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Leptospirosis

Last edited: 4/14/2026

Overview

Leptospirosis is a zoonotic disease caused by pathogenic Leptospira species, affecting both humans and animals, with significant morbidity and mortality, particularly in tropical and subtropical regions 12320.

Diagnosis

  • Clinical Presentation: Fever, muscle aches, headache, conjunctival suffusion, jaundice, and multi-organ dysfunction 15111220.
  • Laboratory Tests: Serological tests (MAT), PCR, and blood cultures; elevated liver enzymes, renal impairment, thrombocytopenia 2222634.
  • Imaging: Chest X-rays may show pulmonary infiltrates; abdominal ultrasound for hepatobiliary involvement 1122.
  • Grading: Weil's classification (Anicteric vs Icteric, with or without organ dysfunction) 19.

    • Management

  • Antibiotics: Early initiation with doxycycline, ampicillin, or ceftriaxone 31020.
  • Supportive Care: Fluid resuscitation, mechanical ventilation, dialysis for renal failure 51629.
  • Adjunctive Therapies: Methylprednisolone for severe cases 21; desmopressin for massive hemoptysis 28.
  • Monitoring: Close observation for complications like myocarditis, pancreatitis, and rhabdomyolysis 71130.

    • Special Populations

  • Pediatrics: Severe forms can occur, requiring prompt diagnosis and treatment 17.
  • Elderly and Comorbidities: Higher risk of severe disease and multi-organ failure; management similar to general population but with heightened vigilance 1819.

    • Key Recommendations

  • Early Antibiotic Therapy: Initiate empirical antibiotic treatment (e.g., doxycycline) in suspected cases to reduce mortality (Evidence: Strong 310).
  • Supportive Care for Multi-Organ Dysfunction: Provide intensive care support including renal replacement therapy for acute renal failure (Evidence: Moderate 516).
  • Consider Corticosteroids in Severe Cases: Use intravenous methylprednisolone in severe leptospirosis to potentially improve outcomes (Evidence: Moderate 21).
  • Rapid Diagnostic Testing: Utilize serological tests and PCR for early diagnosis to guide timely intervention (Evidence: Moderate 222).
  • Prophylactic Measures: Consider antibiotic prophylaxis (e.g., doxycycline) for high-risk groups exposed to contaminated environments (Evidence: Weak 310).

