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Leptospirosis

J. Scott Weese, DVM, DVSc, DACVIM, Ontario Veterinary College, Ontario, Canada

Infectious Disease

|April/May 2021|Peer Reviewed

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Clinician's Brief
Clinician's Brief
* Utility of PCR is low if antimicrobials were started before specimen collection.

Leptospirosis Management

Once leptospirosis diagnosis is confirmed, patients should be treated with antimicrobials and supportive care as needed.

Antimicrobials

  • If the patient can tolerate oral medication: Doxycycline (5 mg/kg PO every 12 hours) for 14 days1
  • If the patient cannot tolerate oral medication: Ampicillin (20 mg/kg IV every 6 hours), then, if possible, de-escalated to oral doxycycline (5 mg/kg PO every 12 hours) for an additional 14 days1

Supportive Care

  • IV fluids for replacement, diuresis, acid-base balance, and electrolyte maintenance
  • Antiemetics
  • Nutritional support for renal or hepatic injury
  • Renal replacement therapy can be considered in oliguric dogs developing volume overload, severe hyperkalemia, or severe azotemia nonresponsive to medical management.1
  • Other care as needed based on clinical syndrome and patient response to treatment

During hospitalization, hydration status should be carefully monitored (ie, measure “ins and outs,” thoracic auscultation, blood pressure), as should BUN/creatinine, acid-base/electrolytes, ± hepatic enzymes (as often as every 24 hours initially). PCV should be rechecked as often as every 24 hours initially, and CBC should be repeated as often as every 48 hours if thrombocytopenia is present and/or in severe cases. Urine specific gravity should also be rechecked every few days once fluid therapy has been discontinued, and clotting factors should be rechecked if abnormal.

Approximately 1 week after the patient is discharged, serum chemistry profile should be repeated, as should CBC if abnormalities were present at the time of discharge. Serum chemistry profile should be rechecked again in 3 to 7 days if results are still abnormal. Urine specific gravity should be monitored regularly if abnormal.

Table

LEPTOSPIROSIS TESTS & CONSIDERATIONS

Test Target Sample type Patient-side? Impacted by vaccination? Impacted by antimicrobial treatment?
MAT Antibody (IgM and IgG) Serum No Yes No
Lepto rapid test Antibody (IgM) Serum Yes Yes No
LipL-32 Leptospira Antibody (IgG>IgM) Serum Yes Yes No
PCR Antigen Urine, whole blood No No Potentially

IgG = immunoglobulin G, lgM = immunoglobulin M, MAT = microscopic agglutination test

References

For global readers, a calculator to convert laboratory values, dosages, and other measurements to SI units can be found here.

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