Leptospirosis Case study (short)

7/27/2019 Leptospirosis Case study (short)

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Leptospirosis

Also known as Weil s disease, Mud fever, Canicola fever, Flood fever, SwineherdsDisease, Japanese Seven Days fever

Definition and Background

A bacterial zoonotic disease caused by spirochaetes of the genus Leptospirathataffects humans and a wide range of animals, including mammals, birds,amphibians, and reptiles.

First described by Adolf Weil in 1886 when he reported an acute infectiousdisease with enlargement of spleen, jaundice and nephritis


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Causative Agent

bacteria of the genus Leptospira

Characteristics of Leptospira

spirochete

motile

both gram-positive and gram-negative characteristics

poor staining, therefore, dark-field or phase-contrast microscopy are

necessary

beta-hemolytic

Leptospira-genus bacteria was isolated in 1907 from post mortem renaltissue slice.commonly found: Leptospira pyrogenes, Leptospira manilae, &other species like L. leterohemorrhagiae, L. canicola, L. batavia, L. Pomona, L.

javinica

Predisposing Factor

age: < 15 years of age

sex: male

season: rainy months

geographic: prevalent in slum areas


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Source of Infection

Infection comes from contaminated food and water, and infected wild life anddomestic animals especially rodents.

1. Rats ( L. leterohemorrhagiae) are the source of Weils disease frequentlyobserved among miners, sewer, and abattoir workers.

2. Dogs (L. canicola) can also be the source of infection among veterinarians,breeders, and owners of dogs.

3. Mice (L. grippotyphosa) may alos be a source of infection that attacks farmersand flax workers.

4. Rats (L. bataviae) are the source of infection that attacks rice field workers.

Modes of Transmission

Wild mammals seem to serve as the primary reservoir of mostleptospiral serovars. The organism has been found in more than 160mammals, including rats, pigs, dogs, cats, raccoons, and cattle. Rats areconsidered the most important reservoir, as they are the most commonsource worldwide. Dogs are often carriers of leptospires, which can cause

problems because of their close association with people.

Transmission occurs by contamination of water, soil, or vegetation byurine excreted from infected animals. Humans can become infected uponcontact of the contaminated material with abraded skin, mucous membranes,or when the contaminated material is ingested.

Humans are considered incidental hosts to the disease becausetransmission of the disease between people is rare, at best. Humans are theend of the line of the disease, with very rare exceptions.


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Incubation Period

6 15 days/ 2 8 weeks


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Clinical Manifestations

1st stage: Septicemic/ Leptospiremic Phase (4 7 days)- onset of high remittent fever, chills, headache, anorexia, nausea &vomiting, abdominal pain, joint pains, muscle pains, myalgia, severeprostration, cough, respiratory distress, bloody sputum.

2nd stage: Immune/ Toxic Phase (4 30 days)- if severe, death may occur between the 9th & 16th day

2 types:

Anicteric (without jaundice) return of fever of a lower degree with rash,conjunctival injection, headache, meningeal manifestations like disorientation,convulsions & signs of meningeal irritations (with CSF finding of aseptic meningitis)

Icteric (with jaundice) Weil syndrome; hepatic & renal manifestations:hemorrhage, hepatomegaly, hyperbilirubinemia, oliguria, anuria with progressiverenal failure; shock, coma & congestive heart failure in severe cases

3rd stage: Convalescence Phase- Relapses may occur during 4th or 5th week

Diagnosis

Diagnosis can be made from culturing the Leptospira bacteria from:

Bodily fluids days 1-7

Cerebrospinal fluiddays 4-10

Urineafter the 10 th day

Prognosis

cause of death: renal & hepatic failure

disease usually last 1 3 weeks but may be more prolonged; relapse may

occur


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Treatment

Specific measures: beneficial if done < 4 days of dse

Aqueous penicillin G (50,000 units/kg/day in 4-6 divided doses intravenouslyfor 7-10 days

Tetracycline (20-40 mg/kg/day in 4 doses); may not be given to children < 8years old

General measures

symptomatic & supportive care

administration of fluid, electrolytes & blood as indicated

peritoneal dialysis (for renal failure)

Nursing Interventions

Monitoring of strict fluid intake and output.

Promptly report the occurrence of dyspnea oliguria or hemorrhage.

Severely ill patients should be nursed in propped-up position to lessen therisk of secondary pulmonary complications.

Patients with vomiting should be managed by I/V fluids and electrolytereplacement.

Monitor weight daily

Isolation of patient: urine must be properly disposed

Health teachings: keep a clean environment


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Drug Study

Tetracycline hydrochloride

Brand Name: Apo-Tetra (CAN), Novo-Tetra (CAN), Nu-Tetra(CAN),Panmycin, Sumycin, Tetracap, Tetracyn, Tetralan, Topicycline

Pregnancy Category D, Pregnancy Category B (Topicycline only)

Drug classes: Antibiotic, Tetracycline

Therapeutic actions

Bacteriostatic: inhibits protein synthesis of susceptible bacteria, preventing cellreplication.

