LEPTOSPIROSIS bahan kuliah

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LEPTOSPIROSIS


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Leptospirosis is an infectious disease caused bypathogenic bacteria called leptospires.

Leptospires are bacteria which can be eitherpathogenic(i.e. having the potential to causedisease in animals and humans) or saprophytic(i.e. free living and generally considered not tocause disease).

Pathogenic leptospires are maintained in naturein the renal tubules of certain animals.

Saprophytic leptospires are found in many typesof wet or humid environments ranging from

surface waters and moist soil to tap water.Saprophytic halophilic (salt-loving) leptospires arefound in seawater.


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Transmitted directly or indirectly from animals to humans

a zoonosis.

The disease is found mainly wherever humans come into

contact with the urine of infected animals or a urine-

polluted environment.

Leptospirosis occurs worldwide but is most common in

tropical and subtropical area with high rainfall.


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History :

Adolf Weil described leptospirosis as a disease

entity in 1886. His name is still attached to aserious form of leptospirosis called Weil's disease

Morphology : Leptospires are corkscrew-shaped bacteria,

which differ from other spirochaetes by the

presence of end hooks.


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Klasifikasi ilmiah

Kerajaan: Bakteri

Filum: Spirochaetes

Kelas:

Spirochaeates

Ordo: Spirochaetales

Famili: Leptospiraceae

Genus: Leptospira

Serovar[2]

Leptospira interogans

Lepstospira australis

Leptospira autumnalis

Leptospira ballum Leptospira icterohemorrhagica

Leptospira canicola

Leptospira grippotyphosa

Leptospira pomona
http://id.wikipedia.org/wiki/Klasifikasi_ilmiahhttp://id.wikipedia.org/wiki/Bakterihttp://d/user/amy/BLOK%20GIT%201112/Leptospirosis.htmhttp://d/user/amy/BLOK%20GIT%201112/Leptospirosis.htmhttp://id.wikipedia.org/wiki/Bakterihttp://id.wikipedia.org/wiki/Klasifikasi_ilmiah


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Serovars having antigenic similarities are formed

into serogroups, and over 200 pathogenic

serovars divided into 25 serogroups have beendescribed.

It is of epidemiological importance. A certain

serovar may develop a commensal orcomparatively mild pathogenic relationship with a

certain animal host species. For instance, cattle

are often associated with serovar hardjo, dogs

with canicola and rats with icterohaemorrhagiae

and copenhageni


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Patophysiology:

A host that becomes infected by accident orincidentally with a serovar for which the animal is nota natural maintenance host is called an accidental orincidental host

After infection, leptospires appear in the bloodandinvade practically all tissues and organs. They are

subsequently cleared from the body by the host'simmune response to the infection.

However, they may settle in the onvoluted tubules ofthe kidneys and be shed in the urine for a period of a

few weeks to several months and occasionally evenlonger. They are then cleared from the kidneys andother organs but may persist in the eyes for muchlonger.


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Typically, the disease presents in four broad

clinical categories:

1. a mild, influenza-like illness;

2. Weil's syndrome characterized by jaundice,

renal failure, haemorrhage and myocarditis

with arrhythmias;

3. meningitis/meningoencephalitis;

4. pulmonary haemorrhage with respiratory

failure.


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AKI : Acute Kidney Injury

ATN : Acute Tubular Necrosis

AIN : Acute Interstitial Nephritis


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Clinical diagnosis is difficult because of the

varied and non-specific presentation.

Confusion with other diseases, e.g. dengueand other haemorrhagic fevers, is particularly

common in the tropics


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Leptospirosis may be underdiagnosed because:

the diagnosis is difficult to confirm

it may be confused with other diseases

the disease may be mild and not be

investigated in the laboratory

Important causes of death include renal failure,

cardiopulmonary failure, and widespread

haemorrhage.


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The incubation period is usually 514 days, with a

range of 230 days.

The virulence factors in leptospires are poorly

understood. Some serovars generally tend to cause

mild disease and others severe disease. However,

there are no serovar-specific presentations of

infection and any serovar may cause mild or severe

disease in different hosts. Patient factors such as old

age and multiple underlying medical problems areoften associated with more severe clinical illness and

increased mortality


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Laboratory support is needed

To confirm the diagnosis. Leptospirosis is

difficult to distinguish from a number of otherdiseases on clinical grounds.

Laboratory methods help to confirm

leptospirosis where the disease is suspectedon clinical grounds

The disease is usually diagnosed in the

laboratory by detecting antibodies(serodiagnosis) and by culturing the bacteria

from blood, urine or tissues


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Leptospires usually circulate in the blood of the

patient for about 10 days after the onset of the

disease. They also appear in other body fluids, suchas urine and cerebrospinal fluid, a few days after the

onset of disease and penetrate internal organs

during this time.

Detectable titres of antibodies appear in the bloodabout 510 days after the onset of disease, but

sometimes later, especially if antibiotic treatment is

instituted

The microscopic agglutination test (MAT) is

considered the "gold standard


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Leptospires grow in a variety of culture media

Their growth is relatively slow, with a doubling

time of about 68 hours at best. Optimal

temperatures for growth are 2830C.

A blood sample is usually examined.


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Treatment with effective antibiotics should be

initiated as soon as the diagnosis of leptospirosis

is suspected and preferably before the fifth day

after the onset of illnes

Severe cases of leptospirosis should be treated

with high doses of intravenous penicillin.

Less severe cases can be treated with oral

antibiotics such as amoxycillin, ampicillin,

doxycycline or erythromycin.


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