After flood or sewage exposure: fever, myalgia, conjunctival suffusion, then jaundice, non-oliguric hypokalaemic AKI, pulmonary haemorrhage and myocarditis. Give penicillin G or ceftriaxone early; dialyse early; lung-protective ventilation for pulmonary haemorrhage.
At the bedside
Timed steps- 1
Exposure
SuspectWading in flood water, farming (paddy), sewer work, animal contact, 2-20 days before.
- 2
Weil's
SevereJaundice with modest transaminase rise, AKI (often non-oliguric with hypokalaemia), thrombocytopenia, haemoptysis/pulmonary haemorrhage, myocarditis, aseptic meningitis.
- 3
Tests
DiagnoseIgM ELISA (after day 5), MAT (reference), PCR in first week; do not wait for results to treat.
- 4
Antibiotics
TreatPenicillin G 1.5 MU IV 6-hourly or ceftriaxone 1-2 g IV daily for 7 days; doxycycline 100 mg 12-hourly for milder disease.
- 5
Kidney and lung
Organ supportReplace K+; early daily dialysis for oliguria, hyperkalaemia, acidosis or overload; pulmonary haemorrhage: intubation, low tidal volume, high PEEP; consider plasma exchange or steroids only in trials/selected cases.
Severe leptospirosis
Benzylpenicillin (penicillin G)
- Dose
- 1.5 million units every 6 h for 7 days
References
- 1
- 2
- 3
Suspected leptospirosis
Step 1 of ~3
Decision: Jaundice, AKI, bleeding or lung involvement?
Based on World Health Organization, International Leptospirosis Society. Educational use; follow local protocol.
Evidence
- WHO 2003 guidance for diagnosis; antibiotic choice from ICMR 2019 and ISCCM 2014.
Controversies
- Benefit of antibiotics late in disease and of steroids/plasma exchange for pulmonary haemorrhage is uncertain.
🇮🇳 India notes
- Outbreaks follow monsoon floods in Mumbai, Kerala, Gujarat, coastal Karnataka and the Andaman Islands.
References
- 1
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- 3
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Educational reference for trained clinicians. Check doses against your hospital protocol and the patient in front of you.