leptospirosis


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1 : Leptospirosis Joey R. Quino Gullas College of Medicine Dept. of Family Medicine
2 : An infectious disease caused by pathogenic leptospires (Leptospira interrogans) Characterized by a broad spectrum of clinical manifestations, varying from inapparent infection to fulminant, fatal disease Definition
3 : Worldwide Occurs most commonly in the tropics Peak incidence during the rainy seasons Male predominance Epidemiology
4 : Occupations that involve contact with contaminated water, soil, or animals Recreational exposure (water exposure) Domestic animal contact Travel to tropical countries where incidence is high Risk Factors
5 : Leptospira interrogans Coiled, thin, highly motile organisms with hooked ends and 2 flagella that permit burrowing into tissue Transmission is direct contact with urine, blood or tissue from an infected animal or exposure to a contaminated environment Most important reservoir: rodents Etiology
6 : Entry via skin abrasions or intact mucous membranes, followed by leptospiremia and widespread dissemination, including entry into the CSF, damaging blood vessel walls and cause vasculitis with leakage and extravasation of cells, including hemorrhages Incubation period is usually 1-2 weeks Pathogenesis
7 : 90% of symptomatic persons have a relatively mild and usually anicteric form, with or without meningitis. First (leptospiremic) phase Acute influenza-like illness Fever Chills Severe headache (frontal or retro-orbital) Nausea Vomiting Myalgias (especially affect calves, back, abdomen) Anicteric Lepstospirosis
8 : Less common manifestations Sore throat Photophobia Mental confusion Cough Chest pain Hemoptysis Anicteric Leptospirosis
9 : Physical findings Fever Conjunctival suffusion Muscle tenderness Lymphadenopathy Pharyngeal injection Maculopapular, erythematous, urticarial rash Hepatomegaly and splenomegaly Anicteric Leptospirosis
10 : Second (immune) phase Fever, less pronounced Myalgias, less severe Aseptic meningitis in up to 15% of patients (more common among children than adults) Iritis and chorioretinitis Anicteric Leptospirosis
11 : Develops in 5-10% of infected persons 4-9 days of mild illness followed by Jaundice Hepatomegaly Right upper quadrant tenderness Splenomegaly Renal dysfunction Pulmonary involvement Hemorrhagic manifestations Weil’s Syndrome
12 : CBC (leukocytosis, thrombocytopenia) CSF ( pleocytosis, elevated protein) Blood chemistry (elevated bilirubin, creatinine, aminotransferases) Chest x-ray (patchy pattern in lower lobes) Culture/isolation of leptospires Laboratory tests
13 : Mild leptospirosis Treat for 7 days with: Tetracycline (500 mg PO qid) Doxycycline (100 mg PO bid) Ampicillin (500-750 mg PO qid) Treatment
14 : Moderate or severe leptospirosis Treat for 7 days with 1 of the following: Penicillin family -Penicillin G (1.5 million units IV qid) -Ampicillin (1g IV qid) Third generation cephalosporins -Ceftriaxone (1g IV every 24 hours) -Cefotaxime (1g IV every 6 hours) Doxycycline (200 mg, then 100 mg IV every 12 hours) Erythromycin (500 mg IV qid) Treatment
15 : Jarisch-Herxheimer reaction may develop rarely within hours after the start of treatment manifestations: Fever, headache and chills Myalgia and tachycardia Increased respiratory rate Increased circulating neutrophil count Vasodilation with mild hypotension Monitoring
16 : Anicteric leptospirosis Iritis Chorioretinitis Uveitis Weil’s syndrome Renal failure Hemolysis Pericarditis Adult respiratory distress syndrome Necrotizing pancreatitis Multiorgan failure Complications
17 : Mortality is almost nil in anicteric leptospirosis Mortality rate is 5-15% in Weil’s syndrome Associated with high fetal mortality rate in pregnancy Prognosis
18 : Persons who may be exposed should be informed of risks. Avoidance of exposure to urine and tissues from infected animals Rodent control Chemoprophylaxis Doxycycline (200 mg once weekly) Prevention

 

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summary of leptospirosis
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