Leptospirosis should be suspected among patients with the following clinical manifestations/features:

- acute fever of at least 2 days

- residing in a ooded area OR has high
risk exposure (de ned as wading in oods and contaminated water, contact with animal uids, swimming in ood water or in
gestion of contaminated water with or without cuts or wounds)
- presenting with at least 2 of the following symptoms:
• myalgia
• calf tenderness
• conjunctival su usion
• chills
• abdominal pain
• headache
• jaundice
• oliguria
Generally, it is not necessary to con rm the diagnosis or wait for the result of the tests before starting treatment. The
clinical assessment and epidemiologic history are more important.

HOSPITAL SETTING OUT‐PATIENT SETTING

a. unstable vital signs a. stable vital signs

b. jaundice/icteric sclerae b. anicteric sclerae
c. abdominal pain c. with good urine output
d. nausea, vomiting and diarrhea d. no evidence of meningismus / meningeal irritation
e. oliguria/anuria e. no evidence of sepsis / septic shock
f. meningismus/meningeal irritation f. no di culty of breathing
g. sepsis/septic shock g. no jaundice
h. altered mental states h. can take oral medications
i. di culty of breathing
j. hemoptysis
ffi
ffi
fl
fi
ff
fl
fi
fl
fl
 Direct Detection Method Indirect Detection Methods

a. Culture and isolation ‐ GOLD standard a. Microagglutination Test (MAT) ‐ a four‐

fold rise of the titer from acute to convalescent sera is con rmatory of
b.Polymerase Chain Reaction (PCR) has the adva the diagnosis.
ntage of early con rmation of the diagnosis esp In endemic areas like the Philippines, a single titer of at least 1:1600 i
ecially during the acute leptospiremic phase ( rs n symptomatic patients is indicative of leptospirosis.
t week of illness) before the appearance of antib
odies. b.Speci c IgM Rapid Diagnostic Tests like LeptoDipstick®, Leptospir
a IgM ELISA (PanBio), MCAT and Dridot®

False negative results can be a problem if the tests are performed

during the early stage of the illness. A second sample should be
obtained for suspected cases with initial negative or doubtful resu
lts.

PhilHealth Standards and Monitoring Department (SMD) Consensus: LAATS (Leptospira Antigen‐
Antibody Agglutination Test) has no value in the con rmation of leptospirosis.
fi
fi
fi
fi
fi
 Pre‐exposure Post exposure

The most e ective preventive measure is avoidance of Doxycycline (hydrochloride and hyclate) is the reco
high‐risk exposure mmended post exposure chemoprophylactic agent for
(i.e. wading in oods and contaminated water, contact wi leptospirosis.
th animal’s body uid). The duration of prophylaxis depends on the degree of
exposure and the presence of wounds. Individuals sho
If high risk exposure is unavoidable, use PPE uld continue to monitor themselves for fever and other
u-
Preexposure antibiotic prophylaxis is NOT ROUTINELY like symptoms and should continue to wear personal
RECOMMENDED. protective measures since antibiotic prophylaxis is not
100% e ective.
However, in those individuals who intend to visit highly e
ndemic areas AND are likely to get exposed (e.g. travel The decision to give prophylaxis depends on the risk e
ers, soldiers, those engaged in water‐ xposure assessment.
related recreational and occupational activities), pre‐
exposure prophylaxis may be considered for short‐ 2.1. LOW-
term exposures. [Grade B]. RISK EXPOSURE is de ned as those individuals with
a single history of wading in ood or contaminated wa
The recommended regimen for pre‐ ter without wounds, cuts or open lesions of the skin.
exposure prophylaxis for non‐pregnant, non‐ Doxycycline 200 mg single dose within 24 to 72 hour
lactating adults is: s from exposure [Grade B]
Doxycycline (hydrochloride and hyclate) 200 mg once
weekly, to begin 1 to 2 days before exposure and contin 2.2. MODERATE‐
ued throughout the period of exposure. [Grade B] RISK EXPOSURE is de ned as those individuals with
a single history of wading in ood or contaminate
Currently, there is NO recommended pre‐ d water and the presence of wounds, cuts, or open
exposure prophylaxis that is safe for pregnant and lac lesions of the skin, OR accidental ingestion of con
tating women. taminated water.
Doxycycline 200 mg once daily for 3‐
5 days to be started immediately within 24 to 72 hour
s from exposure [Grade C]

2.3. HIGH‐
RISK EXPOSURE is de ned as those individuals with
continuous exposure (those having more than a singl
e exposure or several days such as those residing in
ooded areas, rescuers and relief workers) of wading in
ood or contaminated water with or without wounds,
cuts or open lesions of the skin. Swimming in ooded
waters especially in urban areas infested with domesti
c/
sewer rats and ingestion of contaminated water are al
so considered high risk exposures.
Doxycycline 200 mg once weekly until the end of exp
osure [Grade B]
fl
fl
ff
ff
fl
fl
fi
fi
fi
fl
fl
fl
f