Leptospirosis is a zoonotic disease with a worldwide distribution affecting most mammalian species. Clinical leptospirosis is common in dogs but appears to be rare in cats. Both dogs and cats, however, can shed leptospires in the urine. This is problematic as it can lead to exposure of humans. The control of leptospirosis, therefore, is important not only from an animal but also from a public health perspective. The aim of this consensus statement is to raise awareness of leptospirosis and to outline the current knowledge on the epidemiology, clinical features, diagnostic tools, prevention and treatment measures relevant to canine and feline leptospirosis in Europe.

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European consensus statement on leptospirosis in dogs and cats

Background: This case series analyses the beneficial effect of methylprednisolone in pulmonary leptospirosis, which usually has an aggressive course and grave outcome. Methods: 30 patients of pulmonary leptospirosis were evaluated. The initial 13 patients did not receive corticosteroids while the remaining 17 all received bolus methylprednisolone one gram intravenously for three days followed by oral prednisolone 1 mg/kg for seven days, on the basis of occasional case reports of benefit in pulmonary leptospirosis. APACHE III and lung injury scores of similar severity were considered while comparing outcomes in those who received methylprednisolone with those who did not. Results: Dyspnoea and haemoptysis were the commonest symptoms in those with pulmonary manifestations. Overall mortality was 18% (3 of 17) in patients who received methylprednisolone, as compared with 62% (8 of 13 patients) in those who did not (p 2.5), five of eight patients survived in the subgroup with corticosteroids (37% mortality) while only one of nine patients survived in the group that did not receive corticosteroids (89% mortality). Corticosteroids affected outcome only if given within the first 12 hours after the onset of pulmonary manifestations. Mortality seemed to correlate with the APACHE scores, and number of quadrants affected on chest radiographs, more than with blood gas pressures. Conclusions: Corticosteroids reduce mortality and change outcome significantly when used early in the management of pulmonary leptospirosis.

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Pulmonary leptospirosis: an excellent response to bolus methylprednisolone.

The recent high-profile death of a British Olympic rower from leptospirosis has raised awareness to this uncommon but potentially fatal disease. The re-emergence of the disease abroad is well documented in the literature, but less is known about cases in the UK. The increase in participation in water sports, foreign travel and often a combination of the two, has increased the exposure of tourists subsequently returning to the UK from areas of high prevalence. Leptospirosis is a zoonotic infection. The bacteria are shed in the urine of animals to the environment from where humans are infected by incidental hosts. There is a wide spectrum of severity of symptoms, from a self-limiting febrile illness to fatal pulmonary haemorrhage, renal or liver failure. It is thought that cases remain unrecognized every year in the UK, largely due to the mild nature of symptoms and the wide differential for febrile illness and partly due to lack of awareness among clinicians. This review examines the epidemiology of leptospirosis in the UK, over the period 2006-10, the clinical features, diagnostic techniques and treatment.

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Leptospirosis and Weil’s disease in the UK

Leptospirosis-associated disturbances of blood vessels, lungs and hemostasis.

Analysis of risk factors associated with severity in patients with confirmed leptospirosis. Retrospective study in 147 leptospirosis-confirmed patients at two tertiary nonteaching hospital in Reunion Island. 138 men and 9 women, aged 36 ± 14 years, 80 in the ICU and 67 in medical wards. We collected demographic, clinical, biological, and radiographic data and performed univariate and multivariate analysis to examine risk factors associated with admission in ICU and mortality. Pulmonary forms were more frequent (85%) than in previous reports, with 85 cases (65.3%) on abnormal chest radiography. Among the 38 patients who underwent bronchoalveolar lavage at admission 31 (81.5%) had alveolar hemorrhage. Independent factors related to ICU admission were: age over 46 years (OR 3.02), creatinine higher than 200 μmol/l (6.69), shock (13.87), and acute respiratory failure (20.69). Mortality was 12.9%. The only factor independently related to mortality was need for mechanical ventilation (OR 20.94). Icterohemorrhagiae serogroup was found in 62 cases (42.8%) but was not related to death. Pulmonary involvement is a major feature in leptospirosis disease but is not associated with poor outcome. Identification of clinical and laboratory findings on admission may help to better characterize severe cases.

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Leptospirosis in Reunion Island (Indian Ocean): analysis of factors associated with severity in 147 confirmed cases

Background: Leptospirosis is an important sporadic zoonotic disease caused by the spirochete Leptospira icterohaemorrhagiae . The disease becomes a major public health problem, particularly during the monsoon months. Materials and Methods : Analysis of autopsy findings of 62 cases of clinically suspected leptospirosis was carried out to identify the pathology and determine the cause of death. Results : Most patients were young males who presented with fever, breathlessness, haemoptysis, bleeding, oliguria and icterus. They died after a brief stay in hospital. A post-mortem diagnosis of leptospirosis was made on the basis of characteristic organ findings, aided by results of serology, Levaditi's staining and / or immunohistochemistry (IHC) on kidney sections. Massive intra-alveolar haemorrhage (48 cases), acute interstitial nephritis and / or acute tubular necrosis (45 cases) and myocarditis (24 cases) were the main autopsy findings. Haemorrhage in various organs like the heart, gastrointestinal tract, brain, pancreas and adrenals were also seen. Thirty of 54 kidney sections were positive for leptospiral antigens by IHC. There was extensive haemorrhages in the lungs in 48 (77%) cases and that was the cause of death in most of these cases. Conclusion : Bleeding into various tissues and organs is the main finding noted in this study. The post-mortem examination of patients dying of leptospirosis revealed that pulmonary haemorrhage was the cause of death in most individuals.

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J R Deshpande

Papers

A study of sutopsy findings in 62 cases of leptospirosis in a metropolitan city in India.