Leptospirosis: A Neglected Infectious Disease In The Tropics

Fadel Muhammad Garishah, BSc

Department of General Medicine

Faculty of Medicine Diponegoro University

Overview of Leptospirosis

Zoonotic disease caused by Leptospiral pathogens

Systemic infection characterized by fever, thrombocytopathy, liver failure, respiratory failure and acute tubular necrosis

An overlooked infectious disease due to poorly availability of diagnostic tools

Relatively simple medication

Important to Understand

Leptospirosis typically presents as a nonspecific, acute febrile illness characterized by fever, myalgia, and headache and may be confused with other entities such as influenza and dengue fever.

Endemic regions, professions, history of possible exposures affect Clinical Judgement

Epidemiology

Microbiological Aspects

• Spirochetes• Length 15-20 um• Periplasmic flagella• Unstained with

gram• Dark

microscopy/silver impregnation

Reservoir and Transmissions

Transmission

transmitted to humans by direct contact with reservoir animals

by exposure to environmental surface water or soil that is contaminated with their urine

Risks

Natural History of Leptospirosis

Pathobiology

Patients progressing to multisystem organ failure have widespread hematogenous dissemination of pathogens.

Nonoliguric (high output) renal dysfunction should be supported with fluids and electrolytes.

Elevated bilirubin levels are due to hepatocellular damage and disruption of intercellular junctions between hepatocytes, resulting in leaking of bilirubin out of bile caniliculi.

Hemorrhagic complications are common and are associated with coagulation abnormalities.

Severe pulmonary hemorrhage syndrome due to extensive alveolar hemorrhage has a fatality rate of >50 %.

Clinical Manifestations

Clinical features

Conjunctival SuffusionCalf MuscleTenderness

Leptospiral Rash

Diagnostic Terms

Suspect case

Probable case

Confirmed case

Suspect Case

Acute fever > 38,5C; with/out severe headache

Myalgia

Prostration

Conjunctival suffusion

History of exposure!

Probable case

Calf tenderness

Cough with/without hemoptysis

Jaundice

Hemorrhagic

Meningism

Anuria/oliguria/proteinuria

Breathlessness

Cardiac arrythmia

Skin rashes

With Positive Rapid IgM Test or MAT 200/single sample

Diagnostic Tools

Dark field microscopy/Ink stain

Microscopic Agglutination Test

ELISA

PCR

Cultur EMJH/Fletcher’s Medium

Confirmed case

Suspect/Probable Case

With isolation of Leptospira spp.

PCR positive

Seroconversion of MAT 4 folds

MAT titre 400/single sample

Chemotherapeutics

Mild

Doxycyline 2 x 100 mg for 7 days

Amoxicillin/Ampicillin 2 g/day for 7 days

Severe Case

Penicillin G 2 MU IV/6hours for 7 days

Ceftriaxon 1 g/day for 7 days

Supportive managements

Renal (Dialysis)

Hepatic

Pulmonary (Ventilators)

Hemorrhages (Transfusions)