Laptospirosis Laptospirosis

1. LEPTOSPIROSIS
RELIANCE INSTITUTE OF NURSING
TOPIC
PRESENTED BY :-
MR. ROMAN BAJRANG
BASIC BS.C NURSING 2ND YEAR
RELIANCE INSTITUTE OF NURSING

2. INTRODUCTION
• Leptospirosis is an infectious
disease caused by pathogenic
bacteria called leptospires, that are
transmitted directly or indirectly
from animals to humans. It is
therefore a zoonosis. Human-to-
human transmission occurs only
very rarely.
• It often peaks seasonally,
sometimes in outbreaks, and is
often linked to climate changes,to
poor urban slum communities, to
occupation or to recreational
activities.
• The clinical course in humansranges
from mild to lethal with a broad
spectrum of symptoms and clinical
signs.

3. Leptospirosis occurs worldwide but is most common in
tropical and subtropical areas with high rainfall. The diseaseis
found mainly wherever humans come into contact with the
urine of infected animals or a urine-pollutedenvironment.
DISTRIBUTION
INCIDENCE
 The number of human cases worldwide is not knownprecisely.
 Estimated annual incidence (WHO)
—0.1 to 1 per 100 000 per year in temperateclimates
—10 or more per 100 000 per year in the humidtropics
 Estimated case-fatality rates in different parts of the world have been
reported to range from <5% to30%
 Seasonal – peak in summer, during rainy/monsoonseason

4. Exposure depends on chance contacts between human and
infected animals or a contaminated environment through
occupational and/or recreational activities. Some groups are
at higher risk to contract the disease such as:
 Workers in the agricultural sectors
 Sewerageworkers
 Livestock handlers
 Pet shops workers
 Militarypersonnel
 Search and rescue workers in high risk environment
 Disaster relief workers (e.g. during floods)
 People involved with outdoor/recreational activities such
as water recreational activities, jungle trekking, etc.
 Travelers who are not previously exposed to the bacteria
in their environment especially those travellers and/or
participants in jungle adventure trips or outdoor sport
activities
 People with chronic disease and open skin wounds.
HIGH RISK GROUPS

5. MICROBIOLOGY
Causal agent:
 Leptospira Interrogans is pathogenic to human.
 Pathogenic leptospires belong to the genus
Leptospira (long corkscrew-shaped bacteria, too
thin to be visible under the ordinary
microscope); dark-field microscopy is required.
Main modes of transmission:
 Infection is acquired from contact through
skin, mucosa/ conjunctiva with water orsoil
contaminated with the urine of rodents,
carrier or diseased animals in the
environment.
 Ingestion of contaminated water may also
cause infection. There is no documentationof
human to human transmission.
 The incubation usually lasts about 10 days(2
to 30 days).
Most common host: rodent,
especially the common rat
(Rattus norvegicus)

7. • Infection  leptospires appear in the blood 
invade all tissues and organs particularly affecting
the liver and kidney  cleared from the body by
the host's immune response
• May also settle in the convoluted tubules of the
kidneys  shed in the urine for a few weeks to
several months or longer
• Subsequently cleared from the kidneys and other
organs (may persist in the eyes for much longer)
• Produces endotoxin  attach onto the endothelial
cells  capillary vasculitis (endothelial necrosis and
lymphocytic infiltration)
PATHOPHYSIOLOGY

8. • Vasculitis and leakage  petechiae,
intraparenchymal bleeding and bleeding along
serosa and mucosa
• Lost of fluids into the third space  hypovolaemic
shock and vascular collapse
• Humans react to an infection by producing specific
anti-Leptospira antibodies
• Seroconversion – as early as 5–7 days after the
onset of disease – sometimes only after 10 days or
longer – IgM appear somewhat earlier than IgG and
generally remain detectable for months or even
years but at low titre.
PATHOPHYSIOLOGY

