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LEPTOSPIROSIS
Zoonotic d/s
Worldwide ?tropical and subtropical
Causative organism- Leptospira (Spirochete)
Reservoir ? rat(principal source)
dog,cat,livestock,wild animals
Source of infection :
water or soil contaminated with
urine or faeces of infected animals
Risk groups
Agricultural workers
Veterinarians
Meat handlers
Rodent control workers
Laboratory workers
pathogenicity
Leptospira enter the body through cut or
abrasion in skin or through mucous
membrane
Spread to all organs hematogenously
Damage endothelial lining of small blood
vessel
Leakage and extravasation of blood cells ,
hemorrhage and
Ischemic damage to liver,kidneys,meninges
and muscles
Clinical feature
Asymptomatic or
febrile illness (70%)
Symptomatic aseptic meningitis(20%)
wiel d/s(5-10%)
Incubation period:1-2wks
Biphasic
-initial/septicemic phase
-immune/leptospiruric phase
Initial/septicemic phase
Lasts for 2-7 days
Onset is abrupt with high grade fever with
rigor n chills,lethargy,headache,nausea n
vomiting
There may be conjunctival suffusion with
photophobia and orbital pain
Generalised lymphadenopathy and
hepatosplenomegaly
Transient maculopapular rash in<10%
Most patients are asymptomatic within 1 wk
Immune/leptospiruric phase
Leptospira localise to tissues
No more be isolated from blood or CSF
Circulating autoantibodies to leptospira are
present
Some children-aseptic meningitis or uveitis
with recurrence of fever
CNS abnormalities usually normalize within
1wk
Mortality is rare
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
Renal failure-2nd wk
All have abnormal urinary findings
-hematuria,proteinuria,cast
Azotemia is common a/w oliguria or anuria
Mortality is 5-10%
Differential diagnosis
Malaria
Dengue
Enteric fever
a/c viral hepatitis
Hantavirus infection
Diagnosis
CBC-anemia,leukocytosis,thombocytopenia
CRP
Liver enzymes mildly with SGOT>SGPT
CPK is high
In weil d/s-
serum creatinine is elevated
coagulation parameters deranged
direct hyperbilirubinemia
raised transaminase
Specific diagnosis
Serologic testing
gold standard-MAT
commercial kits-rapid test
IgM ELISA
Microscopic examination of organism or
culture
Treatment
DOC in severe cases-parenterel Penicillin G
Acceptable alternatives-Ceftriaxone and
Tetracycline
DOC for oral treatment
Amoxicillin and Doxycycline(>8yrs)
prevention
Avoid exposure to contaminated water
Single dose of doxycyline or amoxicilline
following exposure can prevent illness
THANK YOU
This post was last modified on 12 August 2021