Leptospirosis Infection Disease Specialist In Mumbai Leptospirosis is a widespread and prevalent disease, caused by pathogenic organisms of the genus Leptospira. Various mammals are natural hosts; humans are infected incidentally after animal or environmental exposure. The human infection usually results from exposure to environmental sources, such as animal urine, contaminated water or soil, or infected animal tissue. The portals of entry include cuts or abraded skin, mucous membranes, or conjunctivae. The infection may rarely be acquired by ingestion of food contaminated with urine or via aerosols. Leptospirosis is often associated with increased rainfall or flooding, which presumably increased the risk of exposure to contaminated water. One of the important risk factor is living in rodent infested, flood – prone , overcrowded urban areas. The clinical course is variable. Most cases are mild and self – limited or subclinical, while some are severe and potentially fatal. The prompt consultation with a specialist is paramount. The illness generally presents with the abrupt onset of fever, rigors, myalgias, and headache. The presence of conjunctival suffusion, characterized by conjunctival redness, is an important sign. Some patients may develop nonproductive cough, nausea, vomiting and diarrhea. Less common symptoms include arthralgias, bone pain, sore throat, and abdominal pain. Leptospirosis has been described as a biphasic illness. The first phase consists of an acute febrile phase lasting two to nine days, after which there may be a period with little or no fever and apparent improvement. The second phase is characterized by renewed fever and development of complications. Weil’s disease is when leptospirosis is complicated by jaundice and renal failure. The other alarming complications include bleeding from lungs, acute respiratory distress syndrome ( ARDS ), involvement of heart and brain. The apt participation of a specialist in the care of a patient, is of supreme importance for early recognition and management of complications. The routine laboratory tests may be nonspecific. The white blood cell ( WBC ) counts may range from low normal to high. Many patients develop low platelets. There may be renal failure and jaundice in severe leptospirosis. Approximately 40 percent of patients have minimal to moderate elevations of liver enzymes. A high index of suspicion is required to make the diagnosis, since clinical and laboratory findings are often nonspecific in acute infection. The molecular techniques such as polymerase chain reaction (PCR) are increasingly available and useful for rapid, accurate diagnosis of acute leptospirosis. The serologic tests are used most frequently for diagnosis of leptospirosis. The antibodies only appear from day 5 to 7 of illness. The guidance from a specialist should be sought regarding the appropriate choice of investigations. The antibiotic therapy should be administered to shorten the duration of illness as some patients do develop complications with significant morbidity and mortality. For mild diseases, medications like doxycycline, azithromycin or amoxicillin are used. In patients, hospitalized with severe disease, medications like penicillin, doxycycline, ceftriaxone or cefotaxime are given via intravenous route along with supportive care of the vital organs. The most important control measures include avoiding potential sources of infection such as stagnant water and animal farm water runoff, rodent control and protection of food from animal contamination. There is no human vaccine widely available. There is definite role for prophylaxis with medications for individuals with high likelihood for exposure.