LEPTOSPIROSIS (Preventive Medicine) (UST-1st yr Medicine)

2.  Infectious disease caused by spirochete
bacteria (Leptospira interrogans)
 Acquired when coming in contact with flood
water contaminated by urine of animals such
as rats, dogs, goats, and swine.
 Common in tropical countries with heavy
rainfall

3. “Leptospirosis is a bacterial disease that affects both
humans and animals.The early stages of the disease
may include high fever, severe headache, muscle
pain, chills, redness in the eyes, abdominal pain,
jaundice, haemorrhages in skin and mucous
membranes (including pulmonary bleeding),
vomiting, diarrhea and a rash.”

4.  Infection usually occurs in adolescents or
young adults
 more common in men (male-to-female ratio of
4:1)
▪ peak incidence is in men aged 30 to 39 years
 Leptospirosis is seen worldwide, except in the
polar regions
 human infection is endemic in most temperate and tropical
climates

5.  (annual rates of infection )
 InTEMPERATECLIMATES:
0.1 -1 per 100,000 (WHO)
 InTROPICAL CLIMATES (humid): 10-100 per 100,000
 300,000 – 500,000 severe cases per year

7.  As of September 2013 - 78% lower than
2012 cases
 Most cases reported during rainy /
typhoon season.
 Median age affected: 30 y/o, but age
most affected > 40 y/o.
 86% of cases were male
 *Top 5 areas most affected (from most
to least): NCR, Regions VI, III, XI, II. In
NCR itself, Manila is most affected,
followed by QC, Caloocan, Parañaque.
-DOH

8. I
HEALTHY
INDIVIDUALS
III
SYMPTOMATIC
INDIVIDUALS
II
ASYMPTOMATIC
INDIVIDUALS
IV
OUTCOME
4
STAGES

9. Susceptible
Asymptomatic
infection
Acute febrile
illness
No sequelae
Uveitis
Other potential sequelae
Well’s
Syndrome
Pulmonary
Hemorrhage
Aseptic
Meningitis
Other
potential
sequelae
Includes depression & other
mental health problems
Death

10. HOST VECTOR AGENT
People who work outdoors or
with animals and people in
contact with infected water:
Veterinarians
Farm and agricultural
workers
Meat workers
Sewage system
personnel
Military personnel
Rodents
Dogs
Wild animals
Domesticated animals
Leptospira
interrogans

11. ENVIRONMENT INFECTIVITY PATHOGENICITY
TROPICALAND
SUBTROPICAL
REGIONS
LEPTOSPIREMIA
develops after
Leptospires gain entry
LEPTOSPIRES
multiply in the blood
and tissues and can be
isolated from blood
and CSF during first 4-
10 days of illness
damage walls of small
blood vessels and cause
vasculitis

12.  Incubation period: average 5–14 days
(range: 2-4 weeks)

13. Asymptomatic
infection
Acute febrile
illness
Uveltis
Other potential sequelae
Weil’s
Syndrome
Pulmonary
Hemorrhage
Aseptic
Meningitis
Other
potential
sequelae
Death
Susceptible
Includes depression & other
mental health problems
No sequelae

14.  LEPTOSPIREMIC PHASE
Nonspecific flu-like symptoms
includes
( headaches, muscle aches, eye pain
with bright lights, followed by chills
and fever, watering and redness of
the eyes )
Lasts for 3-10 days
Leptospires in the blood
 IMMUNE PHASE
Fever not responsive to
antibiotics
and aching with stiffness of the
neck
Inflammation of the nerves of
the eyes, brain and spinal
column, RUQ abdominal pain
Leptospires in the urine
WEIL’S SYNDROME
• Fulminant type
 Jaundice, acute kidney
injury, hypotension,
pulmonary
hemorrhage, acute
abdomen, myocarditis,
hepatic injury

15.  Complications:
 Acute Kidney Injury
 Respiratory problems
 Chronic fatigue and other neuropsychiatric
symptoms (headache, paralysis, depression, etc)
 DEATH

16. I
PRIMARY
III
TERTIARY
II
SECONDARY

17.  Health
education/awareness
 Good sanitary practice
 Drinking of safe/potable
water
(distilled/purified/boiled)
 Proper drainage of water
 Avoiding contact with
flood waters
 Use of protective
covering (boots/gloves)
when in contact with
flood water
 Pest/rodent control
(rats/mice)
 Doxycycline prophylaxis
 Vaccination (animals)

18. Mild
leptospirosis
Moderate –
severe
leptospirosis
Antibiotic
therapy
- Doxycycline
- Aamoxicillin
- Azithromycin
dihydrate
- Penicillin G
- Cefotaxime
- Ceftriaxone
- Parenteral
Azithromycin
dihydrate
- 7 days
- 3 days
(azithromycin
dihydrate)
Philippine Society Of Microbiology and Infectious Diseases. Leptospirosis Clinical
Practice Guidelines 2010

19. EARLY DIAGNOSIS
DIRECT METHODS INDIRECT METHODS
Immunofluorescence
staining
Immunoperoxidase staining
Silver staining
Various methods of
POLYMERASE CHAIN
REACTION
various types of ELISA tests
Spot agglutination test
MICROSCOPIC
AGGLUTINATIONTEST

20.  Symptomatic rehabilitation
 Rest kidneys –avoid lifting heavy weights,
avoid contact sports, complete bed rest, if
necessary
 Maintain fluid and electrolyte homeostasis
 Provide ample time for recovery

21.  Environmental sanitation must be
given importance
 Recognition of the signs and
symptoms is the key to prompt
treatment necessary to prevent
dreaded outcomes
 Leptospirosis is treated with
antibiotics and is rarely fatal
 Prevention is better than cure

22. ACCORDING TO WHO:
 If Leptospirosis is detected early, antibiotics can be
administered that can successfully treat the disease.
 The plan: Establish accurate estimates of disease
burden to better direct adequate intervention,
control and prevention efforts.
 If risk factors are identified, then interventions can
be appropriately targeted at the individual and
community level that can successfully prevent the
disease.