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J Crit Care. 2018 Feb;43:361-365. doi: 10.1016/j.jcrc.2017.11.005. Epub 2017 Nov 10.

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

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Head of Critical Care Unit, Hospital San Juan de Dios and Hospital CIMA, San José, Costa Rica. Postgraduate Council Member of Critical Care, Universidad de Costa Rica, Costa Rica.
Division of Critical Care, Karl Heusner Memorial Hospital/Belize Healthcare Partners Belize Central America, Belize.
Division of Critical Care, Charlotte Maxeke Hospital and Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa. Electronic address:
Department of Critical Care Medicine, Bombay Hospital Institute of Medical Sciences, Mumbai, India.


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.

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