Management of Leptospirosis Suspects

Management of Leptospirosis Suspects


A Leptospirosis Suspect is a patient for which leptospirosis is likely or possible, has had a serum sample submitted for leptospirosis titer, and meets the following criteria:

  • Clinician’s suspicion of leptospirosis as a differential diagnosis accompanied by clinical features such as, fever, vomiting, thrombocytopenia, and neutrophilic leukocytosis AND treatment with antibiotics specifically prescribed for treatment of leptospirosis. OR –
  • Acute renal failure without other explanation for the cause AND treatment with antibiotics specifically prescribed for treatment of leptospirosis. OR –
  • Acute hepatic failure or hepatitis without other explanation for the cause, AND treatment with antibiotics specifically prescribed for treatment of leptospirosis.
  • Even though a serum sample may have been submitted for leptospirosis titer, a patient will not be considered a Leptospirosis Suspect if it does not meet the above criteria when the clinician believes in his/her judgment that a diagnosis of leptospirosis is unlikely.

A Patient Remains Classified As A Leptospirosis Suspect Until:

  • a negative titer result is obtained, or
  • has completed a minimum of three days of appropriate antibiotic therapy. Appropriate antibiotic therapy includes any or all of the following drugs: * Penicillin derivatives, ampicillin, amoxicillin. * Tetracyclines, such as doxycycline. * Fluoroquinolones (enrofloxacin, marbofloxacin, orbifloxacin) combined with ampicillin or amoxicillin.
  • Once either of the above are satisfied, the patient is no longer a suspect and no special handling is required.

Handling Procedures For Patients Classified as Leptospirosis Suspects:

  • Gloves, face shield, and gown must be worn when handling the animal.
  • All waste must be placed in biohazard bags and placed in waste for incineration.
  • All request forms for tests must identify the animals as Zoonotic Potential even after they have completed antibiotic treatment.
  • The animal must be placed on a cart if transported. The same cart must be used to transport the animal anywhere it goes in the hospital.
  • Exposure to humans and other animals must be limited as much as possible.
  • A log sheet must be maintained listing everyone who has contact with the animal.
  • When urine is collected, betadine solution (using dilution instructions on label) should be added to urine before it is poured down the janitor’s sink.
  • If the animal urinates outside the cage or in a hallway, the area must be thoroughly disinfected using appropriate solutions. (A456 Solution with a contact time of at least 10 minutes.)
  • The animal should be kept in its cage, or a run in ICU to contain the animal’s urine.

Testing and Diagnosis:

  • Leptospirosis suspects will have a serum sample (collected in red-top tube) submitted to Cornell University for titer determination. An additional plasma sample (collected in purple-top EDTA tube), and a urine sample will be submitted to the NCSU-VH Infectious Disease Laboratory (DOCS Department) for additional tests to be performed at a later date.
  • All specimens submitted for leptospirosis testing, regardless of whether or not the patient is a Leptospirosis Suspect, will be labeled with a “Zoonotic Potential” sticker.