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Leptospirosis
Leptospirosis outbreaks
after the big flood
of Jakarta (Feb.- March 2002)
Nine (33%) of 27 cases died.
1990
1991
Bacteriology
Causative organism: Leptospira
Aerobic, coiled, motile spirochete
with hooked ends
Size 0,1 um, length 6 20 um.
Pathogenic for numerous wild &
domestic animals: rats, cattle and
dogs
Genus Leptospira: 2 species
Leptospira interrogans (pathogenic)
Leptospira biflexa (saprophytic)
24 serogroups & > 240 serovars
45
40
35
30
33
27
28
25
25
20
30
29
88
89
21
19
15
10
5
0
1981
82
83
84
85
86
87
1990
Region
India
Thailand
India
France
Andaman
India
USA
Brazil
Uruguay
Indonesia
Chennai
Ile de la
Reunion
Kerala
Hawaii
Sao Paulo
Semarang
Incidence
Per 100.000
50.0
23.1
10.5
6.0
Mortality
(%)
21.0
2.5
-
5.6
4.0
1.9
1.6
1.2
10.1
0
12.3
100
16.7
Frequency (%)
95%
79%
68%
65%
56%
56%
Unemployed person
34%
14%
Pathology/pathogenesis
Penetration through skin,
conjunctiva or mucous membranes
Multiplication of organisms
and dissemination via the bloodstream
Lungs
Anicteric Leptospirosis
First Stage
3-7 days
(SEPTICEMIC)
Second Stage
0 days - 1 month
(IMMUNE)
First Stage
3-7 days
(SEPTICEMIC)
Second Stage
10-30 days
(IMMUNE)
Fever
Important
Clinical
Findings
Leptospires
Present
Myalgia
Headache
Abdominal
pain
Vomiting
Conjunctival
suffusion
Meningitis
Uveitis
Rash
Blood
Blood
CSF
CSF
Urine
Jaundice
Hemorrhage
Renal failure
Myocarditis
Urine
Clinical presentation
Clinical features
Jaundice
Icteric
(Weil`s Disease)
Anicteric
+++
++
Leucocytosis
+++
Hemorrhage
++
Renal failure
++
Aseptic meningitis
++
Disturbance of
consciousness #
Death
Conjunctival suffusion
Case classification
Clinical case description
Acute febrile illness
Headache
Prostration / chills
Muscle pain & tenderness (calves & thighs!!)
Conjunctival suffusion
Meningeal irritation
Oliguria / anuria
Jaundice
Haemorrhages (hematemesis, hemoptysis)
Cardiac arrhythmia
PLUS A history of exposure to infected animal and / or
environment contaminated with animal urine
RISK FACTORS FOR TRANSMISSION OF LEPTOSPIROSIS
Case classification
Laboratory criteria for diagnosis
Isolation of Leptospira from a clinical specimen
Blood / LCS : 1-7 days of illness
Urine: > 10 days of illness
Positive serology (MAT)
Fourfold or greater increase in Leptospira agglutination titer
between acute and convalescent phase serum specimen,
obtained 2 weeks apart and examined at the same laboratory
Anicteric Leptospirosis
clinical diagnosis
Clinical diagnosis is difficult
Mild, atypical, anicteric leptospirosis cases are often
confused with other febrile illnesses
misdiagnosis
Anicteric leptospirosis should be included in the
differential diagnosis of every patient with acute
fever
Risk factors associated with leptospirosis should be
identified
as high index of suspicion for diagnosis
Anicteric Leptospirosis
differential diagnosis
Influenza
uncomplicated malaria
dengue infection
HIV seroconversion
hantavirus
infection ricketsiosis
typhoid fever
infectious mononucleosis
meningitis
infections etc
Icteric Leptospirosis
clinical diagnosis
Diagnosis of leptospirosis is more easily suspected, and
established only in the more severe cases
Nearly all hospitalized patients with leptospirosis
in the tropics are severe icteric leptospirosis cases
The only fatal leptospirosis
Mortality rates: 515% (3050%) despite in-hospital treatment
Should be included in the differential diagnosis of other
potentially fatal infectious diseases: severe falciparum malaria etc.
Icteric Leptospirosis
differential diagnosis
Severe falciparum malaria
Severe complicated typhoid fever
Haemorrhagic fevers with renal failure
(HFRF)
(hantavirus type Dobrava infection)
Other severe viral haemorrhagic fevers
Icteric leptospirosis
Organs involvements /
Complications
Gastro-hepatobiliary jaundice, hypoalbuminemia
liver dysfunction without necrosis
hematemesis, acute pancreatitis
acalculous cholecystitis etc.
Renal renal failure (oliguric, non-oliguric), uremic syndrome etc.
Gastrointestinal haematemesis, acute pancreatitis
Pulmonary dyspnea, hemoptysis, ARDS, hemorrhagic pneumonitis
Hematologic hemorrhagic diathesis due to vascular damage,
thrombocytopenia, uremic platelet dysfunction.
post haemorrhagic anemia etc
Icteric leptospirosis
Organs involvements / Complications
Conjunctival
suffusion
Laboratory diagnosis:
Serology
MAT (microscopic agglutination test)
gold standard
IgM-ELISA (enzyme linked immuno
sorbent assay)
IFAT (immuno fluorescent antibody
test)
MCAT (microcapsule agglutination
test)
MA (macroscopic agglutination test)
RLA (rapid latex agglutination)
IHA (indirect hemagglutination test)
Quick tests
Treatment
Antibiotics
Penicillins: Penicillin Procain etc.
Doxycycline, Tetracycline
Streptomycin
Supportive
Fluids, water balance
Dialysis *)
Ventilator support
PROGNOSI
S
Severe Leptospirosis is a life-threatening
disease
CFR (case fatality rates) is high, 5 40 %
Factors independently associated with
mortality:
Dyspnea, oliguria, high leukocytosis,
EKG abnormalities
Alveolar infiltrates on chest X-ray
Renal failure is associated with high