Leptospirosis: a forgotten cause of aseptic meningitis and multisystem febrile illness

Abstract

Leptospirosis is a worldwide spirochetal zoonosis that spans a clinical spectrum from a mild febrile illness to a severe icteric disease with renal failure (Weil's syndrome). The illness is characteristically biphasic with conjunctival suffusion and an "immune" meningitis during the later phase of illness. Most patients, even those with severe disease, recover without residual organ impairment. The diagnosis is confirmed by serology, by culture of blood or spinal fluid during the first phase of illness, or by culture of urine during the second phase. Doxycycline is the recommended therapy and is effective if given within the first several days of illness; it may also have a role in prophylaxis.