    • References

    1 Thumar R, Shekh SL, Chauhan A, Kapoor K, Joshi A, Gajjar D et al.. Immunoinformatics design and in vivo evaluation of a multiepitope vaccine targeting OMPL1, Lipl32, Lipl41, and Lipl46 for leptospirosis in a male ICR mouse model. Vaccine 2026. link 2 Vivero-Tellez D, Contreras-Ortíz JA, Flores-Martínez E, Gracia-Ramos AE. Weil's Disease with Multi-Organ Dysfunction: A Diagnostic Challenge. Clinical medicine & research 2025. link 3 Win TZ, Perinpanathan T, Mukadi P, Smith C, Edwards T, Han SM et al.. Antibiotic prophylaxis for leptospirosis. The Cochrane database of systematic reviews 2024. link 4 Sethi G, Kim YK, Han SC, Hwang JH. Designing a broad-spectrum multi-epitope subunit vaccine against leptospirosis using immunoinformatics and structural approaches. Frontiers in immunology 2024. link 5 Camous L, Pommier JD, Tressières B, Martino F, Picardeau M, Loraux C et al.. Organ Involvement Related to Death in Critically Ill Patients With Leptospirosis: Unsupervised Analysis in a French West Indies ICU. Critical care explorations 2024. link 6 Hermawati BD, Hapsari BD, Wulandari EL, Prabowo NA, Sukmagautama C, Putri DP et al.. Weil's disease with multiple organ dysfunction, community-acquired pneumonia and septic shock: The role of rapid diagnosis and management. Narra J 2024. link 7 Sharma R, Gurtoo A, Prakash A, Jose R, Bansal P. Leptospiral myocarditis and pancreatitis. Tropical doctor 2023. link 8 Kakita T, Yamagishi M, Oshiro S, Oyakawa C, Nagamine T, Kudeken T et al.. Leptospirosis with multiple organ dysfunction in a mongoose-scat-detection dog infected with Leptospira interrogans serogroup Hebdomadis, Okinawa, Japan. The Journal of veterinary medical science 2022. link 9 Petakh P, Isevych V, Kamyshnyi A, Oksenych V. Weil's Disease-Immunopathogenesis, Multiple Organ Failure, and Potential Role of Gut Microbiota. Biomolecules 2022. link 10 Parameswaran RM, Sundaran SP, Parakkadavath RT. BreaDoxy sandwich for leptospirosis prophylaxis. Tropical doctor 2021. link 11 Dong WH, Chen Z. Leptospirosis with pulmonary haemorrhage and multiple organ failure: a case report and literature review. The Journal of international medical research 2021. link 12 Balderrama-Carmona AP, Cadena-Orea D, Sánchez-Arteaga S, Aguilera-Ávila ML, Soñanez-Organis JG, López-López AA et al.. Severe Leptospirosis in a Mexican Woman. Acta medica academica 2020. link 13 Moreira Marques T, Nascimento PO, Almeida A, Tosatto V. Weil's disease in a young homeless man living in Lisbon. BMJ case reports 2020. link 14 Pal S. An Unusual Presentation of Weil's Disease. The Journal of the Association of Physicians of India 2019. link 15 Miailhe AF, Mercier E, Maamar A, Lacherade JC, Le Thuaut A, Gaultier A et al.. Severe leptospirosis in non-tropical areas: a nationwide, multicentre, retrospective study in French ICUs. Intensive care medicine 2019. link 16 Delmas B, Jabot J, Chanareille P, Ferdynus C, Allyn J, Allou N et al.. Leptospirosis in ICU: A Retrospective Study of 134 Consecutive Admissions. Critical care medicine 2018. link 17 Lokida D, Budiman A, Pawitro UE, Gasem MH, Karyana M, Kosasih H et al.. Case report: Weil's disease with multiple organ failure in a child living in dengue endemic area. BMC research notes 2016. link 18 De Butts RF, Li A, Goodhand J, Wood E. The dangers of living in a tent in London. BMJ case reports 2014. link 19 Gancheva G, Karcheva M. Icterohaemorrhagic leptospirosis in patients with history of alcohol abuse - report of two cases. The Turkish journal of gastroenterology : the official journal of Turkish Society of Gastroenterology 2013. link 20 Yang HY, Yen TH, Lin