Short presentation about leptospiral infection, all copyrights belong to owner, for educational purposes only

1. Leptospirosis: A Neglected
Infectious Disease In The
Tropics
Fadel Muhammad Garishah, BSc
Department of General Medicine
Faculty of Medicine Diponegoro University

2. Overview of Leptospirosis
 Zoonotic disease caused by Leptospiral pathogens
 Systemic infection characterized by fever,
thrombocytopathy, liver failure, respiratory failure and
acute tubular necrosis
 An overlooked infectious disease due to poorly
availability of diagnostic tools
 Relatively simple medication

3. Important to Understand
 Leptospirosis typically presents as a nonspecific,
acute febrile illness characterized by fever, myalgia,
and headache and may be confused with other
entities such as influenza and dengue fever.
 Endemic regions, professions, history of possible
exposures affect Clinical Judgement

4. Epidemiology

5. Microbiological Aspects
• Spirochetes
• Length 15-20 um
• Periplasmic flagella
• Unstained with
gram
• Dark
microscopy/silver
impregnation

6. Reservoir and Transmissions

7. Transmission
 transmitted to humans by direct contact with
reservoir animals
 by exposure to environmental surface water
or soil that is contaminated with their urine

8. Risks

9. Natural History of Leptospirosis

10. Pathobiology
 Patients progressing to multisystem organ failure have
widespread hematogenous dissemination of pathogens.
 Nonoliguric (high output) renal dysfunction should be
supported with fluids and electrolytes.
 Elevated bilirubin levels are due to hepatocellular damage
and disruption of intercellular junctions between
hepatocytes, resulting in leaking of bilirubin out of bile
caniliculi.
 Hemorrhagic complications are common and are
associated with coagulation abnormalities.
 Severe pulmonary hemorrhage syndrome due to extensive
alveolar hemorrhage has a fatality rate of >50 %.

11. Clinical Manifestations

12. Clinical features
Conjunctival Suffusion
Calf Muscle
Tenderness
Leptospiral Rash

13. Diagnostic Terms
 Suspect case
 Probable case
 Confirmed case

14. Suspect Case
 Acute fever > 38,5C; with/out severe headache
 Myalgia
 Prostration
 Conjunctival suffusion
 History of exposure!

15. Probable case
 Calf tenderness
 Cough with/without hemoptysis
 Jaundice
 Hemorrhagic
 Meningism
 Anuria/oliguria/proteinuria
 Breathlessness
 Cardiac arrythmia
 Skin rashes
 With Positive Rapid IgM Test or MAT 200/single sample

16. Diagnostic Tools
 Dark field microscopy/Ink stain
 Microscopic Agglutination Test
 ELISA
 PCR
 Cultur EMJH/Fletcher’s Medium

17. Confirmed case
 Suspect/Probable Case
 With isolation of Leptospira spp.
 PCR positive
 Seroconversion of MAT 4 folds
 MAT titre 400/single sample

18. Chemotherapeutics
Mild
 Doxycyline 2 x 100 mg for 7 days
 Amoxicillin/Ampicillin 2 g/day for 7 days
Severe Case
 Penicillin G 2 MU IV/6hours for 7 days
 Ceftriaxon 1 g/day for 7 days

19. Supportive managements
 Renal (Dialysis)
 Hepatic
 Pulmonary (Ventilators)
 Hemorrhages (Transfusions)