3. INTRODUCTION
Globally important ZOONOTIC DISEASE
Causative organism –
Order Spirochetales
Family Leptospiraceae
Genus Leptospira
24 serogroups , inturn being classified into 250 serovars
4.
5. LIFE CYCLE & TRANSMISSION
Disease of TROPICS & SUBTROPICS
In Tamilnadu,
North chennai
Vellore
Trichy
Madurai
Namakkal
6. Most cases occur during the MONSOON or the rainy
season
Major Reservoirs & carriers-
RODENTS esp. RATS
Cattles, horses, pigs, dogs, etc.
HUMANS – ACCIDENTAL, DEAD END HOSTS
Source of infection to humans –
* Direct contact with urine, blood, or tissue of infected
animal
* Indirect contact with WATER CONTAMINATED
WITH RAT URINE, through skin cuts, abrasions, or
mucous memebranes
7. OCCUPATION – esp. resource poor populations
* AGRICULTURAL WORKERS
* Sewage workers
* Slaughter house employees
* Fishermen
* Veteriranians
* CAN WE PEOPLE GET ???
Even Travellers, involved in freshwater activities, like
swimming, river rafting, water skiing
8. CANE CUTTER’S DISEASE/
RICE FIELD JAUNDICE/
MUD FEVER/SWAMP FEVER
SWINE HERD’ S DISEASE
AKIYAMI (AUTUMN FEVER )
INJAPAN
9. PATHOGENESIS
Organisms penetrate the skin or mucous membrane,
Cross the tissue barriers through intercellular junctions
Organisms evade the host immune response by many
mechanisms-
• Resist opsonisation and killing by neutrophils, monocyte,
macrophages
• Bind with COMPLEMENT FACTOR H,
• Inhibits activation of alternative complement pathway
• LPS activate TLR2 , release of proinflammatory
cytokines , cauisng end organ damage
10. IP – 5-14 days ( 2-30 days)
Broad clinical spectrum-
1) Asymptomatic / subclinical
2) Mild self limiting flu like illness
fever, chills, headache, myalgia,
transient rash, cough, sorethroat,
abdominal pain, anorexia,
diarrhoea
3) Severe fatal disease
(MULTISYSTEM DISEASE)
- In 60% indivduals
JAUNDICE
AKI
WEIL’S
BLEEDING
DIATHESIS
11. LEPTOSPIREMIC PHASE
• Early, nonspecific phase
• Ist week of illness
• Isolated from
bloodstream
IMMUNE PHASE
• Late phase
• 2nd week of illness
• With the appearance of
antibodies, leptospires
disappear from blood
• But, bacteria persist in
various organs (liver,
kidneys, lung, heart,
brain)
BIPHASIC PATTERN
12.
13. CLINICAL FEATURES –
HYPOTENSION – 45 %
• Low fluid intake – hypovolemia
• Vasodilation , Increased capillary permeability
• Low cardiac output from myocarditis and dysrhythmia
14. HEPATIC DYSFUNCTION – 20 % - 70%
JAUNDICE – related to CHOLESTASIS
Hepatomegaly + (spleenomegaly is unusual)
16. In Mild cases, only the urine routine is abnormal – albuminuria,
micrpscopic hematuria, presence of granular casts
In severe cases, nonoliguric/oliguric/anuric
Commonly occurs together with jaundice
Within first 3 days of illness
AKI – rapid rise in urea, Cr
HYPOKALEMIA
At the end of second week, polyuric phase begins, Sr. Cr. Begins to
fall, becomes normal in 4 weeks
RRT in the form HD
RENAL INJURY IN LEPTO IS NEVER PERMANENT
18. * Pulmonary involvement is unrelated to jaundice
* Occurs as early as 2-3 days after the onset of
fever
•Sx- cough with blood tinged suputum / hemoptysis
Lead to respiratory failure requiring mechanical
ventilation
19. CARDIAC AND VASCULAR COMPLICATIONS-
* ECG –
M/C finding – PR prolongation
M/C dysrhythmia is AF
*Myocarditis can also occur
*These usually resolve after Rx
OCULAR COMPLICATIONS-
Conjunctival suffusion
SUBCONJUNCTIVAL HEMORRHAGE
More serious complications are,
Early- vitreous hemmorhage, retinal hemmorhage
Late – UVEITIS
20. NEUROLOGIC COMPLICATIONS-
ASEPTIC LYMPHOCYTIC MENINGITIS - 11-25 %
Usually occurs 5 days after the onset of fever
DD- VIRAL MENINGITIS
Others-
Encephalomyelitis, GBS, CN palsies, peripheral
neuropathies
PSYCHIATRIC SYMPTOMS- mania
21. BLEEDING DIATHESIS
Can occur anywhere
Mechanisms-
1) Thrombocytopenia
2) Coagulation factor defect due to hepatic dysfuntion
3) Capillary endothelial damage
4) DIC ( consumptive coagulopathy)
OTHER COMPLICATIONS-
• Serositis
• Serum amylase may be raised (not due to acute
pancreatitis, but due to renal dysfunction)
• In PREGNANCY – ABORTION, IUD, PPH
24. DIAGNOSIS
Clinical history, examinations findings
Investigations
ISOLATION-
* from blood in 1st week/ CSF ( within 5 days of illness) /
urine in the 2nd week
* Traditional culture medium – EMJH medium
* It may take around 2-3 weeks for the organism to multiply to
detectable densities
* Every week, needs to be examined by DARK FIELD MICROSCOPY
25. NEW SOLID MEDIUM – LVW AGAR
RAPID GROWTH E TEST FOR ANTIMICROBIAL SUSCEPTIBILITY
26. SEROLOGY –
MAT (MICROSCOPIC AGGLUTINATION TEST)
SEROVAR SPECIFIC
Detects mixed IgG & IgM
POSITIVE –
1) Titre more than or equal to 1: 400 in a single sera or paired sera
2) 4 fold increase of convalescent titre compared to acute titre
Does it help in patient care ?????
Other serological tests- non serovar specific
MCAT (MICROCAPSULE AGGLUTINATION TEST )
ICT ( Immunochromatographic test)
LAT ( latex agglutination test)
Cassette test
MOLECULAR METHODS – not available
27. TREATMENT -
ANTIBIOTICS – in which phase ????
IN EVERY PATIENT AS SOON AS POSSIBLE AT ANY STAGE OF
DISEASE
28. SUPPORTIVE CARE
1) Fluid resuscitation, inotropes
2) RRT– HEMODIALYSIS – TO BE CONTINUED UNTIL
IMPROVEMENT
3) RESPIRATORY SUPPORT for respiratory failure from
ARDS / severe pulmonary hemorrhage
STEROIDS ???
29. PREVENTION
Health education
Immunisation of domestic farm animals & pets
PPE – footwear, long boots, gloves, protective clothing,
goggles
CHEMOPROPHYLAXIS-
High risk people
DOXYCYCLINE 200 mg WEEKLY
Vaccines are not yet available in India
30. Best thing to do – RODENT CONTROL IN HOUSING &
AGRICULTURAL AREAS