9. CLASSIFICATION

10. LEPTOSPIREMIC PHASES

11. • The incubation period is usually 10 days, with a
range of 2 to 30 days.
• The clinical manifestations are highly variable.
Typically, the disease presents in four broad clinical
categories:
(i) a mild, influenza-like illness (ILI);
(ii)Weil's syndrome characterized by jaundice, renal
failure, haemorrhage and myocarditis witharrhythmias;
(iii) meningitis / meningoencephalitis;
(iv) pulmonary haemorrhage with respiratoryfailure.
CLINICAL MANIFESTATIONS

13. • Clinical diagnosis is difficult because of the variedand
non-specific presentation.
• Confusion with other diseases, e.g. dengue and other
haemorrhagic fevers, malaria, typhoid, melioidosis,
influenza, etc. is particularly common in the tropics.
Presentations may also overlap as the infection
progresses.
CLINICAL MANIFESTATIONS
If a patient dies from leptospirosis, what is the cause
of death?
Important causes of death include renal failure,
cardiopulmonary failure, and widespread haemorrhage.
Liver failure is rare, despite the presence of jaundice.

14. Multiorgan involvement
 Ocular
—Suffusion – dilation of the conjunctival vasculature,
subconjuctival haemorrhage, uveitis
—Icterus scleral with conjunctival suffusion-pathognomic of
Weil’s disease
 GI
– Jaundice not associated with hepatocellularnecrosis.
Bilirubin, ALT,AST will normalise
 Renal
– Acute tubular necrosis (direct leptospireinjury)
– Interstitial nephritis (relate to Ag-Abcomplexes)
CLINICAL MANIFESTATIONS

15.  Cardiac – Myocarditis, 1st degree heart block, coronary
arteritis
 Pulmonary
–Spectrum ranging from cough, dyspnoea,haemoptysis
to ARDS
– Pulmonary haemorrhage may causedeath
–Radiology reveals diffuse small opacities which may
disseminate or coalesce
– a sign of intra-alveolar and interstitial haemorrhage
CLINICAL MANIFESTATIONS

17. HOW TO DIAGNOSE ?

18. CASE CLASSIFICATION
Leptospirosis is difficult to distinguish from a number of other diseases on clinical
grounds alone. History of possible exposure is paramount to aid clinical diagnosis.
CLINICAL CASE
A case that is compatible with the following clinical description:
 Acute febrile illness with history of exposure to water and/or environment
possibly contaminated with infected animal urine with ANY of the following
symptoms: Headache
 Myalgia particularly associated with the calf muscles and lumbar region
 Arthralgia
 Conjunctival suffusion
 Meningeal irritation
 Anuria or oliguria and/or proteinuria
 Jaundice
 Hemorrhages (from the intestines and lungs)
 Cardiac arrhythmia or failure
 Skin rash
 Gastrointestinal symptoms such as nausea, vomiting, abdominal pain, diarrhoea

19. CASE CLASSIFICATION
PROBABLE CASE
A clinical case AND positive ELISA/other Rapid tests.
CONFIRMED CASE
A confirmed case of leptospirosis is a suspected OR probable case with any one of
the following laboratory tests:
 Microscopic Agglutination Test(MAT),
For single serum specimen - titre ≥1:400
For paired sera - four fold or greater rise in titre
 Positive PCR (samples should be taken within 10 days of disease onset)
 Positive culture for pathogenic leptospires (blood samples should be taken
within 7 days of onset and urine sample after the 10 th day)
 Demonstration of leptospires in tissues using immunohistochemical staining
(e.g. in post mortem cases)
 In places where the laboratory capacity is not well established, a case can be
considered as confirmed if the result is positive by 2 different rapid diagnostic
tests.
 Cases that require confirmation are:
i. Hospitalized cases
ii. All suspected leptospirosis death cases

22. TREATMENT

23.  Severe cases are usually treated with high
doses of IV C-penicillin (2 M units 6 hourly for
5-7 days).
 Less severe cases treated orally with
antibiotics such as doxycycline (2 mg/kg up to
100 mg 12-hourly for 5-7 days), ampicillin or
amoxicillin.
 Third generation cephalosporin, such as
ceftriaxone and cefotaxime, and quinolone
antibiotics may also be effective.
 Monitoring and supportive care as
appropriate, e.g. dialysis, mechanical
ventilation.