US Agency for International Development, Managua, Nicaragua. Additional studies are under way to confirm the role of leptospiral infection in the outbreak of acute febrile illness, establish animal reservoirs of infection, and identify potentially modifiable risk factors for disease. Human infection may result from indirect or direct exposure to infected urine, often through contaminated water or soil. The investigation in Nicaragua is examining the possibility that infection in humans resulted from exposure to water and soil contaminated by animal urine following recent heavy rainfall and flooding in that region. Leptospirosis is diagnosed by isolation of leptospires from blood or cerebrospinal fluid during the acute illness and from urine greater than or equal to 10 days after the onset of symptoms or by documenting rising titers in serologic tests, such as the microagglutination test.
Alternatives are amoxicillin, ampicillin, doxycycline, and tetracycline.
Supportive therapy is essential for managing dehydration, hypotension, hemorrhage, renal failure, and pulmonary involvement. Handbook of zoonoses. I. Clinical manifestations and antibiotic therapy. Park SK, Lee SH, Rhee YK, et al. Principles and practice of infectious diseases.