis are patients who present with any of the following: uremic symptoms, serum creatinine of >3mg/dL, serum potassium level of >5 meq/L in oliguric patients, pulmonary hemorrhage, blood pH of >7.2, or fluid overload. -GAS