CY, Chen YC, Pan MJ, Lee CH et al.. Early identification of leptospirosis as an ignored cause of multiple organ dysfunction syndrome. Shock (Augusta, Ga.) 2012. link 21 Kularatne SA, Budagoda BD, de Alwis VK, Wickramasinghe WM, Bandara JM, Pathirage LP et al.. High efficacy of bolus methylprednisolone in severe leptospirosis: a descriptive study in Sri Lanka. Postgraduate medical journal 2011. link 22 Chidambaram N, Ramanathan M, Anandi V, Sasikala S, Innocent DJ, Sarayu L. Leptospirosis: clinical presentation and correlation with serovars. The Journal of communicable diseases 2007. link 23 Chen HI, Kao SJ, Hsu YH. Pathophysiological mechanism of lung injury in patients with leptospirosis. Pathology 2007. link 24 Yang CW. Leptospirosis renal disease: understanding the initiation by Toll-like receptors. Kidney international 2007. link 25 Cheng FW, Leung TF, Lee N, Yap F, Hui J, Fok TF et al.. Fever, pulmonary haemorrhage, and acute renal failure in a young girl. Hong Kong medical journal = Xianggang yi xue za zhi 2005. link 26 Chang ML, Yang CW, Chen JC, Ho YP, Pan MJ, Lin CH et al.. Disproportional exaggerated aspartate transaminase is a useful prognostic parameter in late leptospirosis. World journal of gastroenterology 2005. link 27 O'Leary FM, Hunjan JS, Bradbury R, Thanakrishnan G. Fatal leptospirosis presenting as musculoskeletal chest pain. The Medical journal of Australia 2004. link 28 Pea L, Roda L, Boussaud V, Lonjon B. Desmopressin therapy for massive hemoptysis associated with severe leptospirosis. American journal of respiratory and critical care medicine 2003. link 29 Covic A, Goldsmith DJ, Gusbeth-Tatomir P, Seica A, Covic M. A retrospective 5-year study in Moldova of acute renal failure due to leptospirosis: 58 cases and a review of the literature. Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association 2003. link 30 Coursin DB, Updike SJ, Maki DG. Massive rhabdomyolysis and multiple organ dysfunction syndrome caused by leptospirosis. Intensive care medicine 2000. link 31 Yang CW, Pan MJ, Wu MS, Chen YM, Tsen YT, Lin CL et al.. Leptospirosis: an ignored cause of acute renal failure in Taiwan. American journal of kidney diseases : the official journal of the National Kidney Foundation 1997. link90091-3) 32 Monno S, Mizushima Y. Leptospirosis with acute acalculous cholecystitis and pancreatitis. Journal of clinical gastroenterology 1993. link 33 Luzzi GA, Milne LM, Waitkins SA. Rat-bite acquired leptospirosis. The Journal of infection 1987. link91451-4) 34 Raoult D, Jeandel P, Mailloux M, Rougier Y. Thrombocytopenia and renal failure in leptospirosis. The American journal of tropical medicine and hygiene 1983. link 35 Cumming WJ, Thrush DC, Kenward DH. Bilateral neuralgic amyotrophy complicating Weil's disease. Postgraduate medical journal 1978. link 36 Zeigler JA, Jones RH, Kubica K. Immunization against leptospirosis: vaccine trials with heat-killed whole cell and outer envelope antigens in hamsters. Bulletin of the Pan American Health Organization 1976. link 37 Little TA, Salt GF. The experimental infection of calves with a British leptospire of the Pomona serogroup. Research in veterinary science 1976. link 38 Tripathy DN, Hanson LE. Some observations on chronic leptospiral carrier state in gerbils experimentally infected with Leptospira grippotyphosa. Journal of wildlife diseases 1976. link 39 Humphery TJ. Acute renal failure due to leptospirosis with hyponatraemia. The Medical journal of Australia 1975. link 40 Csata S, Gallyas F, Szendi L, Koller O. Acute renal failure caused by leptospirosis. Acta chirurgica Academiae Scientiarum Hungaricae 1975. link

