Internal Medicine

0521779407-13 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:15

896 Leptospirosis, Relapsing Fever Leukocytosis: Neutrophil

management

■General supportive care

specific therapy

■Leptospirosis – doxycycline for 7 days is efficacious in mild to mod-

erate disease if started within 72 hours of onset of symptoms; alter-

native is amoxicillin

■Severe disease requiring hospitalization is usually treated with IV

penicillin G 1.5 million units IV every 4–6 hours.

■Relapsing fever – louse-borne disease treated with a single dose of

tetracycline or erythromycin or a single dose of procaine penicillin

G; tick-borne disease treated with 7–10 days of tetracycline or ery-

thromycin

■Rat-bite fever – penicillin G for 10–14 days; oral therapy with peni-

cillin or tetracycline appropriate for mild disease

follow-up

■Jarisch-Herxheimer reaction can occur with therapy; usually seen

within several hours of first dose, and symptoms may be ameliorated

with aspirin or prevented with antibody to tumor necrosis factor;

hypotension may occur, requiring supportive therapy

complications and prognosis

■Weil’s syndrome is a severe form of leptospirosis characterized by

liver and renal failure and associated with a 20% mortality rate; a

severe hemorrhagic pneumonia can also occur.

■Prophylaxis in endemic areas with doxycycline once weekly is 95%

effective in preventing leptospirosis.

■Mortality of treated relapsing fever is 5%.

■Major complication of rat-bite fever is endocarditis. It occurs in those

with pre-existing heart disease and requires 4–6 weeks of parenteral

antibiotic therapy; mortality of untreated disease is about 5%.

LEUKOCYTOSIS: NEUTROPHIL

NANCY BERLINER, MD

history & physical

History

■Leukocytosis is usually reactive.

■Careful history, including recent fever, infections, travel history, med-

ication use