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(a test requiring expertise since false-positives are frequent in inexperienced hands) or by culture on a semisolid medium (eg, Fletcher s EMJH) Cultures take 1 6 weeks to become positive The organism may also be grown from the urine from the tenth day to the sixth week Diagnosis is usually made by means of serologic tests, of which several are available Agglutination tests (microscopic, using live organisms, and macroscopic, using killed antigen) become positive after 7 10 days of illness, peak at 3 4 weeks, and may persist at high levels for many years Thus, to make a diagnosis, a fourfold or greater rise in titer must be documented The agglutination tests are cumbersome to perform and require trained personnel Indirect hemagglutination, enzyme immunosorbent assay (EIA), and enzyme-linked immunosorbent assay (ELISA) tests are also available The IgM EIA is particularly useful in making an early diagnosis, since it is positive as early as 2 days into illness, a time when the clinical manifestations may be nonspecific, and it is extremely sensitive and specific (93%) PCR methods (presently investigational) appear to be sensitive, specific, positive early in disease, and able to detect leptospiral DNA in blood, urine, cerebrospinal fluid, and aqueous humor Serum creatine kinase (CK) is usually elevated in persons with leptospirosis and normal in persons with hepatitis



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Myocarditis, aseptic meningitis, renal failure, and pulmonary infiltrates with hemorrhage are not common but are the usual causes of death Iridocyclitis may occur





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Various antimicrobial drugs, including penicillin, ceftriaxone, and tetracyclines, show antileptospiral activity Penicillin (eg, 15 million units every 6 hours intravenously) or ceftriaxone (1 g daily intravenously) is the drug of choice in severe leptospirosis and is especially effective if started within the first 4 days of illness Jarisch Herxheimer reactions may occur Doxycycline, 100 mg orally twice daily for 7 days, is also effective as therapy if started early, but this agent is most often used in mild to moderate disease Although therapy for mild disease is controversial, most clinicians treat with oral penicillin, 500 mg four times daily, or doxycycline, 100 mg orally twice daily, for 7 days Azithromycin is also active, but clinical experience is limited Effective prophylaxis consists of doxycycline, 200 mg orally once weekly during the risk of exposure

Without jaundice, the disease is almost never fatal With jaundice, the mortality rate is 5% for those under age 30 years and 30% for those over age 60 years

Then convert them to dotted decimal:

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Ahmad SN et al Laboratory diagnosis of leptospirosis J Postgrad Med 2005 Jul Sep;51(3):195 200 [PMID: 16333192] Bharti AR et al Leptospirosis: a zoonotic disease of global importance Lancet Infect Dis 2003 Dec;3(12):757 71 [PMID: 14652202] Edwards CN et al Prevention and treatment of leptospirosis Expert Rev Anti Infect Ther 2004 Apr;2(2):293 8 [PMID: 15482194]

The leukocyte count may be normal or as high as 50,000/mcL, with neutrophils predominating The urine may contain bile, protein, casts, and red cells Oliguria is common, and in severe cases uremia may occur Elevated bilirubin and aminotransferases are seen in 75%, and elevated creatinine (> 15 mg/dL) is seen in 50% of cases In cases with meningeal involvement, organisms may be found in the cerebrospinal fluid during the first 10 days of illness Early in the disease, the organism may be identified by darkfield examination of the patient s blood

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