{"id":4440,"date":"2021-09-15T15:51:07","date_gmt":"2021-09-15T03:51:07","guid":{"rendered":"https:\/\/www.awanuilabs.co.nz\/central\/wellington\/?page_id=4440"},"modified":"2025-05-05T14:15:05","modified_gmt":"2025-05-05T02:15:05","slug":"leptospirosis","status":"publish","type":"page","link":"https:\/\/www.awanuilabs.co.nz\/central\/wellington\/for-referrers\/microbiology\/how-do-i-diagnose\/leptospirosis\/","title":{"rendered":"Leptospirosis"},"content":{"rendered":"\n<p><strong>Infection:<\/strong> Leptospirosis; Weil\u2019s disease<\/p>\n\n\n\n<div class=\"wp-block-atomic-blocks-ab-accordion ab-block-accordion\"><details><summary class=\"ab-accordion-title\">Brief description:<\/summary><div class=\"ab-accordion-text\">\n<ul>\n<li>In New Zealand the main risk factor is animal exposure e.g. farming, meat processing, but contact with soil or water contaminated by animals is an additional source of exposure. Seen in travelers, particularly to the tropics, who have had water exposure.<\/li>\n\n\n\n<li>Typically causes a non-specific febrile illness, but conjunctival redness is a more specific sign. Muscle tenderness may also be a feature. Can involve a number of organ systems. Illness ranges from very mild to severe.<\/li>\n<\/ul>\n<\/div><\/details><\/div>\n\n\n\n<div class=\"wp-block-atomic-blocks-ab-accordion ab-block-accordion\"><details><summary class=\"ab-accordion-title\">Did you know?<\/summary><div class=\"ab-accordion-text\">\n<p>The organism infects the kidneys of various animals and is shed in the urine \u2013 this is how it contaminates the environment and human exposure occurs.<\/p>\n<\/div><\/details><\/div>\n\n\n\n<div class=\"wp-block-atomic-blocks-ab-accordion ab-block-accordion\"><details><summary class=\"ab-accordion-title\">Who should I test?<\/summary><div class=\"ab-accordion-text\">\n<ul>\n<li>Can be <strong>difficult to diagnose<\/strong>, as often presents non-specifically. Consider leptospirosis in those with possible <strong>exposures<\/strong>, especially if accompanied by <strong>conjunctival redness<\/strong>.<\/li>\n\n\n\n<li>Consider the diagnosis in patients with <strong>febrile multisystem illnesses<\/strong> e.g. lung infiltrates, kidney, liver derangement.<\/li>\n\n\n\n<li><strong>Mimics to consider<\/strong>:&nbsp;Primary HIV infection, syphilis, viral hepatitis (if significant LFT derangement), bacteraemia.<\/li>\n<\/ul>\n<\/div><\/details><\/div>\n\n\n\n<div class=\"wp-block-atomic-blocks-ab-accordion ab-block-accordion\"><details><summary class=\"ab-accordion-title\">Test of choice:<\/summary><div class=\"ab-accordion-text\">\n<p><strong><a href=\"https:\/\/scg.labapps.nz\/#\/WEL\/details\/27200\" target=\"_blank\" rel=\"noreferrer noopener\">IgM serology<\/a><\/strong> is the recommended <strong>initial screening test<\/strong> for most patients, however it may be negative within the <strong>first week<\/strong> of symptoms.<\/p>\n\n\n\n<ul>\n<li>Reasonable<strong> sensitivity&nbsp;&#8211; <\/strong>a <strong>negative<\/strong> test in a person with symptoms &gt;7 days makes the diagnosis <strong>less likely<\/strong><\/li>\n\n\n\n<li>Moderate<strong> specificity &#8211; <\/strong>a <strong>positive<\/strong> test <strong>does not necessarily confirm<\/strong> infection, as other febrile illnesses can cause <strong>cross-reactions<\/strong><\/li>\n<\/ul>\n\n\n\n<p>For this reason, positive tests are sent to a reference laboratory for <strong>microscopic agglutination testing (MAT)<\/strong>, which is <strong>more specific<\/strong>.<\/p>\n\n\n\n<ul>\n<li>To improve diagnostic accuracy, a <strong>convalescent sample<\/strong> collected <strong>14-21 days<\/strong> after the first is recommended.<\/li>\n\n\n\n<li>A significant rise on MAT between the first (acute) and convalescent samples <strong>confirms<\/strong> leptospirosis.<\/li>\n<\/ul>\n\n\n\n<p><strong><a href=\"https:\/\/scg.labapps.nz\/#\/WEL\/details\/27194\" target=\"_blank\" rel=\"noreferrer noopener\">PCR<\/a><\/strong> is also used to diagnose leptospirosis. It can be used on <strong>blood samples<\/strong> within the <strong>first 7 days<\/strong> of illness. After this time, the organisms <strong>move to the kidneys<\/strong>, so a <strong>urine<\/strong> is required.<\/p>\n\n\n\n<ul>\n<li>In the first 7 days of illness: on<strong> blood and urine<\/strong><\/li>\n\n\n\n<li>After 7 days of illness: on<strong> urine <\/strong>(the organisms leave the blood and <strong>move to the kidneys <\/strong>after this time).<\/li>\n\n\n\n<li>Moderate<strong> sensitivity &#8211; <\/strong>particularly in the urine, shedding of organisms is <strong>intermittent<\/strong>, so a <strong>negative<\/strong> test <strong>does not exclude<\/strong> infection<\/li>\n\n\n\n<li>Excellent <strong>specificity<\/strong>&nbsp; &#8211; a <strong>positive<\/strong> test <strong>confirms<\/strong> the diagnosis.<\/li>\n<\/ul>\n\n\n\n<p>We recommend <strong>IgM serology as the initial test for most patients<\/strong>. In general PCR is reserved for <strong>hospitalised<\/strong> patients. In instances of possible <strong>occupational exposure<\/strong> (where WorkSafe NZ may investigate and an ACC claim may be made) PCR is sometimes used, due to its excellent specificity.<\/p>\n<\/div><\/details><\/div>\n","protected":false},"excerpt":{"rendered":"Infection: Leptospirosis; Weil\u2019s disease","protected":false},"author":18,"featured_media":0,"parent":4222,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"page-left-sidebar.php","meta":{"footnotes":""},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v24.2 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Leptospirosis &#8211; Awanui Labs - Wellington<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.awanuilabs.co.nz\/central\/wellington\/for-referrers\/microbiology\/how-do-i-diagnose\/leptospirosis\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Leptospirosis &#8211; 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