Diagnosis and treatment of leptospirosis in the primary care setting

Leptospirosis is an infectious illness that usually develops 1 to 2 weeks after indirect or direct exposure to the urine of infected animals. Infection occurs through open cuts, absorption through intact mucous membranes, and drinking contaminated water. The typical presentation is a flulike syndrome of sudden onset that tends to resolve within 2 weeks. A mild immunologic phase usually presents as an aseptic meningitis. A more severe immunologic phase (Well's syndrome) can result in jaundice, renal failure, adult respiratory distress syndrome, disseminated intravascular coagulation, and death. Laboratory tests take too long to replace clinical diagnosis, which is imperative so that antibiotic therapy can begin before the fourth day of illness. Although leptospirosis is more common in tropical climates, detection in the continental United States is increasing. Early, accurate detection and treatment in the primary care setting are vital for limiting life-threatening complications.