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Chapter 7, Part 3

Medical Science Publication No. 4, Volume II

DISCUSSION

JOSEPH E. SMADEL, M. D.

The excellent presentation on leptospirosis by Colonel Yager purposely omitted the subject of therapy which I will now take up quite briefly. Problems arising in the treatment of this disease were reviewed at length during the Symposium on the Leptospiroses which was held at the Army Medical Service Graduate School during December 1952. I would call your attention to the published report of this 3-day Symposium which appeared last year. The volume brings together current information on practically all aspects of this important group of diseases.

The therapy of leptospirosis may be briefly summarized (1, 2) as follows: Evaluation of therapeutic measures in this group of infections is hampered by the variable severity of the disease. Thus, large groups of carefully studied cases are necessary if valid conclusions are to be drawn about the efficacy of any particular medicament. Over the years claims have been made for the value in this group of diseases of a large number of drugs and antibiotics. It would appear that none has any appreciable therapeutic effectiveness once the disease is well


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established, which is the time when the physician usually sees the patient initially. On the other hand, a number of the antibiotics are of value in experimentally infected animals provided that treatment is given shortly after infection and before obvious or severe disease is well developed. There is some evidence that the similar early usage of those antibiotics in infected human beings may also abort or control the disease. Such findings emphasize the need for further study of antibiotic therapy in explosive outbreaks of leptospirosis which occur when an appreciable number of persons are infected simultaneously or over a short period of time. In such outbreaks it should be possible to initiate treatment within a matter of hours after onset of illness in those persons who sicken during the latter part of the epidemic, after the nature of the infection has been established by investigations on the first few cases appearing in the outbreak.

Preventive measures for the control of leptospirosis have been successfully employed under certain limited circumstances (3, 4). However, the procedures have had little usefulness in the effective control of the disease in military populations in tropical areas where leptospirosis is highly endemic (5, 6).

References

1. Smadel, J. E.: Therapy of Leptospirosis. In Symposium on the Leptospiroses, pp. 202-24, Medical Science Publication No. 1, U. S. Government Printing Office, Washington, 1953.

2. Gsell, O.: Discussion on the Therapy of Leptospirosis. Ibid., pp. 212-220.

3. Broom, J. C.: Prophylaxis and Control of Leptospirosis. Ibid., pp. 186-192.

4. Borg-Petersen, C.: Discussion of Prophylaxis and Control of Leptospirosis. Ibid., pp. 193-201.

5. Broom, J. C.: Leptospirosis in Tropical Countries. A Review. Trans. Royal Soc. Trop. Med. Hyg. 47 : 273-286, 1953.

6. Hughes, W. D.: Discussion of Leptospirosis in Tropical Countries. Ibid., pp. 287-288.