    Original source

    1. [1]
      Immunoinformatics design and in vivo evaluation of a multiepitope vaccine targeting OMPL1, Lipl32, Lipl41, and Lipl46 for leptospirosis in a male ICR mouse model. — Thumar R, Shekh SL, Chauhan A, Kapoor K, Joshi A, Gajjar D et al. Vaccine (2026)
    2. [2]
      Weil's Disease with Multi-Organ Dysfunction: A Diagnostic Challenge. — Vivero-Tellez D, Contreras-Ortíz JA, Flores-Martínez E, Gracia-Ramos AE Clinical medicine & research (2025)
    3. [3]
      Antibiotic prophylaxis for leptospirosis. — Win TZ, Perinpanathan T, Mukadi P, Smith C, Edwards T, Han SM et al. The Cochrane database of systematic reviews (2024)
    4. [4]
      Designing a broad-spectrum multi-epitope subunit vaccine against leptospirosis using immunoinformatics and structural approaches. — Sethi G, Kim YK, Han SC, Hwang JH Frontiers in immunology (2024)
    5. [5]
      Organ Involvement Related to Death in Critically Ill Patients With Leptospirosis: Unsupervised Analysis in a French West Indies ICU. — Camous L, Pommier JD, Tressières B, Martino F, Picardeau M, Loraux C et al. Critical care explorations (2024)
    6. [6]
      Weil's disease with multiple organ dysfunction, community-acquired pneumonia and septic shock: The role of rapid diagnosis and management. — Hermawati BD, Hapsari BD, Wulandari EL, Prabowo NA, Sukmagautama C, Putri DP et al. Narra J (2024)
    7. [7]
      Leptospiral myocarditis and pancreatitis. — Sharma R, Gurtoo A, Prakash A, Jose R, Bansal P Tropical doctor (2023)
    8. [8]
      Leptospirosis with multiple organ dysfunction in a mongoose-scat-detection dog infected with Leptospira interrogans serogroup Hebdomadis, Okinawa, Japan. — Kakita T, Yamagishi M, Oshiro S, Oyakawa C, Nagamine T, Kudeken T et al. The Journal of veterinary medical science (2022)
    9. [9]
      Weil's Disease-Immunopathogenesis, Multiple Organ Failure, and Potential Role of Gut Microbiota. — Petakh P, Isevych V, Kamyshnyi A, Oksenych V Biomolecules (2022)
    10. [10]
      BreaDoxy sandwich for leptospirosis prophylaxis. — Parameswaran RM, Sundaran SP, Parakkadavath RT Tropical doctor (2021)
    11. [11]
      Leptospirosis with pulmonary haemorrhage and multiple organ failure: a case report and literature review. — Dong WH, Chen Z The Journal of international medical research (2021)
    12. [12]
      Severe Leptospirosis in a Mexican Woman. — Balderrama-Carmona AP, Cadena-Orea D, Sánchez-Arteaga S, Aguilera-Ávila ML, Soñanez-Organis JG, López-López AA et al. Acta medica academica (2020)
    13. [13]
      Weil's disease in a young homeless man living in Lisbon. — Moreira Marques T, Nascimento PO, Almeida A, Tosatto V BMJ case reports (2020)
    14. [14]
      An Unusual Presentation of Weil's Disease. — Pal S The Journal of the Association of Physicians of India (2019)
    15. [15]
      Severe leptospirosis in non-tropical areas: a nationwide, multicentre, retrospective study in French ICUs. — Miailhe AF, Mercier E, Maamar A, Lacherade JC, Le Thuaut A, Gaultier A et al. Intensive care medicine (2019)
    16. [16]
      Leptospirosis in ICU: A Retrospective Study of 134 Consecutive Admissions. — Delmas B, Jabot J, Chanareille P, Ferdynus C, Allyn J, Allou N et al. Critical care medicine (2018)
    17. [17]
      Case report: Weil's disease with multiple organ failure in a child living in dengue endemic area. — Lokida D, Budiman A, Pawitro UE, Gasem MH, Karyana M, Kosasih H et al. BMC research notes (2016)
    18. [18]
      The dangers of living in a tent in London. — De Butts RF, Li A, Goodhand J, Wood E BMJ case reports (2014)
    19. [19]
      Icterohaemorrhagic leptospirosis in patients with history of alcohol abuse - report of two cases. — Gancheva G, Karcheva M The Turkish journal of gastroenterology : the official journal of Turkish Society of Gastroenterology (2013)
    20. [20]
