Download MBBS Leptospirosis Lecture PPT

LEPTOSPIROSIS
Zoonotic d/s
Worldwide ?tropical and subtropical

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Causative organism- Leptospira (Spirochete)
Reservoir ? rat(principal source)
dog,cat,livestock,wild animals
Source of infection :
water or soil contaminated with

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urine or faeces of infected animals

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Risk groups
Agricultural workers

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Veterinarians
Meat handlers
Rodent control workers
Laboratory workers

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pathogenicity
Leptospira enter the body through cut or
abrasion in skin or through mucous
membrane

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Spread to all organs hematogenously
Damage endothelial lining of small blood
vessel
Leakage and extravasation of blood cells ,
hemorrhage and

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Ischemic damage to liver,kidneys,meninges
and muscles

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Clinical feature

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Asymptomatic or
febrile illness (70%)
Symptomatic aseptic meningitis(20%)
wiel d/s(5-10%)
Incubation period:1-2wks

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Biphasic
-initial/septicemic phase
-immune/leptospiruric phase

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Initial/septicemic phase
Lasts for 2-7 days
Onset is abrupt with high grade fever with
rigor n chills,lethargy,headache,nausea n
vomiting

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There may be conjunctival suffusion with
photophobia and orbital pain
Generalised lymphadenopathy and
hepatosplenomegaly
Transient maculopapular rash in<10%

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Most patients are asymptomatic within 1 wk

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Immune/leptospiruric phase
Leptospira localise to tissues

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No more be isolated from blood or CSF
Circulating autoantibodies to leptospira are
present
Some children-aseptic meningitis or uveitis
with recurrence of fever

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CNS abnormalities usually normalize within
1wk
Mortality is rare

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Icteric leptospirosis(weil syndrome)
Most severe of all manifestations
Severe hepatic n renal dysfunction
Jaundice n hepatomegaly are usually detected
Splenomegaly in 10% of the cases

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Renal failure-2nd wk
All have abnormal urinary findings
-hematuria,proteinuria,cast
Azotemia is common a/w oliguria or anuria
Mortality is 5-10%

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Differential diagnosis
Malaria
Dengue

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Enteric fever
a/c viral hepatitis
Hantavirus infection

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Diagnosis
CBC-anemia,leukocytosis,thombocytopenia
CRP
Liver enzymes mildly with SGOT>SGPT
CPK is high

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In weil d/s-
serum creatinine is elevated
coagulation parameters deranged
direct hyperbilirubinemia
raised transaminase

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Specific diagnosis
Serologic testing
gold standard-MAT

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commercial kits-rapid test
IgM ELISA
Microscopic examination of organism or
culture

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Treatment
DOC in severe cases-parenterel Penicillin G
Acceptable alternatives-Ceftriaxone and
Tetracycline

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DOC for oral treatment
Amoxicillin and Doxycycline(>8yrs)

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prevention

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Avoid exposure to contaminated water
Single dose of doxycyline or amoxicilline
following exposure can prevent illness

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THANK YOU

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