Leptospirosis is a bacterial disease caused by Leptospira bacteria. It is spread through contact with water or soil contaminated by the urine of infected animals like rats. Symptoms include fever, headache, muscle pains, jaundice and potentially life-threatening complications affecting the lungs, liver or kidneys. Diagnosis involves detecting antibodies or the bacteria in blood or tissues. Treatment consists of antibiotics like penicillin or doxycycline. Prevention focuses on controlling rodents, limiting exposure to contaminated water, and vaccinating at-risk animals and humans.

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LEPTOSPIROSIS
Dr. Amandeep Kaur

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INTRODUCTION
• Also known as – field fever, eye cather’s yellows, 7-
day fever, cane-field fever
• Disease was first described by Adolf Weil in 1886
• Leptospira was first observed in 1907 from a post
mortem renal tissue slice
• World War I - where the sodden conditions of trench
warfare favoured infection
• L. icterohaemorrhagiae was identified as the
causative agent in pre-World War II outbreaks in
Japan
• Reinstated as a nationally notifiable disease as of

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SCOPE OF THE PROBLEM
• Number of human cases worldwide is not well-
documented
• Probably ranges from 0.1 to 1 per 100 000 per year in
temperate climates to 10 or more per 100 000 per
year in the humid tropics
• During outbreaks and in high-risk groups, 100 or
more per 100 000 infected
• 7-10 million peoples are infected annually

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SCOPE OF THE PROBLEM
• Hurricane Mitch (1995) - outbreak of leptospirosis
with pulmonary haemorrhages reported in Nicaragua
• 1998 - outbreak in the continental United States.
• 1998 - outbreak in Peru and Ecuador following heavy
flooding
• 1999 - post-cyclone outbreak was reported in Orissa,
India

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EPIDEMIOLOGICAL
DETERMINANTS

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AGENT
• Corkscrew-shaped bacteria -
spirochaete
• Thin and light motile
• Only strains of L.interrogans are
pathogenic – visible by dark field
illumination and silver staining
• 21 species identified; 13 species
detected in human cases

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AGENT
• About 250 pathogenic serovars
based on diverse sugar composition of
lipopolysaccharide on surface
• Antigenically related serovars are
grouped into 24 serogroups -
identified using the microscopic
agglutination test (MAT)
• Given serogroup is often found in
more than one species, suggesting that
the LPS genes that determine the
serovar are exchanged between

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AGENT
• Source of infection: urine of infected
animals – entire life time in case of
rodents
• Animal reservoirs: wild and domestic
– Especially rodents – rats, mice, moles –
particularly R.norvegicus and Mus
musculus
– Cattle, sheep, goats, buffalo, pigs, horses
– through grazing
– Dogs

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HOST
• Human infection is accidental
• AGE: Children acquire infection from dogs more
frequently
• OCCUPATION: veterinarians, slaughterhouse
workers, farmers, sewer maintenance workers, waste
disposal facility workers, and people who work on
derelict buildings; Rowers, kayakers and canoeists
also sometimes
• IMMUNITY: serovar specific immunity

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ENVIRONMENT
• Leptospira shed in urine survive for weeks in soil and
water – high level of environmental contamination
were carrier animals frequently urinate
• Poor housing
• Limited water supply
• Inadequate waste disposal

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TRANSMISSION
• DIRECT CONTACT: skin abrasions or intact
mucous membrane
• INDIRECT CONTACT:
– broken skin with contaminated soil, water or vegetation
– ingestion of contaminated food or water
• DROPLET INFECTION: breathing air polluted with
droplets of urine – like while milking cattle

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SIGNS & SYMPTOMS
• Incubation period: 7–12 days
• Biphasic disease - sudden fever with chills, intense
headache, severe myalgia, abdominal
pain, conjunctival suffusion, and occasionally a skin
rash
• First phase (septicemic phase) - 3–7 days
• Disappearance of symptoms coincides with the
appearance of antibodies and disappearance of
bacteria from bloodstream - Patient asymptomatic for
3–4 days
• Second phase - more severe; the person may have

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SIGNS & SYMPTOMS
• 90 percent of cases of the disease are mild
leptospirosis.
• Lung affected as the most serious and life-threatening
of all complications
• Often incorrectly diagnosed due to the nonspecific
symptoms
• Case fatality rate is 1 to 5%

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Clinical criteria
• History of fever within past 2weeks and at least two of
the following clinical findings: myalgia, headache,
jaundice, conjunctival suffusion without purulent
discharge, or rash (i.e. maculopapular or petechial); OR at
least one of the following:
– Aseptic meningitis
– GI symptoms (abdominal pain, nausea, vomiting,
diarrhoea)
– Pulmonary complications (cough, breathlessness,
haemoptysis)
– Cardiac arrhythmias, ECG abnormalities
– Renal insufficiency (anuria, oliguria)

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DIAGNOSIS
• Difficult to diagnose clinically; laboratory support is
indispensable
• Supportive:
– Leptospira agglutination titer of ≥ 200 but < 800 by
Microscopic Agglutination Test (MAT) in one or more
serum specimens, or
– Demonstration of anti-Leptospira antibodies in a clinical
specimen by indirect immunofluorescence, or
– Demonstration of Leptospira in a clinical specimen by
dark-field microscopy, or
– Detection of IgM antibodies against Leptospira in an in
acute phase serum specimen.

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DIAGNOSIS
• Confirmed:
– Isolation of Leptospira from a clinical specimen, or
– Fourfold or greater increase in Leptospira agglutination
titer between acute- and convalescent-phase serum
specimens studied at the same laboratory, or
– Demonstration of Leptospira in tissue by direct
immunofluorescence, or
– Leptospira agglutination titer of ≥ 800 by Microscopic
Agglutination Test (MAT) in one or more serum
specimens, or
– Detection of pathogenic Leptospira DNA (e.g., by PCR)
from a clinical specimen.

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Case definition
• Probable
A clinically compatible case with at least one of the
following:
– Involvement in an exposure event (e.g., adventure race,
triathlon, flooding) with known associated cases, or
– Presumptive laboratory findings, but without confirmatory
laboratory evidence of Leptospira infection.
• Confirmed
– A case with confirmatory laboratory results
• Epidemiologic Linkage
– Involvement in an exposure event (e.g., adventure race,
triathlon, flooding) with associated laboratory-confirmed

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TREATMENT
• Penicillin G – drug of choice – 6million units daily
I/V
• Other drugs - ampicillin, amoxicillin and
Doxycycline
• In more severe cases - cefotaxime or ceftriaxone
• Glucose and salt solution infusions
• Dialysis in serious cases.
• Organ specific care and treatment are essential in
cases of renal, liver, or heart involvement

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PREVENTION & CONTROL
• Control of infection source (e.g. rodent control,
animal vaccination);
• Interrupt transmission route (e.g. wearing protective
clothing, refrain from contact with infected animals
and from swimming in contaminated water, provide
clean drinking-water); or
• Prevent infection or disease in human host (e.g.
vaccination, antibiotic prophylaxis, information to
doctors, veterinarians, risk groups and the general
population).

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PREVENTION & CONTROL
• VACCINATION – of pets and occupational risk
persons
• Italy, Russia, China
• Immunity to one serotype does not prevent against
other – vaccines should incorporate strains
predominant in that area

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.THANK YOU.