Leptospirosis classification: Difference between revisions

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==Classification==
==Classification==
===Acute Phase===
===Anicteric leptospirosis===
* Also known as Septicemic phase or leptospiremic phase.
* More common but serious illness is uncommon<ref>{{cite web |url=http://www.ncdc.gov.in/writereaddata/mainlinkfile/File558.pdf |title= Leptospirosis |last=prasad |first=jagadeesh |date= |website= |publisher= |access-date= |quote=}}</ref>
* 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.<ref name="pmid16333189">{{cite journal| author=Bal AM| title=Unusual clinical manifestations of leptospirosis. | journal=J Postgrad Med | year= 2005 | volume= 51 | issue= 3 | pages= 179-83 | pmid=16333189 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16333189  }} </ref>
* 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.<ref name="pmid22843698">{{cite journal| author=Forbes AE, Zochowski WJ, Dubrey SW, Sivaprakasam V| title=Leptospirosis and Weil's disease in the UK. | journal=QJM | year= 2012 | volume= 105 | issue= 12 | pages= 1151-62 | pmid=22843698 | doi=10.1093/qjmed/hcs145 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22843698  }} </ref>
* 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
* Most of cases present either subclinical or of very mild severity
* Few cases present with a febrile illness of sudden onset
* Few cases present with a febrile illness of sudden onset
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* May progress to aseptic meningitis in ≤25% of patients and more common in younger age group than the patients with icteric leptospirosis
* 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
* Mortality is very less when compared to icteric leptospirosis
====Icteric leptospirosis====
===Icteric leptospirosis===
* Rapidly progressive and severe form of leptospirosis(Weil's disease)
* 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.<ref name="pmid11692294">{{cite journal| author=Katz AR, Ansdell VE, Effler PV, Middleton CR, Sasaki DM| title=Assessment of the clinical presentation and treatment of 353 cases of laboratory-confirmed leptospirosis in Hawaii, 1974-1998. | journal=Clin Infect Dis | year= 2001 | volume= 33 | issue= 11 | pages= 1834-41 | pmid=11692294 | doi=10.1086/324084 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11692294  }} </ref>
* In the severe form of leptospirosis renal failure, hepatic failure and pulmonary haemorrhage can occur and associate with Icterohaemorrhagiae.<ref name="pmid11692294">{{cite journal| author=Katz AR, Ansdell VE, Effler PV, Middleton CR, Sasaki DM| title=Assessment of the clinical presentation and treatment of 353 cases of laboratory-confirmed leptospirosis in Hawaii, 1974-1998. | journal=Clin Infect Dis | year= 2001 | volume= 33 | issue= 11 | pages= 1834-41 | pmid=11692294 | doi=10.1086/324084 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11692294  }} </ref>

Revision as of 21:53, 5 March 2017

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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

Anicteric leptospirosis

  • More common but serious illness is uncommon[1]
  • 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.[2]
  • 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

  1. prasad, jagadeesh. "Leptospirosis" (PDF).
  2. 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.