As with most aspects of infectious disease control in the veterinary setting, little objective information defining optimal practices for management of patients with leptospirosis is available. However, basic principles of infection control combined with an understanding of the biology of Leptospira spp and the disease pathophysiology permit development of logical empirical recommendations (see Infection Control Practices for Management of Suspected or Confirmed Leptospirosis Cases1,8). These measures should lower the risk for human infection while allowing proper patient care and effective clinic operations.
Furthermore, the period in which there is realistic risk for infection is short. Although clear data are limited, it is expected that Leptospira spp shedding will stop within 48 to 72 hours after appropriate antimicrobial therapy1,8 has started if not sooner. Therefore, focusing on aggressive infection control in the first few days of hospitalization is key. Some facilities discontinue enhanced precautionary measures after 2 to 3 days of antimicrobial treatment—a reasonable approach, although data to support it are lacking. Additionally, before declaring them low risk, some facilities bathe affected dogs with a biocide that would be antileptospiral (eg, chlorhexidine, accelerated hydrogen peroxide) on the assumption that viable leptospires might be living in warm, moist areas of the haircoat that were contaminated with urine. Whether this is truly necessary is unclear, but this easy and practical measure may provide an added level of protection.
Questions about potential risks for leptospirosis exposure in humans often arise, particularly when precautions were inadequate in initial treatment. Post-exposure treatment for humans exposed to infected animals is rare,8 but there are no clear guidelines. Having potentially exposed individuals monitor themselves for early signs of infection (eg, fever, flu-like symptoms) is common, and all individuals should consult a physician on a case-by-case basis to determine the need for postexposure prophylactic treatment (commonly prescribed to pregnant women because of the potential for spontaneous abortion).8,9 Potentially exposed personnel should consult with a physician to determine whether postexposure treatment is necessary.