Leptospirosis

Introduction
Spirochetal disease, finely coiled, motile,
0.1 x 6 20
Systemic infection manifested as
widespread vasculitis
Zoonosis
L. interogans 23 serogroups and 187
serovars
L. biflexa : non-pathogenic, saprophyte

Historical back ground

1921 : Takaki L.
icterohemorragiae
1942 : sekiguchi L. canicola from mouse
1951 : , 401 -
ictohemorrhagiae
1975 : ,
1984 10 : ,

1984 : 9-11 leptospira

Epidemiology
Disease of the wild animals
Incidental human infection by direct or
indirect contact with the animal
20-40s active males: farmers or soldiers in
harvest time
9-10 peak into November
, , , , ,
,

Reservoires of Infection

Rats
Dogs
Live stocks
Rodents including rabbits
Wild animals
Cats

Sources of Human Infections

Contaminated Water or soil from infected
urine
Direct animal contacts
Occupational exposure : farmers, vets,
abattoire workers
Recreational exposure : campers,
swimmers, visiting graveyards

Routes of Infection
Contact with water or soil contaminated animals
Direct contact with the by urine from infected source,
farmer, vets, butchers, recreational activities
Rodents carry EH fever, scrub typhus, paratyphus,
leptospirosis
Factors for high incidence : rain during harvest time,
carrier rate in rodents
Spirochetes survive longer in wet swampy conditions


1985.2 1986.7 : 11.69%
1987.2 1987. 7 : 5.9 %
1985 in febrile patients : 20%
1986- 1987 in febrile patients : 11.6%


1984
1985
1986
1987

:
:
:
:

15.5%
14.9%
16%
30.9% ( , )

Microbiology and distribution

Mainly serogroup ictohemorrhagiae and
canicola
, , , ,
CH-48 : ,
Serovar : mainly lai

Pathogenesis
Entry sites : skin wounds or abrasions in hand and
feet and mucous membranes, conjunctiva, nasal,
oral
Bacteremia involving the entire body including eye,
CSF
Systemic effect and vasculitis due to endotoxin
(hyaluronidase) and burrowing motility
Hemorrhagic necrosis esp. in liver, lung, and
kidneys jaundice, ARF, hemorrhages

Clinical types
Types

1986

1987

Pneumonitis
Rash type
Weils disease
Renal failure
Flue-like
Acute Hepatitis
Combination

33%
17%
15%
13%
15%
8%

57.7%

53.8%
13.5%
86.5%

Phase I (Septicemic)
Following incubation period of 7-10 days
High spiking fever, headaches, myalgia,
arthralgias
Lasting 4 7 days
Proteinuria and increased creatinnine
Organism detectable but serologic diagnosis
not possible

Phase II (Immune)
Much more variable
Induction of IgM Antibodies
1- 3 day freedom recurrence of
symptoms
Lower fever, CNS signs
Maybe cultured from urine but not from
blood or CSF

Weils Disease
Less common but severe form
Mild phase I, initially
Followed by severe Jaundice , Azotemia,
and Hemorrhage from Lungs, GI tract,
and other organs (3-6 day)
Oliguric renal failure and Liver
dysfunction dominate the clinical picture

Clinical Signs of Leptospirosis

Pulmonary infiltrates, pneumonitis, hemorrhages

Conjunctival injection
Jaundice
Muscle tenderness
Abdominal tenderness
CVA tenderness
Abnormal auscultation
Erythema, petechiae, neck stiffness, adenopathy

Lab. Diagnosis
Microbiologic identification : Blood or CSF
first 10 days Urine second week
(Fletchers, EMJH Medium)
Serology: screeningMicroscopic Slide
Agglutination (MST), titration & serogroup
identification Microscopic Agglutination
(MAT), detection of IgM (ELISA)

Chest X-rays

33 64 % of patientssjows abnormality
Bilateral nodules, rosette densities
Diffuse ill-defined infiltrates
Massive confluent consolidation
Bilateral, Non-lobar, peripheral predominance
Rare pleural reaction
Complete resolution within 5 to 10 days

Treatment
Early anti-microbial therapy is
importantshorten the course and prevent
carrier state
Choice : Penicillin G, Ampicillin
May cause Jarish-Huxheimer type
reaction
Mild cases oral Doxycycline or Amoxicillin

Prevention

Vaccination of domestic animals

Rodent control
Protective gloves and boots
Avoid swimming in contaminated waters
Vaccination in endemic region

Differential Diagnosis
EH fever
Rickettsial disease : Scrub typhus, murine
typhus
Acute viral hepatitis
Sepsis
Influenza
Aseptic Meningitis

Conjunctival hemorrhage
in leptospirosis