Infectious Disease in MRCP- Leptospirosis

Infectious Disease in MRCP-Leptospirosis

OK, I told you before a few common infections which are popular in MRCP examination. These infections include HIV, Tuberculosis, Infective endocarditis. Today, we are going to discuss another common infection which is popular if you are sitting MRCP Part 1 and 2 examination.

Yes, Leptospirosis is important because it is the most wide spread zoonosis caused by Gram-negative organism Leptospira interrogans. It is harboured by wide varities of animals but mainly by rats. Therefore, anyone exposed and has contact with animals, animal products ( like rats’ urine) or soil/water contaminated with leptospiras may get the infection.

Recreational activities like swimming, rafting, canoeing in contaminated rivers/lakes may expose someone to leptospiras.

Signs and symptoms of Leptospirosis

Always remember that patients always go through biphasic course during the illness. Phase 1 ( about 1 week) is considered as febrile/septicaemic phase where patients experience with high fever and non specific symptoms such as myalgia, headache, diarrhoea, arthralgia. ( symptoms that are common in viral infections)

During the second phase (4- 30 days), patients go through what is considered as immune phase where they may have aseptic meningitis, acute renal failure,pulmonary haemorrhage, myocarditis, liver failure ( therefore you may find jaundice) and ARDS.

Investigations

Always check FBC, LFT ( ALT usually mildly elevated), CK which may be raised due to carditis or muscle break down.
Remember that Leptospira can be cultured from blood or CSF during the first week of illness and from urine from 2-4 weeks of illness ( popular question in MRCP). However, diagnosis is usually confirmed by serology.

Complications
Acute renal failure ( common during immune phase), ARDS, DIVC

Treatment

IV penicillin or ceftrixaone or doxycyline for mild disease.