LEPTOSPIROSIS

ETIOLOGY:
LEPTOSPIRA INTERROGANS

LEPTOSPIROSIS
WEILS SYNDROME DANGEROUS
PRETIBIAL (FORG BRAGG) FEVER
MYOCARDITIS
ASEPTIC MENINGITIS

CLINICAL MANIFESTATIONS (1)

INCUBATION PERIOD: 2-20 (7-113) DAYS

A. LEPTOSPIREMIC PHASE (I)

~ LASTS 4-9 DAYS

~ LEPTOSPIRES ARE PRESENT IN THE:

* BLOOD

* CEREBROSPINAL FLUID

CLINICAL MANIFESTATIONS (2)

SYMPTOMS:

~ ABRUPT FEVER TO 37-40C

~ RECURRENT CHILLS

~ ABDOMINAL PAIN

~ ANOREXIA, NAUSEA, VOMITING

~ DIARRHEA

~ PHOTOPHOBIA

CLINICAL MANIFESTATIONS (3)

~ SEVERE HEADACHE:
- FRONTAL
- <RETRO-ORBITAL DHF
- BITEMPORAL
- OCCIPITAL

CLINICAL MANIFESTATIONS (4)

~ PULMONARY MANIFESTATIONS:
* COUGH
* CHEST PAIN
* HEMOPTYSIS IS RARE
* ADULT RESPIRATORY DISTRESS
SYNDROME (ARDS)

CLINICAL MANIFESTATIONS (5)

~ SEVERE MUSCLE ACHING:

- TIGHTS
- LUMBAR AREA
- CUTANEOUS HYPERESTHESIA (CAUSALGIA)
- MYALGIA CALF MUSCLE/GASTROCNEMIUS !!!

CLINICAL MANIFESTATIONS (6)

SIGNS
~ RELATIVE BRADYCARDIA
~ NORMAL BLOOD PRESSURE/HYPOTENSION
~ DISTURBANCES IN THE SENSORIUM
~ CONJUNCTIVAL SUFFUSION !!!
~ PURULENT CONJUNCTIVITIS
~ PHARYNGEAL INJECTION

CLINICAL MANIFESTATION (7)

~ CUTANEOUS HEMORRHAGES
~ SKIN RASHES > ON THE TRUNK
~ SPLENOMEGALY <
~ HEPATOMEGALY <
~ LYMPHADENOPATHY
~ JAUNDICE

CLINICAL MANIFESTATIONS (8)

B. IMMUNE PHASE (1)
~ APPEARANCE OF IgM ANTIBODIES
~ C3 IN SERUM IS NORMAL RANGE
~ CEREBROSPINAL FLUID: PLEOCYTOSIS
~ LEPTO DALAM DARAH/ DALAM CSF
SYMPTOMS
~ ASYMPTOMATIC 1-2 DAYS
~ FEVER 1-3 DAYS DURATION

CLINICAL MANIFESTATIONS (9)

B. IMMUNE PHASE (2)
- ANOREKSIA
- MUAL/MUNTAH
- DIARE
- SEFALGIA
- MIALGIA BETIS, PAHA, PINGGANG
- BATUK / SAKIT DADA

CLINICAL MANIFESTATIONS (10)

SIGNS
~ MENINGISMUS
~ IRDOCYCLITIS
~ OPTIC NEURITIS
~ ENCEPHALITIS
~ MYELITIS
~ PERIPHERAL NEUROPATHY
~ CONJUNCTIVAL SUFFUSION
(CONJUNCTIVAL INJECTION)

CLINICAL MANIFESTATIONS (11)

C. CONVALESCENT PHASE
~ BETWEEN THE SECOND & FOURTH WEEKS
~ FEVER AND ACHING RECUR

Kriteria Beratnya Leptospira Perlapangan

Penglihatan pembesaran 10 x 40

Leptospira/10x40
Tidak ditemukan
<1
1 50
51 100
> 100

Kriteria
+
+
++
+++

Leptospiruria
Negatif
Ragu-ragu
Ringan
Sedang
Berat

(Halim Mubin dan Gatot Laurence, 1997)

