Leptospirosis

Weil disease; Icterohemorrhagic fever; Swineherd's disease; Rice-field fever; Cane-cutter fever; Swamp fever; Mud fever; Hemorrhagic jaundice; Stuttgart disease; Canicola fever Last reviewed: August 14, 2010. Leptospirosis is a rare and severe bacterial infection that occurs when people are exposed to certain environments.

Causes, incidence, and risk factors

Leptospirosis is caused by exposure to several types of the Leptospira bacteria, which can be found in fresh water that has been contaminated by animal urine. It occurs in warmer climates. It is not spread from person to person, except in vary rare cases when it is transmitted through breast milk or from a mother to her unborn child. Risk factors include:

Occupational exposure -- farmers, ranchers, slaughterhouse workers, trappers, veterinarians, loggers, sewer workers, rice field workers, and military personnel Recreational activities -- fresh water swimming, canoeing, kayaking, and trail biking in warm areas Household exposure -- pet dogs, domesticated livestock, rainwater catchment systems, and infected rodents

Leptospirosis is rare in the continental United States. Hawaii has the highest number of cases in the United States.

Symptoms
Symptoms can take 2 - 26 days (average 10 days) to develop, and may include:

Dry cough Fever Headache Muscle pain Nausea, vomiting, and diarrhea Shaking chills

Less common symptoms include:

Abdominal pain

Abnormal lung sounds Bone pain Conjunctivitis Enlarged lymph glands Enlarged spleen or liver Joint aches Muscle rigidity Muscle tenderness Skin rash Sore throat

Signs and tests

The blood is tested for antibodies to the bacteria. Other tests that may be done:

Complete blood count (CBC) Creatine kinase Liver enzymes Urinalysis

Treatment
Medications to treat leptospirosis include:

Ampicillin Ceftriaxone Doxycycline Penicillin

Complicated or serious cases may need supportive care or treatment in a hospital intensive care unit (ICU).

Expectations (prognosis)
The outlook is generally good. However, a complicated case can be life-threatening if it is not treated promptly.

Complications

Jarisch-Herxheimer reaction when penicillin is given Meningitis Severe bleeding

Calling your health care provider

Contact your health care provider if you have any symptoms of, or risk factors for, leptospirosis.

Prevention
Avoid areas of stagnant water, especially in tropical climates. If you are exposed to a high risk area, taking doxycycline or amoxicillin may decrease your risk of developing this disease.

References
1. Ko AI. Leptospirosis. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 344. Review Date: 8/14/2010. Reviewed by: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine. Also reviewed by David Zieve
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002352/ What is leptospirosis?

Leptospirosis is an infectious disease caused by a type of bacteria called a spirochete. Leptospirosis can be transmitted by many animals such as rats, skunks, opossums, raccoons, foxes, and other vermin. It is transmitted though contact with infected soil or water. The soil or water is contaminated with the waste products of an infected animal. People contract the disease by either ingesting contaminated food or water or by broken skin and mucous membrane (eyes, nose, sinuses, mouth) contact with the contaminated water or soil. Leptospirosis occurs worldwide, but it is most commonly acquired in the tropics. The U.S. Centers for Disease Control and Prevention states 100-200 cases of leptospirosis are reported each year in the United States, with about 50% of cases occurring in Hawaii. Although the incidence in the United States is relatively low, leptospirosis is considered the most widespread disease that is transmitted by animals in the world. A 2010 outbreak in Michigan caused serious illness in numerous pets, raising concern for the local human population. In 2009, typhoons hit the Philippines, causing a leptospirosis outbreak. The Philippines Department of Health then reported 1,887 cases of leptospirosis, which resulted in 138 deaths.

What are leptospirosis symptoms and signs?

Leptospirosis symptoms begin from two to 25 days after initial direct exposure to the urine or tissue of an infected animal. This can even occur via contaminated soil or water. Veterinarians, pet shop owners, sewage workers, and farm employees are at particularly high risk. People participating in outdoor sporting activities like canoeing, rafting, hiking, and camping can also come into contact with contaminated water or soil. The illness typically progresses through two phases:

The first phase of nonspecific flu-like symptoms includes headaches, muscle aches, eye pain with bright lights, followed by chills and fever. Watering and redness of the eyes occurs and symptoms seem to improve by the fifth to ninth day.

