Leptospirosis. Do you consider the diagnosis?

Patients with Leptospirosis, usually a water borne zoonotic disease, are likely to present themselves to Royal Naval primary health carers, who deal with a young active population, frequently participating in watersports. Leptospira, which belong to the order Spirochaetaceae, comprise of two distinct species. Within each species there are a number of serologically different serovars (serotypes), arranged in related serogroups. L. interrogans var Icterhaemorrhagiae and L. interrogans var Hebdomadis serovar hardjo are the most commonly reported organisms in Great Britain. Traditionally water and sewage workers have been amongst those most frequently infected, but with improved health care awareness this group has been overtaken by farmworkers, and a growing group of people engaged in aquatic sports. Symptoms of Leptospiral infection vary in severity from a mild flu-like illness to symptoms resulting from severe renal, hepatic or meningeal involvement. Mild symptoms respond to oral penicillin, erythromycin or tetracyclines, whilst more serious illness requires i.v. penicillin and supportive nursing. Spirochaetes can be detected in culture using darkground microscopy, and sero-conversion detected by IgM specific dot ELISA techniques. Suspected sera should be sent to PHLS Leptospira Reference Unit, County Hospital, Hereford. HR1 2ER. (Tel: 0432 277117).