Indications

Systemic administration

Infections caused by rickettsiae; Mycoplasma pneumoniae; agents of psittacosis, ornithosis, lymphogranuloma venereum andgranuloma inguinale;Borrelia recurrentis, Haemophilus ducreyi,Yersinia pestis, Yersinia tularensis,Bartonella bacilliformis,Bacteroides, Vibrio cholerae, Campylobacter fetus, Brucella, Escherichiacoli, Enterobacter aerogenes, Shigella,Acinetobacter calcoaceticus, Haemophilus influenzae,Klebsiella, Streptococcus pneumoniae

When penicillin is contraindicated, infections causedby Neisseriagonorrhoeae, Treponema pallidum, Treponema pertenue,Listeriamonocytogenes, Clostridium,Bacillus anthracis,Fusobacterium fusiforme, Actinomyces, Neisseria meningitidis

Adjunct to amebicides in acute intestinal amebiasis


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Treatment of acne (oral)

Uncomplicated urethral, endocervical or rectal infections in adults causedby Chlamydia trachomatis

Instilled in a chest tube, unlabeled use: pleural sclerosing agent inmalignant pleural effusions

Treatment of trachoma

Contraindications

Systemic administration and dermatologic solution

Contraindicated with allergy to any of the tetracyclines; allergy

totartrazine (in 250-mg capsules of Panmycin ); pregnancy (toxic to the fetus);lactation (causes damage to the teeth of infant).

Adverse effects

Phototoxic reactions, rash, exfoliative dermatitis

Discoloring and inadequate calcification of primary teeth of fetus if used by pregnant women, discoloring and inadequate calcification of permanent teeth if used during period of dental development, fatty liver, liver failure, anorexia,

nausea, vomiting, diarrhea, glossitis, dysphagia, enterocolitis, esophageal ulcers

Hemolytic anemia,thrombocytopenia, neutropenia, eosinophilia,leukocytosis, leukopenia

Reactions from urticaria to anaphylaxis, including intracranial hypertension

Superinfections, local irritation at parenteral injection sites

Drug Interactions:

Decreased absorption with calcium salts, magnesium salts, zinc salts,aluminum salts, bismuth salts, iron, urinary alkalinizers, food, dairy products,charcoal

Increased digoxin toxicity

Increased nephrotoxicity with methoxyflurane


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Decreased effectiveness of hormonal contraceptives, though rare, has beenreported with a risk of breakthrough bleeding or pregnancy

Decreased activity of penicillins

Nursing considerations

Administer oral medication on an empty stomach, 1 hr before or 23 hr aftermeals. Do not give with antacids. If antacids must be used, give them 3 hrafter the dose of tetracycline.

Culture infection before beginning drug therapy.

Do not administer during pregnancy; drug is toxic to the fetus.

Do not use outdated drugs; degraded drug is highly nephrotoxicand shouldnot be used.

Do not give oral drug with meals, antacids, or food.

Arrange for regular renal function tests with long-term therapy.

Use topical preparations of this drug only when clearly indicated.Sensitization from the topical use may preclude its later use in seriousinfections. Topical preparations containing antibiotics that are not ordinarily

given systemically are preferable.


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Penicillin G

Brand names: Pfizerpen, Penicillin G Benzathine, Bicillin L-A, Crystapen(Canada), procaine penicillin G

Pregnancy CategoryCategory B

Therapeutic Classanti-infectives

Pharmacologic Classpenicillins

Indications Treatment of a wide variety of infections including:

o Pneumococcal pneumonia,o Streptococcal pharyngitis,o Syphilis,o Gonorrhea strains.

Treatment of enterococcal infections (requires the addition of anaminoglycoside).

Prevention of rheumatic fever. Should not be used as a single agent to treat anthrax.Unlabeled Use(s):

Treatment of Lyme disease, prevention of recurrent Streptococcal pneumoniae septicemia in children with sickle-cell disease.

Action

Bind to bacterial cell wall, resulting in cell death.
http://nursing.unboundmedicine.com/nursingcentral/ub/view/Davis-Drug-Guide/109508/0/Category_Bhttp://nursing.unboundmedicine.com/nursingcentral/ub/view/Davis-Drug-Guide/109508/0/Category_B


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Therapeutic Effect(s):Bactericidal action against susceptible bacteria.Active against:

Most gram-positive organisms, including many streptococci(Streptococcus pneumoniae , group A beta-hemolytic streptococci),staphylococci (nonpenicillinase-producing strains) and Bacillus anthracis ,

Some gram-negative organisms, such as Neisseria meningitidis and N.gonorrhoeae (only penicillin susceptible strains),

Pharmacokinetics

Absorption: Variably absorbed from the GI tract. Procaine and benzathine penicillin G IM absorption is delayed and prolonged and results in sustainedtherapeutic blood levels.Distribution: Widely distributed, although CNS penetration is poor in the presenceof normal (uninflamed) meninges. Crosses the placenta and enters breast milk.Protein Binding: 60%.Metabolism and Excretion: Minimally metabolized by the liver, excreted mainlyunchanged by the kidneys.Half-life: 3060 min.TIME/ACTION PROFILE (blood levels)

