Leptospirosis Upload
Transcript of Leptospirosis Upload
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A case history
A 25 year old man is brought to the Out
Patient Department with history of fever of
3 days duration with following symptoms& signs.
High grade fever of continuous nature.
Generalized aches & severe myalgia.
Yellowish discoloration of eyes & urine.
Non-specific head ache.
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MA. ESTRELLA LENA M. PUSAG RN
M
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Introduction
Leptospirosis is a most widespread zoonoticdisease in the world caused by the pathogenicbacteria called leptospires.
Human to human transmission occurs onlyvery rarely.
Generally it is transmitted by the infected urineof rodents.
Case fatality may vary from 0.3 8 %.
Severe form of leptospirosis is called Weils
Syndrome Also included as water borne & milk borne
disease
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Distribution
Worldwide disease.
Most common in tropical & subtropical
areas with high rainfall. In India with frequent outbreaks in
Maharashtra ,Gujarat,Karnataka , Kerala
& Andaman islands especially during the
monsoon.
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Leptospirosis-synonyms
Mud fever
Japanese seven day fever
Leptospiral Jaundice Spirochete Jaundice
Autumn fever
Weil's disease Rat Catcher's Yellows
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History ofLeptospirosis
1883 it was recognized as an occupational
disease of sewer workers 1886 first description (by Adolf Weil) of the
clinical manifestations seen in 4 men -severe
jaundice, fever, and hemorrhage with renal
involvement
1916 the causal agent was identified by Inada
et al in Japan
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Epidemiological determinants
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Causative agent-Leptospira
Corkscrew -shaped delicate flexiblespirochetes.
About 6 20 micrometer long & 0.1
micrometer thick. Posses a large number of closely wound
spirals & characteristic end hooks.
Actively motile.
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Leptospira --
Too thin to visible under ordinary
microscope.
dark field micros copy is using.
Order-Spirochaetals.
Family- Leptospiraceae.
Genus- Leptospira
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Natural maintenance hosts Rats
icterohaemorrhagiae,copenhageni
& smithi, etc
Dogs canicola etc
Cattle pomona ,hardjo ,etc
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resistance- leptospira
Very susceptible to heat
10 mnts at 50 degree centigrade
10 seconds in 60 degree centi:
Sensitive to acid
Readily destroyed by chlorine
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Reservoir of infection
Rodents(Rattus rattus ,Rattus
norvegicus, Mus musculus )
Dogs
Wild animals
Domesticated animals
Caged game animals
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Source of infection Leptospires are excreted in the urine of
infected animals ,rodents etc.
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Host factor
Agemost affected age group is 20-40 yrs
Children acquire infection from domestic dogs
Sex - males are more prone to get infection
Occupation agricultural & live stock farmers
Immunity A solid host specific immunity
follows an infection
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Risk groups
Agricultural & Live stock farmers
Workers in rice fields & sugar cane fields
Underground sewer
Meat & animal handlers
Swimmers
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Environmental factors
Endemic in many countries.
Has a seasonal distribution.
Associated with
Poor housing
Limited water supply
Inadequate method of waste disposalRodent intensity
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Leptospirosis as Epidemic-
Associated with
1. Changes in human behavior
2. Contamination of water by animal / sewage
3. Changes in animal reservoir density
4. Follow natural disasters like cyclones &
floods
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Incubation period
Usually 10 days
Range- 4-20 days
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Mode of transmission
1.Direct contact with urine or tissue of infectedanimal
a.through skin abrasions
b.intact mucus membrane2.Indirect contact-
a.broken skin with infected soil, water orvegetation
b.through ingestion of food & watercontaminated with leptospira
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Pathogenesis of severe disease
Leptospira
Damage to smallblood vessels
vasculitis
Direct cytotoxic injuryImmunological injury
Massive migration of fluid fromIntravesicular to interstitial compartment
Renal dysfunction,vascular injuryTo internal organs
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Clinical variety
1. Septicemic Stage Fever lasting 4-7 days
Abrupt onset of high remittent fever,chills, headache, n/v, abdominalpain,myalgia
Respiratory manifestations like cough,respiratory distress, bloody sputum
Fever subsides by lysis and othersymptoms improve
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2. Immune or Toxic Stage
With or without jaundice
Lasting 4-30 days
If severe, death may occur bet. 9-16th day
a. Anicteric Type
Leptospiruria
b. Icteric TypeWeil Syndrome
Major organs involvement
Clinical variety
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3. Convalescence
relapses may occur during 4th- 5th
week
Clinical variety
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Diagnosis
Suspected clinically by
Deep jaundice
Sub- conjunctival haemorrhageMuscle tenderness
Decreased urine output
Possible exposure to rats urine
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Diagnosis
Culture
yBlood 1-7 days
yCerebrospinal Fluid 4- 10days
yUrine- after the 10th day until
period of convalescence
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Diagnosis
Agglutination tests
- done after 2nd or 3rd week
Dark field microscopy (MAT)
Culture from blood (IgM ELISA)
Macroscopic Slide Agglutination Test
PCR
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Differential diagnosis
Influenza;
Dengue and dengue haemorrhagic fever;
Yellow fever and other viral haemorrhagicfevers;
Malaria
Pyelo nephritis
Aseptic meningitis Viral hepatitis
Typhoid & other enteric fevers
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Complications
Renal failure
Acute hepatic failure
Acute cardio vascular failure Haemorrhage
Meningitis
pneumonia
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Cause of death
Renal failure
Cardio pulmonary failure
Widespread haemorrhage Liver failure rare
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Recovery from Leptospirosis
Most patient recover completely.
Some patients may take months/years.
Late sequlae may occur.
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General measures
Complete bed rest
Light easily digestible diet
Plenty of oral fluids Anti-pyretic medication as needed
Patients with complication shall be admitted
Sodium, potassium & phosphorus may be
restricted Nephrotoxic drugs should be avoided
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Treatment
Penicillin is the drug of choice when given
early -7 days.
If penicillin allergic tetracycline/erythromycin.
Early recognition and treatment within 2 daysof illness
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Management of severe cases
Should be treated in higher centre with facilitiesfor organ support.
Organ dysfunction may be treated on standard
lines. There is nothing specific treatment to
leptospirosis.
Hypovolemia should be corrected with normal
saline. Adequate calories (1000Kcal+100Kcal/year of
age) may be given.
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Prevention & control
Should be targeted at the
1.Source of infection
2.Route of transmission3.Level of human host
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Source of infection
Possible interventions
a. Rodent control.
b. Infected animals can be treated withantibiotics.
c. Immunization of pets & farm animals.
d. Excreta of domestic animals should bedisposed
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Interventions at the transmission route
Wearing protective clothings (boots,gloves ,aprons
mask ,etc) .
Covering skin lesions with water proof dressings. Strictly maintaining hygienic measures during
handling all animals.
Mechanization in agricultural operations.
Disinfection of water & swimming pool with
chlorine.
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Interventions at the level of human host
Raising awareness about the disease.
Antibiotic prophylaxis- Doxycycline give
some degree of protection.It can reduce
the severity of disease.
Immunization in available
countries.Vaccine give protection only
against the specific serovar.
Health education.
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