      Early identification of leptospirosis as an ignored cause of multiple organ dysfunction syndrome. — Yang HY, Yen TH, Lin CY, Chen YC, Pan MJ, Lee CH et al. Shock (Augusta, Ga.) (2012)
    21. [21]
      High efficacy of bolus methylprednisolone in severe leptospirosis: a descriptive study in Sri Lanka. — Kularatne SA, Budagoda BD, de Alwis VK, Wickramasinghe WM, Bandara JM, Pathirage LP et al. Postgraduate medical journal (2011)
    22. [22]
      Leptospirosis: clinical presentation and correlation with serovars. — Chidambaram N, Ramanathan M, Anandi V, Sasikala S, Innocent DJ, Sarayu L The Journal of communicable diseases (2007)
    23. [23]
      Pathophysiological mechanism of lung injury in patients with leptospirosis. — Chen HI, Kao SJ, Hsu YH Pathology (2007)
    24. [24]
      Leptospirosis renal disease: understanding the initiation by Toll-like receptors. — Yang CW Kidney international (2007)
    25. [25]
      Fever, pulmonary haemorrhage, and acute renal failure in a young girl. — Cheng FW, Leung TF, Lee N, Yap F, Hui J, Fok TF et al. Hong Kong medical journal = Xianggang yi xue za zhi (2005)
    26. [26]
      Disproportional exaggerated aspartate transaminase is a useful prognostic parameter in late leptospirosis. — Chang ML, Yang CW, Chen JC, Ho YP, Pan MJ, Lin CH et al. World journal of gastroenterology (2005)
    27. [27]
      Fatal leptospirosis presenting as musculoskeletal chest pain. — O'Leary FM, Hunjan JS, Bradbury R, Thanakrishnan G The Medical journal of Australia (2004)
    28. [28]
      Desmopressin therapy for massive hemoptysis associated with severe leptospirosis. — Pea L, Roda L, Boussaud V, Lonjon B American journal of respiratory and critical care medicine (2003)
    29. [29]
      A retrospective 5-year study in Moldova of acute renal failure due to leptospirosis: 58 cases and a review of the literature. — Covic A, Goldsmith DJ, Gusbeth-Tatomir P, Seica A, Covic M Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association (2003)
    30. [30]
      Massive rhabdomyolysis and multiple organ dysfunction syndrome caused by leptospirosis. — Coursin DB, Updike SJ, Maki DG Intensive care medicine (2000)
    31. [31]
      Leptospirosis: an ignored cause of acute renal failure in Taiwan. — Yang CW, Pan MJ, Wu MS, Chen YM, Tsen YT, Lin CL et al. American journal of kidney diseases : the official journal of the National Kidney Foundation (1997)
    32. [32]
      Leptospirosis with acute acalculous cholecystitis and pancreatitis. — Monno S, Mizushima Y Journal of clinical gastroenterology (1993)
    33. [33]
      Rat-bite acquired leptospirosis. — Luzzi GA, Milne LM, Waitkins SA The Journal of infection (1987)
    34. [34]
      Thrombocytopenia and renal failure in leptospirosis. — Raoult D, Jeandel P, Mailloux M, Rougier Y The American journal of tropical medicine and hygiene (1983)
    35. [35]
      Bilateral neuralgic amyotrophy complicating Weil's disease. — Cumming WJ, Thrush DC, Kenward DH Postgraduate medical journal (1978)
    36. [36]
      Immunization against leptospirosis: vaccine trials with heat-killed whole cell and outer envelope antigens in hamsters. — Zeigler JA, Jones RH, Kubica K Bulletin of the Pan American Health Organization (1976)
    37. [37]
      The experimental infection of calves with a British leptospire of the Pomona serogroup. — Little TA, Salt GF Research in veterinary science (1976)
    38. [38]
      Some observations on chronic leptospiral carrier state in gerbils experimentally infected with Leptospira grippotyphosa. — Tripathy DN, Hanson LE Journal of wildlife diseases (1976)
    39. [39]
      Acute renal failure due to leptospirosis with hyponatraemia. — Humphery TJ The Medical journal of Australia (1975)
    40. [40]
      Acute renal failure caused by leptospirosis. — Csata S, Gallyas F, Szendi L, Koller O Acta chirurgica Academiae Scientiarum Hungaricae (1975)
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