abscess advanced trauma life support anterior open bite antibiotics braces csf leaks dental diseases doxycycline dr dr shabeel drshabeel’s face eye trauma gingival infection medical medicine periodontal gum surgery pharmacy pn
A 11-year-old female child was admitted to the hospital with fever, body aches, headache, abdominal pain, decreased appetite, and difficulty breathing for the past few days. On examination, she was tachypnic and hypoxic. Lab tests confirmed leptospirosis with organ dysfunction affecting the lungs, liver, kidneys, and brain. She required intensive care including mechanical ventilation, dialysis, and antibiotics. After 25 days in the hospital, she received a diagnosis of leptospirosis with multi-organ failure and intracranial hemorrhages.
Leptospirosis is a zoonotic bacterial disease caused by Leptospira interrogans. It is transmitted to humans via contact with water or soil contaminated by the urine of infected animals. Clinical features range from a mild flu-like illness to a potentially fatal disease affecting multiple organ systems. Diagnosis involves serological tests, culture, PCR and microscopic examination of body fluids. Treatment of severe cases requires supportive care and antibiotics such as penicillin or doxycycline to shorten illness duration and reduce mortality. Prevention focuses on controlling animal reservoirs and interrupting transmission routes.
The document discusses definitions and key concepts related to sepsis. It defines terms like infection, bacteremia, SIRS, sepsis, severe sepsis, septic shock, and multiple organ dysfunction syndrome. It describes the physiological response to localized infection and how this occurs systemically in septic shock. It identifies risk factors for sepsis and discusses recognition of septic shock. The evaluation and initial treatment of sepsis is also summarized.
Approach to Sepsis & Septic Shock in Emergency Medicine.AngelGovekar
Sepsis and septic shock result from a dysregulated host response to infection. Sepsis criteria include suspected or proven infection and an increase in the SOFA score of 2 or more, while septic shock requires sepsis with vasopressor need to maintain blood pressure and elevated lactate. Treatment involves early recognition, source control with antibiotics, initial fluid boluses of 1-2L for hypotension or elevated lactate, vasopressors if needed, and lactate clearance-guided resuscitation.
This document provides an overview of pneumonia, including its definition, classifications, predisposing factors, pathophysiology, clinical manifestations, diagnostic tests, medical management, complications, and prognosis. Pneumonia is an acute respiratory illness associated with lung inflammation and accumulation of secretions in the alveoli. It is commonly classified based on location (e.g. community-acquired), anatomy (e.g. lobar), or cause (e.g. bacterial, viral). Common predisposing factors include smoking, age, and underlying lung diseases. Diagnosis involves tests like chest x-rays, sputum analysis, and bloodwork. Treatment focuses on oxygenation, antibiotics, and supportive care. Complications can include
Respiratory Manifestations in Systemic Lupus Erythematosus.pptxssusere39f231
This document summarizes the respiratory manifestations that can occur in patients with systemic lupus erythematosus (SLE). It describes several types of lung involvement including airway disease, parenchymal lung disease, vascular diseases, and pleural disease. Specific conditions discussed in detail include acute lupus pneumonitis, diffuse alveolar hemorrhage, interstitial lung disease such as lymphocytic interstitial pneumonia and organizing pneumonia, acute reversible hypoxemia syndrome, and pulmonary embolism. Treatment options are provided for some of the conditions.
This document provides an overview of pulmonary renal syndromes (PRS), which refers to the combination of diffuse alveolar hemorrhage and rapidly progressive glomerulonephritis. PRS can be caused by a variety of conditions and represents a major diagnostic and treatment challenge with mortality rates reaching 25-50% if not addressed early. The document discusses the classification, presentation, diagnostic workup, and management of PRS, and provides three case examples to illustrate the approach to diagnosis and treatment.
abscess advanced trauma life support anterior open bite antibiotics braces csf leaks dental diseases doxycycline dr dr shabeel drshabeel’s face eye trauma gingival infection medical medicine periodontal gum surgery pharmacy pn
A 11-year-old female child was admitted to the hospital with fever, body aches, headache, abdominal pain, decreased appetite, and difficulty breathing for the past few days. On examination, she was tachypnic and hypoxic. Lab tests confirmed leptospirosis with organ dysfunction affecting the lungs, liver, kidneys, and brain. She required intensive care including mechanical ventilation, dialysis, and antibiotics. After 25 days in the hospital, she received a diagnosis of leptospirosis with multi-organ failure and intracranial hemorrhages.
