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Treatment of Leptospirosis

"Incidence and guidelines"
By: Nicole BautistaTreatment of Leptospirosis

“Scary” may sound like an understatement after learning about leptospirosis, but the good news is this is a highly preventable disease—not to mention it’s seasonal (hence, predictable enough). According to the Philippine Society for Microbiology and Infectious Diseases (PSMID), in their Leptospirosis Guidelines, records show “an average of 680 leptospirosis cases and 40 deaths from the disease reported every year and a prevalence of 10/100,000.”

Awareness of the possibility of leptospirosis helps in identifying and treating it as soon as possible. That ASAP-rule is important because leptospirosis can bring about serious complications such as meningitis (infection of the lining of the brain), kidney failure, heart rhythm problems, and liver problems if allowed to persist too long (for example, when diagnosed late).

Left untreated, leptospirosis—which may otherwise have been treated easily as an out-patient case—may instead turn out to be fatal.

The PSMID’s Leptospirosis Guidelines identifies two stages of leptospirosis infection and how to deal with each.

1.  Mild leptospirosis. When diagnosed early, leptospirosis can be treated with oral medication, either with the antibiotic doxycycline, or an alternative like amoxicillin. According to the Guidelines, “Any suspected case of leptospirosis presenting with acute febrile [feverish] illness and various manifestations but with stable vital signs, anicteric sclera [non-yellowing of the whites of the eyes], with good urine output, and no evidence of… meningeal [brain lining] irritation, sepsis [blood infection] or septic shock, difficulty of breathing nor jaundice, and can take oral medications is considered mild leptospirosis and can be managed on an out-patient setting without requiring antimicrobial therapy.”

2.  Severe leptospirosis. On the other hand, the Guidelines state, “Any suspected case of leptospirosis presenting with acute febrile illness associated with unstable vital signs, jaundice or icteric sclera [yellowing of the whites of the eyes], abdominal pain, nausea, vomiting, and diarrhea, oliguria or anuria [little to no urine], meningeal irritation, sepsis or septic shock, altered mental states or difficulty of breathing and hemoptysis [coughing of blood] is considered moderate-severe leptospirosis  and best managed in a healthcare or hospital setting.” In a hospital setting, patients are treated with non-oral medication and monitored every few hours to watch for developments in the progress of the disease. The survival rate for severe leptospirosis is minimal.

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