Ocular manifestations in the initial bacteraemia phase are conjunctival congestion without discharge, chemosis, subconjunctival haemorrhage and yellow sclera. The severity of systemic presentation has no influence over the ocular severity. Uveitis is an important ocular manifestation of immunological stage. In this phase, patient presents with non-granulomatous anterior uveitis. Slit lamp examination shows keratic precipitates on endothelium with moderate to severe anterior chamber inflammation. Hypopyon is seen when the inflammation is severe (Fig. 20.1). Unlike other complicated cataracts, these patients may occasionally develop white pearly cataract early in the course of the disease (Fig. 20.2). This cataract may rarely get spontaneously absorbed (Rathinam et al. 2000). Vitritis, papillitis and periphlebitis are important posterior segment findings (Fig. 20.3). Veil-like vitreous membranes may be present in the posterior segment, and persistence of this membrane is noted even after the inflammatory control (Fig. 20.4). Absence of retinitis and choroiditis in the above setting usually clinches the diagnosis.

In case of systemic leptospirosis, the diagnosis can be made from blood, CSF and urine samples by direct methods such as microscopy, culture or molecular methods. Indirect serological methods include detection of IgM antibodies by Micro Agglutination Test (MAT) or Enzyme-Linked Immuno Sorbent Assay (ELISA). Micro Agglutination Test (MAT) is the gold standard test. Although it is less sensitive, this test is highly specific and detects serovar-specific antibodies. MAT can be performed only in laboratories where maintenance of strains is possible, and it is labour intensive. ELISA kit for leptospirosis is available commercially. The methods available are detailed in Table 20.2 (Budihal and Perwez 2014).

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