ROUTE ONSET PEAK DURATION

Penicillin G IM rapid 0.250.5 hr 46 hr

Benzathinepenicillin IM

delayed

1224 hr 3 wk

Procaine penicillinIM

delayed

14 hr 12 hr

Penicillin G IV rapid end of infusion

46 hr

Contraindication/Precautions

Contraindicated in: Previous hypersensitivity to penicillins (cross-sensitivity exists with

cephalosporins and other beta-lactam antibiotics) Hypersensitivity to procaine or benzathine (procaine and benzathine

preparations only) Some products may contain tartrazine and should be avoided in patients

with known hypersensitivity.Use Cautiously in:

Severe renal insufficiency (dosage reduction recommended) OB: Although safety not established, has been used safely Lactation: Safety not established


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Geri: Consider decreased body mass, age-related decrease inrenal/hepatic/cardiac function, intercurrent diseases and drug therapy.

Adverse Reactions/Side Effects

CNS: SEIZURESGI: diarrhea , epigastric distress , nausea , vomiting , pseudomembranous colitisGU: interstitial nephritisDerm: rash , urticariaHemat: eosinophilia, leukopeniaLocal: pain at IM site , phlebitis at IV siteMisc: ALLERGIC REACTIONS INCLUDING ANAPHYLAXIS AND SERUM SICKNESS,superinfection* CAPITALS indicate life-threatening.Italics indicate most frequent.

Interactions

Drug-Drug Penicillin may effectiveness of oral contraceptive agents. Probenecid renal excretion and blood levels of penicillin (therapy

may be combined for this purpose). Neomycin may absorption of penicillin. Concurrent use with methotrexate methotrexate elimination and risk

of serious toxicity.

Route/Dosage

Aqueous Penicillin GIM: IV: (Adults) Most infections 15 million units q 46 hr.IM: IV: Children 833316,667 units/kg q 4 hr; 12,55025,000 units/kg q 6 hr; up to250,000 units/kg/day in divided doses, some infections may require up to 300,000units/kg/day.IV: (Infants >7 days): 75,000 units/kg/day in divided doses every 8hr; meningitis 200,000300,000 units/kg/day in divided doses q 6 hr.IV: (Infants


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Assess for infection (vital signs; appearance of wound, sputum, urine, andstool; WBC) at beginning of and during therapy.

Obtain a history to determine previous use of and reactions to penicillins,cephalosporins, or other beta-lactam antibiotics. Persons with a negativehistory of penicillin sensitivity may still have an allergic response.

Obtain specimens for culture and sensitivity before initiating therapy.First dose may be given before receiving results.

Observe patient for signs and symptoms of anaphylaxis (rash, pruritus,laryngeal edema, wheezing). Discontinue drug and notify physician or otherhealth care professional immediately if these symptoms occur. Keepepinephrine, an antihistamine, and resuscitation equipment close by in caseof an anaphylactic reaction.

Lab Test Considerations:May cause positive direct Coombs' test results.

Hyperkalemia may develop after large doses of penicillin G potassium. Monitor serum sodium concentrations in patient with hypertension or HF.

Hypernatremia may develop after large doses of penicillin sodium. May cause AST, ALT, LDH, and serum alkaline phosphatase

concentrations. May cause leukopenia and neutropenia, especially with prolonged

therapy or hepatic impairment.

Potential Diagnoses Risk for infection Noncompliance

Implementation

Do not confuse penicillin with penicillamine. Do not confuse penicillin G aqueous(potassium/sodium salts) with penicillin G procaine or benzathine.Penicillin G Potassium

Y-Site Compatibilityo acycloviro amiodaroneo cyclophosphamideo diltiazemo enalaprilato esmololo fluconazoleo foscarneto heparino hydromorphoneo labetalolo magnesium sulfateo meperidineo morphineo nicardipine


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o perphenazineo potassium chlorideo tacrolimuso theophyllineo verapamilo vitamin B complex with C

Y-Site Incompatibility Additive IncompatibilityIncompatible with aminoglycosides; do not admix. Additive IncompatibilityIncompatible with aminoglycosides; do not admix.

Penicillin G Sodium Y-Site Incompatibility Additive IncompatibilityIncompatible with aminoglycosides; do not admix.

Nursing Considerations

Instruct patient to take medication around the clock and to finish drug completelyas directed, even if feeling better. Advise patient that sharing this medication maybe dangerous.

Advise patient to report signs of superinfection (black, furry overgrowthon tongue; vaginal itching or discharge; loose or foul-smelling stools) andallergy.

Instruct patient to notify health care professional if fever and diarrheadevelop, especially if stool contains blood, pus, or mucus. Advise patient notto treat diarrhea without consulting health care professional.

Instruct patient to notify health care professional if symptoms do notimprove.

Advise patient taking oral contraceptives to use an additionalnonhormonal method of contraception during therapy with penicillin anduntil next menstrual period.

Patient with an allergy to penicillin should be instructed to always carryan identification card with this information.

Documents

Leptospirosis Case study (short)