1 / 29

Leptospirosis

Leptospirosis. Internal Medicine Workshop Series Laos September /October 2009. What do you know about leptospirosis ?. Write down … 2 animals that can be infected with leptospirosis 2 ways the bacteria can enter the human body 2 complaints the patient may have (history)

sylvialewis
Download Presentation

Leptospirosis

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Leptospirosis Internal Medicine Workshop Series Laos September /October 2009

  2. What do you know about leptospirosis? • Write down … • 2 animals that can be infected with leptospirosis • 2 ways the bacteria can enter the human body • 2 complaints the patient may have (history) • 2 examination findings (physical) • 2 organs that may be involved and how the organ damage can be shown • 2 antibiotics to treat leptospirosis

  3. Background • Caused by gram negative spirochetes: Genus Leptospira • Most common zoonosis (disease from animals) in the world • Humans and animals (mammals, birds, amphibians and reptiles) can develop Leptospira infection • Humans are rarely chronic carriers (they are accidental hosts) • Animals are often chronic carriers

  4. A scanning electron micrograph depicting Leptospira on a 0.1-µm polycarbonate filter

  5. How does infection happen? • Direct contact with • the body fluid of an acutely infected animal • exposure to soil or fresh water contaminated with the urine of an animal that is infected or a chronic carrier

  6. How does infection happen? • Leptospires enter host through… • abrasions in healthy skin • waterlogged , wet skin • intact mucus membranes or conjunctiva, nasal mucosa • lungs (aerosolized body fluid) • placenta (during pregnancy) • Then through the lymphatics, causing septicemia and spread to all organs • Host develops immunoglobulin to clear bacteria

  7. Two stages • Acute • septicemic stage of acute febrile illness • lasts 5-7 days • Delayed • immune phase • lasts 4-30 days

  8. Two presentations • Anicteric leptospirosis • self limited disease, flu like illness • septicemic phase (acute) • immune phase (delayed) • Icteric leptospirosis (Weil disease) • severe illness with multi-organ involvement and failure • septicemic and immune phase are mixed together

  9. Morbidity/mortality • Mild forms are rarely fatal • 90% of cases are mild • In severe forms, mortality is 5-40% • Elderly and immunocompromised are at highest risk for severe cases • Working aged-males have more exposure

  10. How quickly and for how long? • Incubation period usually 5-14 days (3-30) • Leptospires remain in renal tubules, brain anterior chamber of eye for 60 days (longer in animals)

  11. Leptospirosis is an infective systemic vasculitis • Leptospires multiply in the small blood vessel endothelium resulting in vasculitis

  12. Leptospirosis is an infective systemic vasculitis • Kidneys • interstitial nephritis and tubular necrosis • Liver • centrilobular necrosis and hepatocyte dysfunction • Pulmonary • alveoloar and interstitial vascular damage with hemorrhage ( MAJOR CAUSE OF LEPTOSPIROSIS ASSOCIATED DEATH )

  13. Silver stain, liver, fatal human leptospirosis

  14. Leptospirosis is an infective systemic vasculitis • Skin • epithelial blood vessels leak (rash, purpura) • Skeletal muscle • edema • Capillary leakage • hypovolemia, shock • Coagulation abnormalities • disseminated intravascular coagulation (DIC) • hemolytic uremic syndrome (HUS) • thrombotic thrombocytopenic purpura (TTP)

  15. Up to 80% of people in the tropics have evidence of past infection

  16. History • Exposure • Urine, kidneys, or conception products of infected animals. • Rodents, dogs, cattle and pigs • Direct infection (body fluids, organs of infected animals) • Indirect infection (inoculated soil and water)

  17. Acute phase 5-7 days • High temperature • Rigors • Sudden headache • Nausea and vomiting • Anorexia • Diarrhea • Cough, pharyngitis • Non pruritic skin rash • Muscle pains (calf and lumbar area)

  18. Physical • Fever (about 7 days) • Signs of volume depletion • tachycardia • hypotension • oliguria • Abnormal chest exam • Skin • transient petechial eruption (palate) • Jaundice • purpura • Eyes • conjuctival suffusion (like conjunctivitis but no exudates) • uveitis

  19. Physical • Muscle tenderness • paraspinal and calf muscles • Lung exam • crackles or consolidation from alveoloar hemorrhage • Myocarditis • signs of heart failure • Abdomen • liver enlargement and tenderness from acalculouscholecystitis • Meningeal signs • neck stiffness • rigidity • photophobia • delerium • In severe disease, may have prolonged mental symptoms like depression, anxiety, irritability, psychosis, dementia

  20. Clinical Diagnosis Fever > 38.0°C (100.4 °F) AND at least TWO from COLUMN A or ONE from COLUMN B • COLUMN A • Headache • Myalgias • Jaundice • Chills/Rigors • Skin rash • Conjunctival suffusion without purulent discharge • COLUMN B • Aseptic meningitis • Acute renal failure • Hemorrhagic pneumonitis • Cardiac arrhythmias, EKG abnormalities • Liver failure • Jaundice with acute renal failure (Weil’s disease)

  21. Differential diagnosis Influenza Enteric fever Hantavirus Rickettsial disease Encephalitis Primary HIV infection

  22. Laboratory: confirm diagnosis • Isolate the leptospires from human tissue or body fluids (urine) • Paired acute and convalescent serum specimens using microscopic agglutination test (MAT) 4X rise in antibody titre • Singly MAT titer of 1:800 • Identification of spirochetes on dark-field microscopy

  23. Laboratory: organ involvement • CBC (hemorrhage, platelets from DIC) • Creatinine and BUN (renal failure, shock) • Magnesium and potassium (wasting) • Bilirubin, (capillaritis in the liver). Alkaline phosphatase AST, ALT • INR PTT (DIC, liver disease)

  24. Diagnostic imaging • Chest Xray • bilateral diffuse airspace disease • cardiomegaly, pulmonary edema • patchy infiltrates • Abdominal ultrasound • acalculous cholecystitis

  25. Treatment: antimicrobial • Outpatient treatment • Oral doxycycline • Decreases duration of fever and most symptoms • 100 mg PO bid for 7 days • Hospitalized patient • Intravenous penicillin G • 20-24 million U/d IV divided q4-6h for 7 days • Intravenous doxycycline • 100 mg IV q12h for 7 days

  26. Other antimicrobials • Amoxicillin • 0.5-1.0 g PO q8h • Cefotaxime • 1 g IV q6h • Ceftriaxone • 1 g IV q24h • Erythromycin (pregnant, penicillin allergy) • 500 mg IV q6h • 500 mg PO qid

  27. Treatment: supportive • Monitor and treat patient for • Shock • Renal failure (usually always reversible) • Respiratory failure (mechanical ventilation) • Cardiac monitoring (arrhythmias) • Plasma exchange, corticosteroids, IV immunoglobulin

  28. Prevention • Avoid or reduce contact with animals, contaminated soil or water • Wear protective garments including footwear, gloves and eye protection • Attention to hygiene and sanitation

  29. What new knowledge do you have? • Write down different information! • 2 animals that can be infected with leptospirosis • 2 ways the bacteria can enter the human body • 2 complaints the patient may have (history) • 2 examination findings (physical) • 2 organs that may be involved and how the organ damage can be shown • 2 antibiotics to treat leptospirosis

More Related