Crystel Sheena Baguisa-Reyes, MD

 Acute fever for at least 2 days

 Residing in a flooded area OR has high-risk
exposure
 At least 2 of the following symptoms:
 Myalgia
 Calf tenderness
 Conjunctival suffusion
 Chills
 Abdominal pain
 Headache
 Jaundice
 Oliguria
 Direct Detection Method
 Culture and Isolation – GOLD Standard
▪ Blood and CSF: within 7 days of illness
▪ Urine: 2nd-4th week of illness
 PCR
▪ Early confirmation of the diagnosis especially during the
acute leptospiremic phase
▪ Blood and CSF: within 7 days of illness
▪ Urine: 2nd-4th week of illness
 Indirect Detection Method
 MAT (Microagglutination Test)
▪ Confirmatory: four-fold rise of the titer
▪ Blood collected twice at an interval of 10days: >1week
of illness
 Specific IgM Rapid Diagnostic Tests
▪ LeptoDipstick, Leptospira IgM ELISA (PanBio), MCAT
and Dridot
▪ False negative during the early stages of illness
▪ Blood or serum: >1week of illness
 Stable VS
 Anicteric sclerae
 Good UO
 No evidence of meningeal irritation
 No evidence of sepsis
 No DOB
 No jaundice
 Can take ORAL meds
 Unstable VS
 Jaundice/Icteric sclerae
 Abdominal pain
 Nausea, vomiting, diarrhea
 Oliguria, anuria
 Meningeal irritation
 Sepsis
 Altered mental state
 DOB
 Hemoptysis
 MOST EFFECTIVE preventive measure:
avoidance of high-risk exposure
 Antibiotics are NOT routinely recommended
 For NON-pregnant, NON-lactating adults who are
likely to get exposed (travelers, soldiers, water-
related recreational and occupational activities):
▪ Doxycycline 200mg once weekly, to begine 1-2 days
before exposure and continued throughout the period of
exposure
 DOXYCYCLINE
 Duration of prophylaxis depends on
▪ Degree of exposure, and
▪ Presence of wound/s
 Should continue to monitor for fever and flu-like
symptoms
 Should continue to wear personal protective
measures because antibiotic prophylaxis is NOT
100% effective
 LOW-RISK Exposure
 Single history of wading in flood or contaminated
water
 NO wounds, cuts or open lesions of the skin

 Doxycycline 200mg SINGLE dose withing 24-

72hrs from exposure
 MODERATE-RISK Exposure
 Single history of wading in flood or contaminated
water
 WITH wounds, cuts or open lesions of the skin
 OR accidental ingestion of contaminated water

 Doxycycline 200mg OD x 3-5days to be started

immediately within 24-72hrs from exposure
 HIGH-RISK Exposure
 Continuous exposure of wading in flood or
contaminated water
 WITH or WITHOUT wounds, cuts or open lesions of
the skin
 Swimming in flooded waters especially areas infested
with domestic/sewer rats
 Ingestion of contaminated water

 Doxycycline 200mg once weekly until the end of

exposure
 Contraindications:
 Pregnant – permanent teeth discoloration of
unborn baby
 Breastfeeding – passes into breastmilk
 Child <8 y/o – permanent yellowing or graying of
teeth, can affect bone and child growth
 Allergy to similar medicines such as
Demeclocycline, Minocycline, or Tetracycline
 Precautions:
 Can make birth control pills less effective
 Avoid exposure to sunlight or artificial UV rays
 Do NOT take Iron, MVT, Ca, Antacids or Laxatives
within 2hrs before or after taking Doxycycline
 Take WITH food or after a meal
 Nausea inducing, stomach irritation
 Do NOT lie down for an hour after intake
 Prevent esophageal damage
 One of the major complications of
leptospirosis
 10-60% of patients

 Combination of acute tubular damage and

tubule-interstitial nephritis
 Clinical Features:
 Tubular dysfunction:
▪ Hypokalemia
▪ Polyuria
 Severe AKI:
▪ Hyperkalemia
▪ Oliguria
 Diagnostics:
 Creatinine: increased
 Na, K: decreased
 Urinalysis: pyuria, hematuria, proteinuria,
crystalluria
 CXR: when pulmonary involvement is suspected
 Management:
 IVF: PNSS with K incorporation
 Hemodialysis if with any of the following:
▪ Uremic symptoms – nausea, vomiting, altered mental status,
seizure, coma
▪ Serum creatinine >3mg/dl
▪ Serum K >5meq/L in an oliguric patient
▪ ARDS, Pulmonary hemorrhage
▪ pH >7.2
▪ Fluid overload
▪ Oliguria despite hydration measures
 Pulmonary hemorrhage
 Acute respiratory distress syndrome

 Both are associated with worse prognosis and high mortality

 Signs and Symptoms:
 Tachypnea (RR > 30/min) – FIRST sign of
pulmonary involvement
 Cough
 Hemoptysis
 Dyspnea
 Diagnostics:
 CXR: bilateral pulmonary infiltrate as early as
24hrs of the systemic stage
 ABG: hypoxemia and hypocarbia
 Treatment:
 Methylprednisolone
▪ BOLUS within the 1st 12hrs of onset of respiratory
involvement
▪ 1gm IV/day x 3days then, Oral Prednisolone 1mg/kg/day
x 7days
 O2 support