Leptospirosis

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Leptospirosis:

Leptospirosis

Introduction:

Introduction Zoonotic disease Leptospires (Spirochetes) Coiled, thin, highly motile Seen microscopically by dark field examination and after silver impregnation staining Requires special media and conditions for growth May take weeks for culture to become positive

Introduction:

Introduction Reservoir Rodents (Rats) Domestic / farm and Wild animals L. Interrogans L. Icterohaemorrhagiae – Rats L. Canalicolo – Dogs L. Hebdomadis – Cattle L. Pomona - Pigs

Introduction:

Introduction Synbiotic Relationship Persists indefinitely in renal tubules Shed in urine in large number Transmission Direct contact with urine / blood / tissue of infected animal Contaminated environment – “water” Most common in tropics / monsoons

Pathogenesis:

Pathogenesis Enters humans through skin / mucus membrane Cuts / Abrasions Intact  Leptospiremia and spread to all organs Most commonly affects Kidney / Liver / Meninges / Brain

Pathogenesis:

Pathogenesis All forms of leptospirae damage walls of small blood vessels – Vasculitis Adheres to cell surface and causes cellular toxicity

Clinical Features:

Clinical Features Tropics / Monsoons / History of Exposure) Incubation period – 2 to 20 days ( 1 to 2 weeks) Inapparent infections – fatal illness Acute Leptospiremic phase – Immune Leptospiruric phase Distinction not always clear Milder cases do not have second phase

Anicteric Leptospirosis:

Anicteric Leptospirosis Fever, Chills Severe headache (Frontal / Retroorbital) Nausea, Vomiting Myalgia (Calves / Back) Tenderness Conjuctival congestion – IMP SIGN

Anicteric Leptospirosis:

Asymptomatic within 1 week Interval 1 to 3 days Illness recurs Immune phase Fever and myalgia – less severe Anicteric Leptospirosis

Anicteric Leptospirosis:

Development of Aseptic Meningitis Most common among children than adults Symptoms and signs present in few though CSF findings present Disappearance of Symptoms – within few days – weeks CSF findings – 2 weeks - months Anicteric Leptospirosis

Anicteric Leptospirosis:

Uveitis / Iritis / Iridocyclitis / Chorioretinitis Earliest appearance – 3 weeks – usually months after initial illness Late complications may persist for years Mortality in Anicteric Leptospirosis – almost NIL Anicteric Leptospirosis

Weils Syndrome / Disease / Severe Leptospirosis:

Weils Syndrome / Disease / Severe Leptospirosis < 10% Charecterised by Fever Jaundice Renal dysfunction Hemorrhagic diathesis Mortality – 5 to 15%

Weils Syndrome / Disease / Severe Leptospirosis:

Onset – similar After 4 to 9 days (Jaundice / Renal / Bleeding) Biphasic disease is absent May have a transient macular erythematous rash Tender hepatomegaly (Hepatic failure / Encephalopathy not common) Weils Syndrome / Disease / Severe Leptospirosis

Weils Syndrome / Disease / Severe Leptospirosis:

Splenomegaly (20%) Renal Failure Hypovolemia / Impaired renal perfusion / ATN) Oliguria / Anuria Haemorrhagic manifestation (MC) Epistaxis / Petechiae / Purpura / Ecchymosis (LC) – Haematemesis / Melaena / Pleural / Pericardial / Subarachnoid / Adrenal Weils Syndrome / Disease / Severe Leptospirosis

Weils Syndrome / Disease / Severe Leptospirosis:

Pulmonary involvement Cough / Dyspnoea / Chest pain / Hemoptysis / Respiratory Failure Myocarditis / pericarditis / CHF / Cardiogenic shock / ARDS / Rhabdomyolisis / Hemolysis / Necrotising Pancreatitis / MOF Weils Syndrome / Disease / Severe Leptospirosis

Investigations:

Investigations CBC Polymorphonuclear leucocytosis Thrombocytopenia CPK – elevated LFT Raised bilirubin & ALP Mild increase in aminotransferases (upto 200) PT prolongation

Investigations:

RFT – deranged Urine Leukocyte / Erythrocyte / Hyaline / granular casts Mild proteinuris Investigations If renal involvement +

Investigations:

CSF Initially polymorphonuclear leucocytes later mononuclear cells predominate Elevated protein concentration Normal glucose levels Serology After 6 days Lepto IgM - ELISA Investigations

Investigations:

Cultures Blood – Before 10 th day Urine – from 2 nd week onwards Investigations

Treatment:

Treatment Initiated as early as possible Mild cases Doxycycline 100 mg orally BD Moderate / Severe IV Penicillin G 15 Lakhs Q6H 1 week duration

Treatment:

Treatment Other options Ampicilline 500 to 750 mg orally Q6H Amoxycillin 500 mg orally Q6H Ampicillin 1 gm IV Q6H Amoxycillin 1 gm IV Q6H Erythromycin 500 mg IV Q6H

Treatment:

Treatment Jarisch – Herxheimer reaction After staring antimicrobials Rare in Leptospirosis Blood transfusions / Dialysis

Prevention:

Prevention Chemoprophylaxis – Doxycycline 200 mg once weekly

Prognosis:

Prognosis Most recover Mortality highest among Elderly Weils syndrome Anicteric – Almost NIL WEILS – 5 to 15%

Prognosis:

Prognosis During pregnancy Associated with high fetal mortality Good recovery of Renal / Hepatic dysfunction

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