LEPTOSPIROSISLEPTOSPIROSIS

LeptospirosisLeptospirosis

• A common zoonotic diseaseA common zoonotic disease• Caused by L.interrogans and Caused by L.interrogans and

L.biflexaL.biflexa• Rats –common hostsRats –common hosts• Organism shed in the urineOrganism shed in the urine• Enters the body-skin/mucous Enters the body-skin/mucous

membranemembrane• Organs affected-kidney, liver, Organs affected-kidney, liver,

meninges, brainmeninges, brain

Clinical FeaturesClinical Features Age group of 10-20 years;malesAge group of 10-20 years;males Malaise, body pain, non specific Malaise, body pain, non specific

features of viral fever initiallyfeatures of viral fever initially Conjunctival suffusion, tendernes in Conjunctival suffusion, tendernes in

calf and lumbar regionscalf and lumbar regions Headache, chills, anorexia and Headache, chills, anorexia and

jaundicejaundice Epigastric pain, tenderness and Epigastric pain, tenderness and

vomiting vomiting

Second stage occurs after a weekSecond stage occurs after a week Common leptospiral Common leptospiral

syndrome(CLS):20%syndrome(CLS):20% CLS+ bleeding tendency:5%CLS+ bleeding tendency:5% CLS+ meningitis:5%CLS+ meningitis:5% CLS+ involvement of liver, kidney, CLS+ involvement of liver, kidney,

lungs etc:70%lungs etc:70%

Other ManifestationsOther Manifestations

Renal failureRenal failure Meningeal irritationMeningeal irritation Petechial haemorrhages from skin, Petechial haemorrhages from skin,

mucous membranemucous membrane MyocarditisMyocarditis HyptotensionHyptotension Multi organ failureMulti organ failure

2 types of leptospirosis2 types of leptospirosis

AnictericAnicteric

Milder formMilder form Fever, Myalgia, Fever, Myalgia,

Headache, Headache, Conjunctival suffusionConjunctival suffusion

90% patients present 90% patients present with this formwith this form

Icteric(Weil’s Icteric(Weil’s Syndrome)Syndrome)

Severe formSevere form Jaundice + Jaundice +

involvement of other involvement of other organsorgans

Oliguria, anuria, Oliguria, anuria, proteinuriaproteinuria

5-10% have this type5-10% have this type

Weils SyndromeWeils Syndrome

Weils syndrome can be defined as Weils syndrome can be defined as severe leptospirosis with severe leptospirosis with jaundicejaundice accompanied by accompanied by azotemiaazotemia, , haemorrhagehaemorrhage, , anemiaanemia, , disturbance in disturbance in consciousness consciousness andand continued fever continued fever

Hepato renal syndromeHepato renal syndrome

ComplicationsComplications

Renal failureRenal failure Cardiac failure Cardiac failure Respiratory failureRespiratory failure Severe thrombocytopenia, Severe thrombocytopenia,

hemoptysishemoptysis CNS involvementCNS involvement PericarditisPericarditis

Differential DiagnosisDifferential Diagnosis

DHFDHF Typhoid feverTyphoid fever Septicemia Septicemia Pancreatitis Pancreatitis Viral hepatitisViral hepatitis Falciparum malaria Falciparum malaria Fulminant hepatic failureFulminant hepatic failure

Lab DiagnosisLab Diagnosis

IgM specific dot ELISA –sensitive and IgM specific dot ELISA –sensitive and specificspecific

MAT and slide agglutination test-MAT and slide agglutination test-screeningscreening

Elevated WBC count with Elevated WBC count with neutrophilianeutrophilia

Increaed ESR (about 60mm)Increaed ESR (about 60mm)

Serum Bilirubin-mildy elevatedSerum Bilirubin-mildy elevatedSGOT/SGPT-mildy elevatedSGOT/SGPT-mildy elevatedHigh levels of CPKHigh levels of CPK

TreatmentTreatment

Inj Crystalline Penicilline 20 Lakh Inj Crystalline Penicilline 20 Lakh units i.v 6units i.v 6thth hourly hourly

Maintain adequate fluids and Maintain adequate fluids and hydrationhydration

Doxycycline 100mg BD for 7 daysDoxycycline 100mg BD for 7 days

Children-2 to 4 lakh units/kg of Inj. Children-2 to 4 lakh units/kg of Inj. CP for 7 daysCP for 7 days

PreventionPrevention

Avoid infection from animal sourcesAvoid infection from animal sources Personal hygienePersonal hygiene Disinfection of water sourcesDisinfection of water sources Health EducationHealth Education Vaccination of animals and rodent Vaccination of animals and rodent

controlcontrol