Specifically, the presence of serovar-specific lipopolysaccharide (LPS) with an increase of Interleukin-6 (IL-6), IL-8, IL-10, IL-12p70, and tumor necrosis factor (TNF) cytokines and selective neutrophil infiltration in aqueous humor is indicative of endotoxin as a possible causative factor for leptospiral uveitis. The etiology of ocular features of leptospirosis has been postulated as a host immune response and/or toxin production. In addition, leptospiral uveitis is most prevalent in young to middle-aged men, likely from their higher involvement in agricultural work. The incidence of infection is 10 times higher in tropical and subtropical climates as opposed to temporal climates. Leptospirosis is the most common zoonotic illness globally with an estimated 500,000 high-risk cases per year and 30% mortality rate. cattle, pigs, horses, racoons, porcupines, domesticated dogs) or their body fluids (especially urine) via water or soil contamination. The primary mode of human transmission is direct or indirect contact with infected animals (e.g. Both anterior and posterior segment ophthalmic manifestations can occur in Leptospirosis and this Eyewiki emphasizes these ocular findings. Weil disease is the late icteric phase following severe systemic manifestations including interstitial nephritis, uremia, oliguria, kidney lesions, vascular injury, meningitis, jaundice, psychosis, confusion, and delirium. The majority of cases present with the acute (anicteric) phase consisting of self-limiting clinical manifestations including sudden fever, myalgia, headache, scleral icterus, chemosis, nausea, anorexia, and abdominal pain. This tropical disease is the most common zoonotic illness worldwide. In a few instances, more invasive procedures such as cholangiography or liver biopsy may be needed to arrive at a diagnosis.Leptospirosis (Weil disease) is a gram-negative, water-borne, spirochete that is part of the Leptospira genus within the Leptospiraceae family. If the complete blood count and initial tests for liver function and infectious hepatitis are unrevealing, the work-up typically proceeds to abdominal imaging by ultrasonography or computed tomographic scanning. The laboratory work-up should begin with a urine test for bilirubin, which indicates that conjugated hyperbilirubinemia is present. Gallstone formation is the most common and benign posthepatic process that causes jaundice however, the differential diagnosis also includes serious conditions such as biliary tract infection, pancreatitis, and malignancies. Posthepatic disorders also can cause conjugated hyperbilirubinemia. The conjugated (direct) bilirubin level is often elevated by alcohol, infectious hepatitis, drug reactions, and autoimmune disorders. Intrahepatic disorders can lead to unconjugated or conjugated hyperbilirubinemia. Prehepatic causes of jaundice include hemolysis and hematoma resorption, which lead to elevated levels of unconjugated (indirect) bilirubin. Organizing the differential diagnosis by prehepatic, intrahepatic, and posthepatic causes may help make the work-up more manageable. Jaundice in an adult patient can be caused by a wide variety of benign or life-threatening disorders.
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