LEPTOSPIROSIS

1. LEPTOSPIROSIS No2 hospital CMU department of infectious disease Huang Fen

2. DEFINITION • 1. Leptospirosis is a kind of zoonotic • infectious disease caused by pathogenic leptospires; • 2. rats and swine are cardinal source • of infection; • 3. the disease often occurs in summer • and fall;

3. DEFINITION • 4. clinical features: • three symptoms, • three signs, • internal organ damage, • seguelae of eyes and nerve system • 5. treatment: penicillin.

4. ETIOLOGY • 1.pathogen : pathogenic leptospira • 2.features of leptospia: • helicoid with hook, • length 6~ 20 um,G - • darkfield microscope; • in korthof’s media;

5. ETIOLOGY • several months in water and • moist soil (PH7.0~7.5) • 3.Classification: • 23 serogroups and more then 200 • serotypes in the world; • 19 serogroup and 74 serotypes in china. • icterohemorrhagic group, • pomona group

6. EPIDEMIOLOGY • 1.Source of infection: • rat: apodemus agrarius, • rice field type; • pigs: flood or rain type; • patient

7. EPIDEMIOLOGY • 2.Routes of transmission: • (1) water borne (indirect contact • transmission): • by skin,mucosa,when skin is injured. • (2) direct contact transmission: • (3) food borne • 3.Susceptibility of population:

8. EPIDEMIOLOGY • 4.Epidemiologic features: • (1)season: summer and fall; • (2) nosogenic age: • young and middle age,children • (3)occupation: • farmer,slaughter, • fisher,veterinarian.

9. EPIDEMIOLOGY • 4.Epidemiologic features: • (4)epidemic type : • rice field type • flood type • rain type

10. PATHOGENESIS • leptospira • skin,mucosa • Initial stage leptospiremia toxic symptoms • (1~3days) three symptoms: • fever,myalgia,fatigue; • three signs: • conjunctival suffussion; • muscle tenderness; • enlargement of lymphonodes;

11. PATHOGENESIS • severe toxic symptoms • lesion of organs: • influenza form • pneumorrhagic form • middle stage icterohemorrhagic form • (3~10d) • meningoencephalitis • renal failure form.

12. PATHOGENESIS • immunopathological reaction • after fever; • sequelae of eyes; • reactive • meningitis; • cerebro arteritis • obliterans. • convalescent stage

13. PATHOLOGY • 1. basic pathological change is • infective,toxic injured of systemic • capillaries; • 2. severe:lung,liver,kidneys,brain. • exudation,hemorrhage, • edema or necrosis.

14. CLINICAL MANIFESTATIONS • Incubation period: 2~28 days • usually 7~13days; • 1. Influenza-typhoid type:5~10days • three symptoms: • fever,myalgia and fatigue. • three signs: • conjunctival suffusion,

15. CLINICAL MANIFESTATIONS • three signs: • conjunctival suffusion, • tenderness of • gastrocnemius muscle; • enlargement and tenderness • of superficial lymphnodes. • Inguinal and axillary • lymphodes.

16. CLINICAL MANIFESTATIONS • 2. pneumorrhagia form: • 1). three symptoms and three signs • 2). pneumorrhagia symptoms(3~4d) • (1). mild pneumorrhagia type • cough,expectoration with blood. • a few moist rales. • X-ray of chest: scattering spotty and small fasciola shadow • dyspnea, • palpitaton,aspharyxia,rales.

17. CLINICAL MANIFESTATIONS • 2. pneumorrhagia form: • (2) diffuse pneumorrhagia type • short breathing, palpitation, • dysphoria, • massive hemoptysis, asphyxia, • cyanosis, • a lot of moistrales. • X-ray: extensive fasciola shadow • .

18. CLINICAL MANIFESTATIONS • 3.Icterohemorrhagic type:(Weil ,s disease) • 1). three symptoms and three signs • 2). jaundice, hemorrage, renal injury • (4~5d) • liver injury: • anorexia,vomiting, jaundice, • abnormal liver function.

19. CLINICAL MANIFESTATIONS • 3.Icterohemorrhagic type:(Weil ,s disease) • hemorrhage: petechiae,ecchymoses,hemoptysis,hematemesis etc. • renal injury: proteinuria, • RBC, WBC, cast, • oliguria,azotemia,uremia.

20. CLINICAL MANIFESTATIONS • 4.renal failure type: • oliguria, azoteinia, uremia. • 5.meningoencephalitis type: • 1). three symptoms and three signs • 2). 3~4days later, meningitis, encephalitis. • headache,vomiting,meningeal irritation, • lethargy,coma,paralysis or convulsion.

21. CLINICAL MANIFESTATIONS • CSF is abnormal. • pressure increase • pleocytosis<500 × 106/L • protein is normal or elevated slightly. • glucose and chloride is normal. • leptospira isolation: positive.

22. CLINICAL MANIFESTATIONS • SEQUELAE • 1. after fever :1~5days after defervascence • 2. sequelae of eyes: 1week~1month • iridocycyclitis, choroiditis , uveitis • 3.reactive meningitis • 4.cerebroarteritis obliterans:2w~2m • hemiplegia aphasia

23. LABORATORY FINDINGS: • 1. routine examination: • 1). blood routine examination: • WBC is increased slightly; • 2).urine routine examination: • protein (2/3) • 2. serological examination: • 1).microscopic agglutination test (MAT) • detect antibody >1:400

24. LABORATORY FINDINGS: • 2). ELISA: serum and CSF IgM antibody • 3. pathogenic test • 1).blood culture: • 2).PCR: DNA

25. DIAGNOSIS • 1.epidemiologic data: • 1).epidemic area; • 2).epidemic season; • 3).a history of contact with contaminated • water; • 2.clinical manifestations: • 3.Lab findings:

26. DIFFERENTIAL DIAGNOSIS • 1.Influenza; Typhoid fever, • 2.Lobar pneumonia; • 3.Viral hepatitis; • 4.Viral meningitis; • 5.Epidemic hemorrhagic fever;

27. TREATMENT • 1.Pathogenic therapy • 1). first choice: penicillin • 40万 u q6h or q8h im 7days • note: Herxheimer reaction • first time - small amount 5万 u • im • 2). Gentamycin 8万 u q8h im

28. TREATMENT • 2.Symptomatic therapy • 1).Herxheimer reaction • physical cooling, sedative, • hydrocortisone. • 2). pneumorrhagia type • sedative, hydrocortisone, cardiotonics • 3.treatment of sequlea

29. PREVENTION • 1.control of pigs: • 1). stable breeding • 2).immunized by vaccine • 2.killing of rats, • 3.cutting route of transmission, • 4.vaccination: multivalent vaccine