Diagnosis

Leptospirosis should be considered in the

differential diagnosis of acute flu-like febrile
illnesses with a history of direct contact with
animals or with soil or water contaminated
with animal urine.
The clinical diagnosis of leptospirosis should
be based on an appropriate exposure history
combined with any of the protean
manifestations of the disease.
 1. Direct Detection Method

a. Culture and isolation labor-intensive, requires

6 to 8 weeks for the result, needs darkfield
microscopy and has low diagnostic yield. It can
identify the serovar but is insensitive.
b. Polymerase Chain Reaction (PCR) has the
advantage of early confirmation of the diagnosis
especially during the acute leptospiremic phase
(first week of illness) before the appearance of
antibodies.
 2. Indirect Detection Methods
a. Microagglutination Test (MAT) a fourfold rise of the
titer from acute to convalescent sera is confirmatory of
the diagnosis. In endemic areas like the Philippines, a
single titer of at least 1:1600 in symptomatic patients is
indicative of leptospirosis.

a. Specific IgM Rapid Diagnostic Tests like LeptoDipstick,

Leptospira IgM ELISA (PanBio), MCAT and Dridot -False
negative results can be a problem if the tests are
performed during the early stage of the illness. A
second sample should be obtained for suspected cases
with initial negative or doubtful results.
 Treatment
Leptospires are highly susceptible to a broad
range of antibiotics, and early intervention
may prevent the development of major organ
system failure or lessen its severity.
 Dose (oral) Comments
Penicillin G 6-8 million U/m/day Adverse effects can include hypersensitivity
divided every 4 hr reactions including urticaria, fever, joint pains,
TIV for 7 days rashes, angioedema, anaphylaxis, serum
sickness-like reaction.
Tetracycline 10-20 mg/kg/day Do not give this medicine to a child younger
divided every 6 than 8 years old. Tetracycline can cause
hours PO or TIV for 7 permanent yellowing or graying of the teeth,
days and it can affect a child's growth.
Take tetracycline with a full glass of water (8
ounces).
Take this medication on an empty stomach, at
least 1 hour before or 2 hours after meals.
Do not take tetracycline with milk or other
dairy products, unless your doctor has told you
to. Dairy products can make it harder for your
body to absorb the medicine.
 Dose (oral) Comments
Doxycycline 4 mg/kg single dose, Proven efficacy for
Max dose : 200 mg preventing clinical disease.
Adverse effects are similar
to other tetracyclines; in
children below 8 years of
age, doxycycline is unlikely
to cause dental staining at
the dose and duration
recommended to treat
serious infections
Avoid milk, dairy products,
iron and antacids 1 hour
before and 2 hours after
administration; may be
given with food to avoid
stomach upset.
 Dose (oral) Comments

Azithromycin 10 mg/kg single dose, Efficacy for prevention of

max dose: 500mg leptospirosis was seen in
vitro and animal models
Amoxycillin 50 mg/kg/day every 6 hours for No clinical trial for
3-5 days prevention of
Max dose: 500 mg every 6 hours leptospirosis, but
amoxycillin is a known
alternative for the
treatment of disease
Dose is for 3-5 days to the
very short half life.
 Prophylaxis
1. Preexposure
The most effective preventive measure is avoidance of
highrisk exposure (i.e. wading in floods and
contaminated water, contact with animals body fluid). If
high risk exposure is unavoidable, appropriate personal
protective measures include wearing boots, goggles,
overalls, and rubber gloves.

Preexposure antibiotic prophylaxis is NOT ROUTINELY

RECOMMENDED. However, in those individuals who
intend to visit highly endemic areas AND are likely to get
exposed (e.g. travelers, soldiers, those engaged in
waterrelated recreational and occupational activities),
preexposure prophylaxis may be considered for
shortterm exposures.
 The recommended regimen for preexposure
prophylaxis for children is: Doxycycline
(hydrochloride and hyclate) 4 mg/kg single dose, max
dose : 200 mg, once weekly, to begin 1 to 2 days
before exposure and continued throughout the
period of exposure.
2. Post exposure
Doxycycline (hydrochloride and hyclate) is the
recommended post exposure chemoprophylactic
agent for leptospirosis.
The duration of prophylaxis depends on the
degree of exposure and the presence of wounds.
Individuals should continue to monitor
themselves for fever and other flulike symptoms
and should continue to wear personal protective
measures since antibiotic prophylaxis is not 100%
effective.
The decision to give prophylaxis depends on the
risk exposure assessment.
2.1. LOWRISK EXPOSURE -is defined as those individuals
with a single history of wading in flood or contaminated
water without wounds, cuts or open lesions of the skin.
Doxycycline 4 mg/kg single dose within 24 to 72 hours
from exposure

2.2. MODERATERISK EXPOSURE is defined as those

individuals with a single history of wading in flood or
contaminated water and the presence of wounds, cuts, or
open lesions of the skin, OR accidental ingestion of
contaminated water.
Doxycycline 4 mg/kg once daily for 35 days to be
started immediately within 24 to 72 hours from
exposure
 2.3. HIGHRISK EXPOSURE- is defined as those
individuals with continuous exposure (those having
more than a single exposure or several days such as
those residing in flooded areas, rescuers and relief
workers) of wading in flood or contaminated water
with or without wounds, cuts or open lesions of the
skin. Swimming in flooded waters especially in
urban areas infested with domestic/sewer rats and
ingestion of contaminated water are also
considered high risk exposures.

Doxycycline 4 mg/kg once weekly until the end of

exposure
 Prevention
Prevention of leptospirosis includes the
following:
1. Parents should instruct children
not to wade or swim in flood
waters.

2. If exposure to flood waters is

unavoidable, protective gear such as
boots, goggles, overalls, and rubber
gloves should be used.

3. All food and drinking water should

be protected against contamination.
Fresh vegetables and fruit should be
washed in previously boiled or clean
water and then cooked or peeled.
4. Boil drinking water for at least 10-15
minutes. Physical filtration through
ceramic or charcoal filters is not
adequate for leptospirosis.

5. Food should be protected against

rodent attack or contamination.

6. If children are exposed to flood

waters, antibiotic prophylaxis may
decrease occurrence of clinical disease
and mortality. Prophylactic antibiotics
should be given under the supervision
of a physician, who can give advice
regarding effects, precautions and
contraindications for these medications.
 Prognosis
Most patients with leptospirosis recover.
However, post leptospirosis symptoms, mainly
of depression like nature, may occur and
persist for years after the acute disease.
Mortality rates are highest among patients
with pulmonary hemorrhage and Weils
syndrome.
Long term follow up of patients with renal
failure and hepatic dysfunction has
documented good recovery of renal and
hepatic function.