Clinical Manifestations

Figure VIII.81.2 shows the phases of leptospirosis and the relevant diagnostic procedures. The first phase of the disease is characterized by an acute onset of high fever, headache, malaise, conjunctival reddening, muscle pain, often meningism, renal irritation, hypotonia, and relative bradycardia (see Table VIII.81.2). In the second stage, there is danger of organ involvement, which is accompanied by the appearance of specific antibodies in the serum. The disease frequently causes the liver to become enlarged and painful, and can be life-threatening when renal damage is severe. Icterus, when it occurs, can be very intense and last for several weeks. Leptospirosis also causes kidney damage, although the most common second-stage symptom is serosal meningitis, and less frequently encephalomyelitis or neuritis. Swineherds' meningitis is particularly well known (Gsell 1952). Meningitis symptoms usually subside completely in the third week.

As Figure VIII.81.2 indicates, there can be other damage from the disease, but only rarely. When it causes death, postmortem findings reveal renal and hepatic failure represented by renal tubular necroses, hemoglobinemia, and liver cell necrosis with general jaundice and anemia. Hemorrhages can be found in almost any organ, and in muscles and subcutaneous tissue.

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