When should I consider referring a patient with suspected leptospirosis to secondary care for further management?

While the provided guidelines do not specifically detail referral criteria for suspected leptospirosis, if a patient presents with suspected leptospirosis and shows signs of severe illness, particularly suspected sepsis, the National Institute for Health and Care Excellence (NICE) guidelines for suspected sepsis should be followed for referral to secondary care ⁴.

• Immediate Transfer to Acute Hospital Setting:
• For people aged 16 or over, including those who are or have recently been pregnant, if they meet any high-risk criteria for suspected sepsis, they should be referred for emergency medical care immediately ⁴. This typically involves using a 999 ambulance ⁴. Secondary care should be pre-alerted ⁴.
• Urgent Referral for Emergency Care:
• For people aged 16 or over, including those who are or have recently been pregnant, if they meet any moderate to high-risk criteria for suspected sepsis, they should be assessed to make a definitive diagnosis and determine if their condition can be safely treated outside the hospital ⁴. If a definitive diagnosis is not reached, or the condition cannot be safely managed in primary care, an urgent referral for emergency care is required ⁴.
• Low Risk Management:
• If a person aged 16 or over with suspected sepsis (including those who are or have recently been pregnant) does not meet any high-risk or moderate to high-risk criteria, they are considered low risk ⁴. In such cases, provide information on symptoms to monitor and how to access medical care if they become concerned ⁴.
• Considerations for Children and Young People:
• For people under 16 who have suspected sepsis and meet no high-risk or moderate to high-risk criteria, a clinician review is necessary, and clinical judgement should be used to manage their condition ⁴.