Clinical features

• incubation period 3-20 days (average 10)

• severe headache

• macular rash: conjunctivitis

Some may develop the immune phase (after an asymptomatic period of 1-3 days) with aseptic meningitis or jaundice and nephritis (icterohaemorrhagic fever, Weil's disease) with a significant mortality.

Diagnosis

• high or rising titre of antibodies: can be cultured

Treatment 10

• doxycycline 100 mg (o) bd for 5-7 days or benzylpenicillin 900 mg IV, 6 hourly for 5-7 days

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