Leptospirosis is a zoonotic bacterial disease caused by Leptospira interrogans. It is transmitted to humans via contact with water or soil contaminated by the urine of infected animals. Clinical features range from a mild flu-like illness to a potentially fatal disease affecting multiple organ systems. Diagnosis involves serological tests, culture, PCR and microscopic examination of body fluids. Treatment of severe cases requires supportive care and antibiotics such as penicillin or doxycycline to shorten illness duration and reduce mortality. Prevention focuses on controlling animal reservoirs and interrupting transmission routes.
The document discusses definitions and key concepts related to sepsis. It defines terms like infection, bacteremia, SIRS, sepsis, severe sepsis, septic shock, and multiple organ dysfunction syndrome. It describes the physiological response to localized infection and how this occurs systemically in septic shock. It identifies risk factors for sepsis and discusses recognition of septic shock. The evaluation and initial treatment of sepsis is also summarized.
Approach to Sepsis & Septic Shock in Emergency Medicine.AngelGovekar
Sepsis and septic shock result from a dysregulated host response to infection. Sepsis criteria include suspected or proven infection and an increase in the SOFA score of 2 or more, while septic shock requires sepsis with vasopressor need to maintain blood pressure and elevated lactate. Treatment involves early recognition, source control with antibiotics, initial fluid boluses of 1-2L for hypotension or elevated lactate, vasopressors if needed, and lactate clearance-guided resuscitation.
This document provides an overview of pneumonia, including its definition, classifications, predisposing factors, pathophysiology, clinical manifestations, diagnostic tests, medical management, complications, and prognosis. Pneumonia is an acute respiratory illness associated with lung inflammation and accumulation of secretions in the alveoli. It is commonly classified based on location (e.g. community-acquired), anatomy (e.g. lobar), or cause (e.g. bacterial, viral). Common predisposing factors include smoking, age, and underlying lung diseases. Diagnosis involves tests like chest x-rays, sputum analysis, and bloodwork. Treatment focuses on oxygenation, antibiotics, and supportive care. Complications can include
Respiratory Manifestations in Systemic Lupus Erythematosus.pptxssusere39f231
This document summarizes the respiratory manifestations that can occur in patients with systemic lupus erythematosus (SLE). It describes several types of lung involvement including airway disease, parenchymal lung disease, vascular diseases, and pleural disease. Specific conditions discussed in detail include acute lupus pneumonitis, diffuse alveolar hemorrhage, interstitial lung disease such as lymphocytic interstitial pneumonia and organizing pneumonia, acute reversible hypoxemia syndrome, and pulmonary embolism. Treatment options are provided for some of the conditions.
This document provides an overview of pulmonary renal syndromes (PRS), which refers to the combination of diffuse alveolar hemorrhage and rapidly progressive glomerulonephritis. PRS can be caused by a variety of conditions and represents a major diagnostic and treatment challenge with mortality rates reaching 25-50% if not addressed early. The document discusses the classification, presentation, diagnostic workup, and management of PRS, and provides three case examples to illustrate the approach to diagnosis and treatment.
Based on the information provided, the most likely diagnosis is idiopathic nephrotic syndrome. Some key points:
- The child is 5 years old, which is a common age for nephrotic syndrome to present.
- There is generalized body swelling (edema), hypoalbuminemia (serum albumin 17), heavy proteinuria (4+ on urine dipstick), and hyperlipidemia (cholesterol 12), meeting the criteria for nephrotic syndrome.
- No obvious underlying cause is identified, so it is likely primary/idiopathic in nature.
The main possible etiologies/causes of nephrotic syndrome include minimal change disease, focal segment
This document discusses lupus nephritis (LN), a serious complication of systemic lupus erythematosus (SLE) where the kidneys are affected. It covers the presentation, diagnosis, classification, histopathology, and treatment of LN. Renal involvement is common in SLE, with proteinuria and cellular casts seen on urinalysis and renal biopsy used to classify LN into six classes based on immune complex-mediated glomerular disease pathology. Treatment varies by class but often involves steroids with immunosuppressants like mycophenolate mofetil or cyclophosphamide to induce remission. Renal biopsy is important for diagnosis and guiding optimal treatment to improve outcomes in LN.
Pulmonary sarcoidosis is a multisystem inflammatory disease of unknown etiology characterized by non-caseating granulomas. It most commonly affects the lungs, skin, eyes and lymph nodes. The pathogenesis involves accumulation of inflammatory cells and T lymphocytes forming granulomas that can damage tissues. Diagnosis is based on clinical features, radiological evidence of non-caseating granulomas on biopsy with other causes excluded. Treatment depends on severity and organ involvement but may include corticosteroids.