SPECIFIC FEATURES

1. WEILS SYNDROME (1)

2. ASEPTIC MENINGITIS
3. PRETIBIAL ( FORT BRAGG) FEVER
4. MYOCARDITIS

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SPECIFIC FEATURES
1. WEILS SYNDROME (1)
~ SEVERE LEPTOSPIROSIS
~ CLINICAL MANIFESTATIONS
* JAUNDICE
* AZOTEMIA
* HEMORRHAGES
* ANEMIA

1. WEILS SYNDROME (2)

* DISTURBANCES IN CONSCIOUSNESS
* CONTINUED FEVER SEVERAL WEEKS
* RENAL OR HEPATIC MANIFESTATIONS
* HEPATIC TENDERNESS & ENLARGEMENT
* SGOT <4X HYPERBILIRUBINEMIA >> DIRECT
SERUM BILIRUBIN OF 40 MG/DL WITH SGOT OF 170 IU

1. WEILS SYNDROME (3)

RENAL MANIFESTATION:
- PROTEINURIA
- PYURIA
- HEMATURIA
- AZOTEMIA
- DYSURIA IS RARE

1. WEILS SYNDROME (4)

-ACUTE TUBULAR NECROSIS OLIGURIA
- BLOOD UREA NITROGEN (BUN)
- HEMORRHAGIC MANIFESTATION
- HYPOPROTHROMBINEMIA
- THROMBOCYTOPENIA

2. ASEPTIC MENINGITIS
~ PLEOCYTOSIS IS PRESENT AFTER THE IMMUNE PHASE
~ LEUKOCYTES TENS HUNDREDS/MM 3
>>NEUTROPHILS OR MONONUCLEAR CELLS
~ CSF GLUCOSE NORMAL
~ CSF PROTEIN >100 MG%
~ XANTHOCHROMIC CSF

3. PRETIBIAL ( FORT BRAGG) FEVER

~ DEVELOPMENT OF A RASH:
- ON ABOUT THE FOUTH DAY
- SLIGHTLY RAISED
- ERYTHEMATOUS LESIONS USUALLY SYMMETRICALLY
DISTRIBUTED OVER THE PRETIBIAL AREAS
- SPLENOMEGALY 95%
-

4. MYOCARDITIS
~ CARDIAC ARRHYTMIAS
- ATRIAL FIBRILATION
- ATRIAL FLUTTER
- VENTRICULAR CONTACTIONS
~ ACUTE LEFT VENTRICULAR FAILURE
~ JAUNDICE
~ PULMONARY INFILTRATES
~ ARTHRITIS
~ SKIN RASHES

TREATMENT (1)
* ANTIMICROBIAL DRUGS:
~ PENICILLIN G/ PP
~ CEFTRIAXON 2-3 GRMS DAILY
~ STREPTOMYCIN
~ TETRACYCLINE
~ CHLORAMPHENICOL
~ ERYTHROMYCIN
~ MUST BE ADMINISTERED WITHIN 2-4 DAYS,
OF THE ONSET OF ILLNESS

TREATMENT (2)
* SUPPORTIVE THERAPY
~ EARLY BED REST
~ FLUID & ELECTROLYTE
~ PERITONEAL DIALYSIS/HEMODIALYSIS AZOTEMIA
~ EXCHANGE TRANSFUSION HYPERBILIRUBUNEMIA

PROGNOSIS
~ THE VIRULENCE OF THE ORGANISM

THE JAUNDICE:

* ANICTERIC PATIENTS DEATH <<

* JAUNDICE MORTALITY 15-40%
~ THE GENERAL CONDITION OF THE PATIENT
~ AGE:
- MORTALITY RATE:
* 10% IN <50 YRS
* 56% IN > 51 YRS