Calamba Doctors ’

College
National Highway Parian ,
Calamba City

“ They ’ re Bold , They ’ re Breeding

The disease is SPREADING ”

LEPTOSPIROSIS
A Clinical
Approach
M s . B les sil da U . Buj al anc e R N , M A N
Resource
Speaker
Just a Mere
Flashback ..
 It did not only gave heavy rains
that washed all our investments and
even memories , which took years to
build ; it left us wounds that no one
knows when to heal and alarming
diseases that took hundreds of
lives .
OUTLINE
 Introduction
 Leptospira
interrogans
 Transmission
 Clinical
features
 Diagnosis
 Management
 Prevention
 Conclusion

 Introd uction
 A zoonotic disease
 Caused by Leptospira interrogans
 Geographically widespread
 Most common in tropical and subtropical
areas with high rainfall
 First detected in 1886 by Adolph Weil
 Synonyms: Rat fever, fish handler's
disease, mouse fever & rice field fever
 Leptospira Interrog an s
Flexible, filamentous bacteria made up of

fine spirals with hook-shaped ends
 Gram -ve
 Spirochetes
 > 200 known serotypes
 Obligate aerobes
 Slow growing in culture
 Survives in a moist
 environment for weeks-months


9
Animals spread
Leptospirosis


 Rats, Mice, Wild

Rodents, Dogs, Swine,
Cattle are principle
source of infection
 The above animals
excrete Leptospira
both in active infection
and Asymptomatic
stage
 The Leptospira survive
and remain viable for
several weeks in
stagnant water.
 Transmissi on
 Wild & domesticated animal hosts 
Human
 Common reservoirs: rodents, dogs & farm
animals
 Human: incidental, “dead-end” hosts
 Contact with soil, water & feed
contaminated by urine or tissue of
infected animals
  Occupational exposure
  Recreational activities
 Enter through broken skin or mucous
membranes or conjunctiva

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12
Epidemiology - Occupation

 Certain
occupational groups
such as agriculture
workers in rice and
cane fields, miners
and sever cleaners
are potential victims
How Man gets Infected
 Water the great source
 Drinking
 Swimming
 Bathing, as the urine of
Rodents chronically
infected contaminate
water sources


Children get infected



when in contact with

infected Dogs

 Clinical Fea tures
 Incubation period: 2 - 30
days
 Clinical presentations range
from a self-limited febrile
illness to a severe illness
associated with multi-organ
damage
 Mortality rate in severe
cases: 10-15%


15
Clinical Features ( con ’ t )

petechial rash

conjunctival suffusion
16
May present with Major
Complications

 Nephritis
 Hepatitis.
 Manifestations in eye
 Muscular lesions
 Many infections are mild
and subclinical
Weil’s Syndrome
 Weil's syndrome is a severe form of
leptospirosis that causes a continuous
fever, stupor, and a reduction in the
blood's ability to clot, which leads to
bleeding within tissues. Blood tests
reveal anemia. By the third to sixth day,
signs of kidney damage and liver injury
appear. Kidney abnormalities may cause
blood in the urine and painful urination.
Liver injury tends to be mild and usually
heals completely.
Hepatitis - Leptospirosis
 Hepatitis is the
frequent
complication
 Elevation of serum
creatine
phosphilipae
enzyme raise
differentiates
from Viral
hepatitis where
the enxymeis
not raised

Nephritis - Leptospirosis
 Kidney involvement
in animals produce
chronic disease of
the kidney and the
infected animal
starts shedding
large number of
leptospira and
main source of
environmental
contamination of
bacteria and
results I human
infections
 Human urine also
contain
Spirochetes in the
second and third
week of infection
Early and Prompt Diagnosis is
Highly Essential
 The development of simpler, rapid assays
for diagnosis has been based largely on
the recognition that early initiation of
antibiotic therapy is important in acute
disease but also on the need for assays
which can be used more widely.
Laboratory Diagnosis
 Specimens

 1 Blood to be collected
in a heparin tube
 2 CSF, Tissues
 Microscopic
examination
 3 Urine to be collected
with great care to
avoid contamination
 4 Serum for
agglutination tests

Culturing Leptospira
 Blood and Urine be
cultured in Fletcher’s
semisolid agar or other
media chemically defined
protein-free media for the
growth of leptospireshave
been proposed. In order to
obtain the desired rapid
and abundant growth of
organisms necessary for
the efficient production of
vaccines, it has been
necessary to supplement
such media with a source of
fatty acids,

Serology
Agglutinating
antibodies raise
to very high titers
 1 : 10,000 or higher
 occurs 5 – 10
weeks after onset of
infection
Serology - ELISA
 Several
Immunoassays are
available as
commercial kits
 Detection of IgM and
razing titers of IgG
will guide in
association with
clinical history will
help in Diagnosis
Treatment

 Antibiotic of choice is Benzyl Pencillin
given by injection in doses of 5 mega units
in a day, for 5 days.
 If the patients are genuinely hypertensive to
Pencillin opted with Erythromycin
250mgs four times a day for a period of 5
days.
Treatment - Other alternatives
 The leptospirosis can be effectively treated
with
 Doxycycline
 Ampicillin
 Amoxicillin
Severe patients need administration

Intravenous Pencillin or Amoxcillin

Epidemiology

 Leptospirosis causes several animal
infections
 Most wide spread zoonotic infection in
Nature
 Human infections are accidental
associated with contamination of water,
other materials contaminated with
excreta and animal flesh.
 Animal carriers often excrete upto
100million leptospirosis per ml of urine


Control of Leptospirosis


 Rodent control is
most important.
 Human’s should
avoid contact
with water
contaminated
with animal
contact.

 Chemoprophylaxis



Doxycycline 200
mg orally once a
week is simple
effective measure.
When heavy
exposure is
anticipated

Vaccination in humans

 Vaccination for humans is justified where
they cannot be separated from animal
sources or where the animals cannot be
immunized successfully
 Necessity of human vaccinated will arise
where people live and work in proximity
to rodents in wet, tropical conditions, in
wet rice planting and harvesting, in
military operations, or working in sewers.
 Yet no universally accepted vaccine is
available for humans
Vaccination of Animals


 Vaccinating animals have a dual purpose

 1 Protecting animals
 2 Protecting humans who may contract
leptospirosis from them
 It is probably true as that immunization of
animals will prevent leptospirosis in people
in contact with them .
 It proved true in 1980 when extensive
vaccination of dairy cows in New Zealand
lead to marked decreased incidence in
Humans .
 Animals immunized experimentally with
polysaccharide derived from Leptospira LPS
linked to diphtheria Toxoid were protected
against challenges
 Several other vaccines in use to suit
local needs .
New Vaccine trails - Leptospira