Leptospirosis is a worldwide zoonotic disease.1 Acute renal failure with or without acute hepatic failure commonly develops. Pancreatitis, disseminated intravascular coagulation, hepatic failure (without renal involvement), and pulmonary hemorrhage syndrome have also been documented.1
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Leptospirosis is seen most commonly in late fall and after periods of heavy rainfall.2 Organisms are shed in the urine of reservoir hosts (eg, raccoons, rodents) and transmitted through contact of mucous membranes or broken skin with contaminated water or soilwhere the organism can survive for extended periodsor directly through ingestion of infected tissues.2 The incubation period is 1 week, and leptospiremia is present for 3 to 4 days before the organisms reach the renal tubules, where they are shed in the urine.2 Doxycycline is the treatment of choice and should be initiated as soon as oral therapy is tolerated to resolve urine shedding and decrease the risk to humans.2 Penicillins are effective at clearing leptospiremia and can be used until doxycycline is tolerated; however, they do not clear the carrier state.2 Treatment with doxycycline is recommended for 2 to 3 weeks, and prognosis can be fair at 50% to 80% survival.2 Complete renal recovery may take 3 to 4 weeks, and residual renal damage may persist.2
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