If you’ve ever waded through floodwater after a typhoon (hello, Kabayan nurses), you already know why leptospirosis matters. It’s easy to dismiss as “just a fever,” and that’s exactly what makes it dangerous. Here are my notes, then a practice test at the end.
Table of Contents
What is Leptospirosis?
Leptospirosis is a bacterial infection caused by Leptospira spirochetes. It’s a zoonotic disease, which means it passes from animals to humans, most often from the urine of rats, but also from dogs, cattle, and pigs.
- Enters through cuts or broken skin, and through mucous membranes (eyes, nose, mouth) after contact with contaminated floodwater, mud, or soil.
- Common after floods and in farmers, sewer workers, and people who walk through floodwater.
- Incubation is about 2 to 30 days (usually 5 to 14).
- Watch Out For: kidney failure, liver failure with jaundice, bleeding in the lungs, and meningitis.
- Safety Precaution: Standard precautions. It rarely spreads from person to person, but handle urine carefully.
Pathophysiology
The bacteria enter the bloodstream and spread to the organs, especially the kidneys, liver, lungs, and eyes. Damage to the small blood vessels causes inflammation, bleeding, and organ dysfunction.
The illness often happens in two phases:
- Septicemic phase (about the first week): the bacteria are in the blood and cause fever.
- Immune phase: antibodies appear and the illness can return or turn severe.
The severe form is called Weil’s disease: jaundice, kidney failure, and bleeding.
Assessment and Diagnostic Findings
Clinical presentation: Sudden high fever, chills, severe headache, and muscle pain, especially in the calves. Many people also have red eyes (conjunctival suffusion) without discharge, nausea, vomiting, and rash.
Severe disease: jaundice, decreased urine output, shortness of breath, coughing blood, and bleeding.
Laboratory findings
- PCR (early) and antibody tests such as MAT (later) help confirm the diagnosis.
- Elevated creatinine and bilirubin, and low platelets in severe cases.
- Urine may show protein, blood, or casts.
NCLEX Tip: Fever with calf pain and red eyes after floodwater exposure means leptospirosis.
Medical Management
- Doxycycline for mild disease.
- IV penicillin or ceftriaxone for severe disease.
- Supportive care: fluids, oxygen, and dialysis for kidney failure.
- Antibiotics are best started early, even before confirmation, when the history fits.
- Prophylaxis: A single weekly dose of doxycycline may be given to people with high-risk exposure, as per local guidelines.
- Some clients have a temporary worsening (Jarisch–Herxheimer reaction) soon after starting antibiotics.
Nursing Management
Nursing care focuses on early recognition, monitoring organ function, comfort, and education.
- MONITOR: vital signs, urine output, oxygen saturation, bleeding, and level of consciousness.
- Kidney protection: Strict intake and output, fluids as ordered, and report decreased urine output.
- Medication administration: Give antibiotics on time, and ask about the exposure history (floodwater, animals, work).
- Comfort: Acetaminophen for fever and pain, rest, and a quiet environment.
- Infection control: Standard precautions and careful handling of urine and body fluids.
- Education: Avoid wading in floodwater when possible. If it can’t be avoided, wear boots and gloves, cover wounds, wash with soap and water right after, and get checked early if a fever develops within weeks. Control rats and keep food covered.
NCLEX High-Yield Notes
- Rat urine in floodwater is the classic source.
- Calf muscle pain and red eyes without pus.
- Weil’s disease = jaundice + kidney failure + bleeding.
- Doxycycline for mild and IV penicillin or ceftriaxone for severe.
- Watch urine output closely.
Mnemonic (LEPTO):
- Lots of rat urine in floodwater
- Eyes are red (conjunctival suffusion)
- Pain in the calves
- Treat early with antibiotics
- Output of urine must be monitored