The second phase begins after a few days of feeling well. The initial symptoms recur with fever and aching with stiffness of the neck. Some patients develop serious inflammation of the nerves to the eyes, brain, spinal column (meningitis), or other nerves. Right upper area abdominal pain may occur. Less common symptoms relate to disease of the liver, lungs, kidneys, and heart.

Leptospirosis associated with liver and kidney disease is called Weil's syndrome and is characterized by yellowing of the eyes (jaundice). Patients with Weil's syndrome can also develop kidney disease and have more serious involvement of the organs affected.
How is leptospirosis diagnosed?

The diagnosis of leptospirosis is made by culture of the bacterial organism Leptospira from infected blood, spinal fluid, or urine. However, many doctors must rely upon rising Leptospira antibody levels in the blood in order to make the diagnosis, as the technique required to perform the culturing is delicate and difficult.

Diagnosis
Live Leptospires can be identified by their writhing movements on dark-field examination of wet-mount preparations. Specific fluorescent antibody staining techniques have also been developed. Urine contains the highest concentration of organisms , but they can also be identified in blood and other fluids. Leptospires are difficult to culture - especially from blood and CSF as they are only present in significant numbers for the first week of infection. Urine samples collected directly from the bladder (cystocentesis) are preferred. Blood samples need to be collected into heparin anticoagulant - not citrate. Microscopic agglutination (MA) test is the standard serological test for Leptospires and it must be performed in a commercial laboratory. One problem with the test is that dogs may have

positive antibody titres following natural subclinical infection, or following vaccination. Demonstration of a rising antibody titre is the only way to confirm that an active infection is present. ELISA tests have been used to measure IgG and IgM antibody concentrations. The IgM increases within a week of infection and peaks within 14 days; whereas the IgG develops in 2-3 weeks and peaks after about 30 days. Dogs that die within a week have high IgM, but ormal MA and IgG titres. Most clinical cases of leptospirosis have azotaemia with increased blood urea (82-100%) and creatinine (82-100%) concentrations. The majority have hyperphosphataemia (47-83%) and a large number have increased alkaline phosphatase (33-65%) and alanine aminotransferase (2235%) concentrations.
http://www.provet.co.uk/health/diseases/Lepto.htm

Pathophysiology
Infection is initiated through direct or indirect contact with urine of infected animals. Other sources of exposure include contact with blood or fluids, or tissues of parturition of infected animals. Rodents are the most common hosts but infection can also be acquired after contact with cattle, pigs, and other domestic and wild animals. Leptospires penetrate through broken skin, mucous membranes, inhalation of respiratory droplets, and waterlogged contact with intact skin and conjunctivae. Incubation period is generally 7 to 14 days but ranges between 2 and 30 days. Dissemination of leptospires is probably a result of motility of the organism. Virulence factors have not been well described; however, it has been postulated that pathogenic leptospires release haemolysins, sphingomyelinases, and phospholipases. Additional potential virulence factors include toxin production, immune mechanisms, and surface proteins. A well-described major surface lipoprotein is LipL 32, which is present in pathogenic strains. [26] LipL32 is a target of the immune response and is involved in the development of tubulointerstitial nephritis in patients with renal insufficiency. [1] [2] Disease presents in 2 phases: the initial or septicaemic stage characterised by high fevers, malaise, headache, myalgia, and abdominal pain. The second stage is associated with antibody production and excretion of the organism in urine. During the second or immune stage, patients suffer from severe systemic manifestations, such as renal failure, hepatic failure, and pulmonary haemorrhages, which can be fatal.
http://bestpractice.bmj.com/best-practice/monograph/913/basics/pathophysiology.html http://nursingcrib.com/nursing-care-plan/nursing-care-plan-leptospirosis/

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