Leptospirosis

Abstract

Leptospirosis, a waterborne spirochetal illness, is common in tropical climates. Rodents and wild animals are the most common reservoirs for this widespread zoonosis. Human disease is acquired by contact with urine or tissues of an infected animal or through contaminated water and soil. Systemic leptospirosis is characterized by its multisystem involvement, protean manifestation, and varying severity. The clinical presentation ranges from occult infection to fatal complications like hepatorenal failure. Early diagnosis is important to halt the fulminate course. The microagglutination test is considered the gold standard serological test for leptospirosis, although molecular techniques are now under study. Treatment of systemic leptospirosis includes penicillin or tetracycline in addition to supportive treatment. Ocular involvement occurs during the immunological phase of the disease. One or both eyes may be involved, typically with a panuveitis often accompanied by retinal periphlebitis and hypopyon. In general, leptospiral uveitis has a good prognosis and the patient recovers full vision in spite of severe panuveal inflammation. Awareness of this infectious uveitic entity is essential not only in order to differentiate it from other severe autoimmune uveitides, but also to reduce the percentage of idiopathic uveitis in endemic areas.

The incidence and clinical characteristics of the immune phase eye disease in treated cases of human leptospirosis

“…[8] None of the cases in our series had recurrence of eye disease after the initial involvement and its successful treatment. Recurrent uveitis in leptospirosis is more common with panuveitis cases, [8,10] which were not seen in this study. Rapid maturation/ absorption of cataract was not observed in any of the patients as reported by others.…”

“…[8][9][10][11][12][13][14][15] Even though animal studies suggest immunologic mechanisms related to molecular mimicry between leptospiral proteins and ocular antigens for the pathogenesis of eye disease, [16,17] there is only limited evidence to suggest the same mechanism for the occurrence of ocular disease in human beings. [13] It is not known whether the systemic antibiotic treatment during the acute phase of human leptospirosis has any protective role on longterm complications like uveitis.…”

“…[6] Uveitis is an important late complication of leptospirosis and may present as anterior or posterior uveitis or as panuveitis. [8][9][10][11][12][13][14] The other manifestations described [9][10][11][12][13][14][15] are hypopyon, rapid maturation of cataract, absorption of cataract, glaucoma, vitreous inflammatory reaction, optic neuritis, retinal vasculitis, retinal hemorrhage, retinal detachment and neuroretinitis. Leptospirosis is a common cause of uveitis in south India and accounts for a signifi cant proportion of cases, which were previously labeled as idiopathic uveitis.…”

Role of Intraocular Leptospira Infections in the Pathogenesis of Equine Recurrent Uveitis in the Southern United States

“…Titers were reported as the reciprocal of the highest dilution in which 50% of the leptospires were agglutinated. Titers ≥100 were considered diagnostic [1,13,14]. Horses with M A N U S C R I P T A C C E P T E D ACCEPTED MANUSCRIPT 5 antibody titers in ocular fluid that were higher than antibody titers in serum were defined as having intraocular antibody production.…”

Oculo-renal Disorders in Infectious Diseases

“…One or both eyes may be involved, typically with a panuveitis often accompanied by retinal periphlebitis and hypopyon [50]. In acute phase of leptospirosis, conjunctival hyperemia, ophtalmic examination showed increased retinal venous caliber, optic disc redness, subconjunctival hemorrhage, retinal hemorrhage, hard exudates and papillitis [51].…”