leptospirosis

leptospirosis

diagnosisPaparan terhadap urin hewan.Nyeri kepalaDemamNyeri otot (otot betis dan area lumbal)MualMuntahDiareBatukFaringitisKonjungtivitisRuam kulit Conjunctival suffusion (dilated conjunctival blood vessels in the absence of discharge); pharyngeal erythema without exudate; muscle tenderness; rales on lung auscultation or dullness on chest percussion over areas of pleural hemorrhage; rash (which may be macular, maculopapular, erythematous, petechial, or ecchymotic); jaundice; meningismus; and hypo- or areflexia, particularly in the legs.Hematologic abnormalities are variable but common: leukocytosis (typical in severe disease), leukopenia, hemolytic anemia, mild to moderate anemia, and thrombocytopenia.Urinalysis may show abnormalities of the sediment (leukocytes, erythrocytes, hyaline and granular cases). Elevation of the noncardiac isoform of creatine kinase may indicate skeletal muscle damage.On chest radiography, the appearance of the lungs varies. Alveolar infiltrates predominate and are associated with hemoptysis but not with purulent sputum. Other findings include diffuse interstitial infiltrate patterns corresponding to hyaline membrane disease (acute respiratory distress syndrome) and small nodular infiltrates and pleural-based densities representing hemorrhage.Leptospires can be cultured from blood and CSF during the first 710 days of illness and from urine beginning in the second week.Cultures usually become positive after 24 weeks (range, 1 week to 6 months). Urine cultures can remain positive for months or years despite antibiotic therapy.DIFFERENTIAL DIAGNOSISWhen fever and severe myalgia predominate, influenza is often considered, although the absence of coryza, sore throat, and cough is not consistent with this diagnosis. Other important possibilities include malaria, rickettsial diseases, arboviral infections (e.g., dengue and chikungunya), typhoid fever, hantavirus infection (hemorrhagic fever with renal syndrome or hantavirus cardiopulmonary syndrome), and viral hepatitis.PREVENTIONGeneral sanitationapproaches (e.g., rodent control) and avoidance of swimming inpotentially contaminated places (e.g., for recreational use) are recommended,but these measures are difficult to apply consistently.