Leptospirosis: Report from the task force on tropical diseases by the World Federation of Societies of Intensive and Critical Care Medicine.

Leptospirosis is a zoonosis caused by a gram negative aerobic spirochete of the genus Leptospira. It is acquired by contact with urine or reproductive fluids from infected animals, or by inoculation from contaminated water or soil. The disease has a global distribution, mainly in tropical and subtropical regions that have a humid, rainy climate and is also common in travelers returning from these regions. Clinical suspicion is critical for the diagnosis and it should be included in the differential diagnosis of any patient with a febrile hepatorenal syndrome in, or returning from endemic regions. The leptospiremic phase occurs early and thereafter there is an immunologic phase in which the most severe form, Weil's disease, occurs. In the latter, multiple organ dysfunction predominates. The appropriate diagnostic test depends on the stage of the disease and consists of direct and indirect detection methods and cultures. Severely ill patients need to be monitored in an ICU with appropriate anti-bacterial agents and early, aggressive and effective organ support. Antibiotic therapy consists of penicillins, macrolides or third generation cephalosporins.

Potential benefits of plasma exchange by apheresis on the treatment of severe Icteric Leptospirosis: case report and literature review.

The role of plasmapheresis on the treatment of Leptospirosis has not been define, although it has already been used with beneficial effects in the reported case mentioned above, where was possible to contribute to the resolution of the toxic effects on the tubular renal cells. This case report show how plasma exchange prevents the multiorganic failure.

[Therapy and prevention of leptospirosis]. / Terapia e profilassi della leptospirosi.

After a brief description of the experimental and clinical data on antibiotic treatment of leptospirosis, personal experience of 47 patients is reported. The administration of antibiotics to these patients with Weil's disease, lymphocytic meningitis or grippe-like syndrome began well after the onset of the infection and appeared to have little therapeutic effect. The symptomatic therapy of leptospirosis, especially in the form of Weil's disease with serious renal insufficiency is then referred to and the early use of peritoneal dialysis is recommended. General specific and immunizing (vaccination) prophylaxis procedures are then described.