Health Care Workers
Symptoms include fever, headache, chills, muscle aches, vomiting, jaundice, anemia, and sometimes a rash. The incubation period is usually 7 days, with a range of 2-29 days. If not treated, the patient could develop kidney damage, meningitis, liver failure, and respiratory distress. In rare cases, death occurs.
Leptospires are long, thin, motile spirochetes. They may be free-living or associated with animal hosts and survive well in fresh water, soil, and mud in tropical areas. Organisms are antigenically complex, with over 200 known pathogenic serologic variants. Although certain geographic regions contain specific leptospiral serovars and species, the serologic characterization of an isolate is not an absolute predictor of its species designation.
Clinical course is highly variable. The serious icteric form (Weil's disease) is not common, but hemorrhage, hepatomegaly, pulmonary hemorrhage, ARDS, and jaundice are among the severe features. Case fatality rate is 1 to 5%.
Despite not being a reportable disease, leptospirosis has been reported in numerous states. To better identify leptospirosis in high-risk areas, active surveillance will be necessary.
Incidence and Trends
It is estimated that 100-200 Leptospirosis cases are identified annually in the United States. About 50% of cases occur in Hawaii.
The largest recorded U.S. outbreak occurred in 1998, when 775 people were exposed to the disease. Of these, 110 became infected.
Although incidence in the United States is relatively low, leptospirosis is considered to be the most widespread zoonotic disease in the world.
Significant increases in incidence have been reported from Peru and Ecuador following heavy rainfall and flooding in the spring of 1998. Thailand has also reported a rapid increase in incidence between 1995 and 2000.
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