Leptospirosis Upload

8/9/2019 Leptospirosis Upload

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A case history

A 25 year old man is brought to the Out

Patient Department with history of fever of

3 days duration with following symptoms& signs.

High grade fever of continuous nature.

Generalized aches & severe myalgia.

Yellowish discoloration of eyes & urine.

Non-specific head ache.


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MA. ESTRELLA LENA M. PUSAG RN

M


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Introduction

Leptospirosis is a most widespread zoonoticdisease in the world caused by the pathogenicbacteria called leptospires.

Human to human transmission occurs onlyvery rarely.

Generally it is transmitted by the infected urineof rodents.

Case fatality may vary from 0.3 8 %.

Severe form of leptospirosis is called Weils

Syndrome Also included as water borne & milk borne

disease


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Distribution

Worldwide disease.

Most common in tropical & subtropical

areas with high rainfall. In India with frequent outbreaks in

Maharashtra ,Gujarat,Karnataka , Kerala

& Andaman islands especially during the

monsoon.


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Leptospirosis-synonyms

Mud fever

Japanese seven day fever

Leptospiral Jaundice Spirochete Jaundice

Autumn fever

Weil's disease Rat Catcher's Yellows


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History ofLeptospirosis

1883 it was recognized as an occupational

disease of sewer workers 1886 first description (by Adolf Weil) of the

clinical manifestations seen in 4 men -severe

jaundice, fever, and hemorrhage with renal

involvement

1916 the causal agent was identified by Inada

et al in Japan


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Epidemiological determinants


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Causative agent-Leptospira

Corkscrew -shaped delicate flexiblespirochetes.

About 6 20 micrometer long & 0.1

micrometer thick. Posses a large number of closely wound

spirals & characteristic end hooks.

Actively motile.


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Leptospira --

Too thin to visible under ordinary

microscope.

dark field micros copy is using.

Order-Spirochaetals.

Family- Leptospiraceae.

Genus- Leptospira


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Natural maintenance hosts Rats

icterohaemorrhagiae,copenhageni

& smithi, etc

Dogs canicola etc

Cattle pomona ,hardjo ,etc


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resistance- leptospira

Very susceptible to heat

10 mnts at 50 degree centigrade

10 seconds in 60 degree centi:

Sensitive to acid

Readily destroyed by chlorine


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Reservoir of infection

Rodents(Rattus rattus ,Rattus

norvegicus, Mus musculus )

Dogs

Wild animals

Domesticated animals

Caged game animals


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Source of infection Leptospires are excreted in the urine of

infected animals ,rodents etc.


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Host factor

Agemost affected age group is 20-40 yrs

Children acquire infection from domestic dogs

Sex - males are more prone to get infection

Occupation agricultural & live stock farmers

Immunity A solid host specific immunity

follows an infection


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Risk groups

Agricultural & Live stock farmers

Workers in rice fields & sugar cane fields

Underground sewer

Meat & animal handlers

Swimmers


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Environmental factors

Endemic in many countries.

Has a seasonal distribution.

Associated with

Poor housing

Limited water supply

Inadequate method of waste disposalRodent intensity


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Leptospirosis as Epidemic-

Associated with

1. Changes in human behavior

2. Contamination of water by animal / sewage

3. Changes in animal reservoir density

4. Follow natural disasters like cyclones &

floods


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Incubation period

Usually 10 days

Range- 4-20 days


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Mode of transmission

1.Direct contact with urine or tissue of infectedanimal

a.through skin abrasions

b.intact mucus membrane2.Indirect contact-

a.broken skin with infected soil, water orvegetation

b.through ingestion of food & watercontaminated with leptospira


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Pathogenesis of severe disease

Leptospira

Damage to smallblood vessels

vasculitis

Direct cytotoxic injuryImmunological injury

Massive migration of fluid fromIntravesicular to interstitial compartment

Renal dysfunction,vascular injuryTo internal organs


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Clinical variety

1. Septicemic Stage Fever lasting 4-7 days

Abrupt onset of high remittent fever,chills, headache, n/v, abdominalpain,myalgia

Respiratory manifestations like cough,respiratory distress, bloody sputum

Fever subsides by lysis and othersymptoms improve


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2. Immune or Toxic Stage

With or without jaundice

Lasting 4-30 days

If severe, death may occur bet. 9-16th day

a. Anicteric Type

Leptospiruria

b. Icteric TypeWeil Syndrome

Major organs involvement

Clinical variety


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3. Convalescence

relapses may occur during 4th- 5th

week

Clinical variety


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Diagnosis

Suspected clinically by

Deep jaundice

Sub- conjunctival haemorrhageMuscle tenderness

Decreased urine output

Possible exposure to rats urine


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Diagnosis

Culture

yBlood 1-7 days

yCerebrospinal Fluid 4- 10days

yUrine- after the 10th day until

period of convalescence


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Diagnosis

Agglutination tests

- done after 2nd or 3rd week

Dark field microscopy (MAT)

Culture from blood (IgM ELISA)

Macroscopic Slide Agglutination Test

PCR


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Differential diagnosis

Influenza;

Dengue and dengue haemorrhagic fever;

Yellow fever and other viral haemorrhagicfevers;

Malaria

Pyelo nephritis

Aseptic meningitis Viral hepatitis

Typhoid & other enteric fevers


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Complications

Renal failure

Acute hepatic failure

Acute cardio vascular failure Haemorrhage

Meningitis

pneumonia


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Cause of death

Renal failure

Cardio pulmonary failure

Widespread haemorrhage Liver failure rare


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Recovery from Leptospirosis

Most patient recover completely.

Some patients may take months/years.

Late sequlae may occur.


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General measures

Complete bed rest

Light easily digestible diet

Plenty of oral fluids Anti-pyretic medication as needed

Patients with complication shall be admitted

Sodium, potassium & phosphorus may be

restricted Nephrotoxic drugs should be avoided


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Treatment

Penicillin is the drug of choice when given

early -7 days.

If penicillin allergic tetracycline/erythromycin.

Early recognition and treatment within 2 daysof illness


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Management of severe cases

Should be treated in higher centre with facilitiesfor organ support.

Organ dysfunction may be treated on standard

lines. There is nothing specific treatment to

leptospirosis.

Hypovolemia should be corrected with normal

saline. Adequate calories (1000Kcal+100Kcal/year of

age) may be given.


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Prevention & control

Should be targeted at the

1.Source of infection

2.Route of transmission3.Level of human host


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Source of infection

Possible interventions

a. Rodent control.

b. Infected animals can be treated withantibiotics.

c. Immunization of pets & farm animals.

d. Excreta of domestic animals should bedisposed


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Interventions at the transmission route

Wearing protective clothings (boots,gloves ,aprons

mask ,etc) .

Covering skin lesions with water proof dressings. Strictly maintaining hygienic measures during

handling all animals.

Mechanization in agricultural operations.

Disinfection of water & swimming pool with

chlorine.


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Interventions at the level of human host

Raising awareness about the disease.

Antibiotic prophylaxis- Doxycycline give

some degree of protection.It can reduce

the severity of disease.

Immunization in available

countries.Vaccine give protection only

against the specific serovar.

Health education.


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Leptospirosis Upload