This document provides information on sepsis for EMS providers, including causes and risk factors, signs and symptoms, treatment guidelines, and case studies. Sepsis is a serious condition that can lead to septic shock and organ failure if not treated quickly. The guidelines describe identifying septic patients in the field using specific criteria and initiating fluid resuscitation and transport to the hospital for early goal directed therapy to improve outcomes. Case studies demonstrate application of the guidelines and emphasize importance of early recognition and treatment.
Leptospirosis is a worldwide public health problem. In humid tropical and subtropical areas, where most developing
countries are found, it is a greater problem than in those with a temperate climate. The magnitude of the problem in
tropical and subtropical regions can be largely attributed to climatic and environmental conditions but also to the
great likelihood of contact with a Leptospira-contaminated environment caused by, for example, local agricultural
practices and poor housing and waste disposal, all of which give rise to many sources of infection. In countries with
temperate climates, in addition to locally acquired leptospirosis, the disease may also be acquired by travellers
abroad, and particularly by those visiting the tropics.
Leptospirosis is a potentially serious but treatable disease. Its symptoms may mimic those of a number of other
unrelated infections such as influenza, meningitis, hepatitis, dengue or viral haemorrhagic fevers. Some of these
infections, in particular dengue, may give rise to large epidemics, and cases of leptospirosis that occur during such
epidemics may be overlooked. For this reason, it is important to distinguish leptospirosis from dengue and viral
haemorrhagic fevers, etc. in patients acquiring infections in countries where these diseases are endemic. At present,
this is still difficult, but new developments may reduce the technical problems in the near future. It is necessary,
therefore, to increase awareness and knowledge of leptospirosis as a public health threat.
1) Acute Poststreptococcal Glomerulonephritis (APSGN) is caused by certain strains of Group A streptococci that lead to the formation of immune complexes and activation of the complement system, causing inflammation in the glomeruli.
2) It typically presents with hematuria, edema, hypertension, and sometimes acute renal failure. Treatment involves bed rest, antibiotics, controlling hypertension and edema, and dialysis in severe cases.
3) The prognosis is generally good, with over 95% of patients making a full recovery without long-term effects on kidney function. However, a small percentage can develop chronic kidney disease if the acute phase is severe.
Leptospirosis - clinical manifestations and diagnosis.pdfJim Jacob Roy
Leptospirosis is a commonly encountered infection , especially in tropical regions.
In this document , the clinical manifestations and diagnosis of leptospirosis is described.
The modified FAINE'S criteria is also described at the end.
Acute Poststreptococcal Glomerulonephritis (APSGN) is caused by certain strains of Group A streptococci that infect the throat or skin. It presents with hematuria, edema, hypertension, and sometimes acute renal failure. The kidneys show enlarged glomeruli with immune complex deposition on the glomerular basement membrane. Treatment focuses on supportive care with bed rest, salt restriction, diuretics for hypertension or edema, and antibiotics to limit spread of infection. The condition usually resolves spontaneously within a few weeks.
1) A 55-year-old diabetic female presented to the emergency room complaining of epigastric pain and vomiting for 12 hours. Laboratory and imaging findings confirmed acute pancreatitis.
2) Her condition deteriorated rapidly and she developed septic shock, requiring intensive care unit admission, mechanical ventilation, vasopressors, and renal replacement therapy.
3) Despite aggressive management, her condition continued to worsen. She became hypoxic, hypotensive, and acidotic, and suffered cardiac arrest. Resuscitation efforts were unsuccessful and she did not survive.
The document provides information on sepsis epidemiology, pathogenesis, diagnosis, management and prognosis. Some key points:
- Sepsis cases and deaths are increasing worldwide, with the highest incidence among Black males, older adults, and in winter months. Regional disparities exist with most cases in low-income countries.
- Common infectious organisms include gram-positive bacteria and opportunistic fungi/viruses in immunocompromised patients. Culture-negative sepsis occurs in around half of cases.
- Sepsis diagnosis is based on life-threatening organ dysfunction caused by infection, as indicated by a SOFA score ≥2. Septic shock requires vasopressors to maintain blood pressure.
- Management
Systemic Lupus-erythmatosus a detailed review.pdfUsamaSaleem91
Systemic lupus erythmatosus is an autoimmune disease affecting multiple organ systems. This presentation almost describes everything you need to know about this disease. A proper knowledge of this disease is necessary for healthcare professionals specially those related to medicine and rheumatology.
Community acquired pneumonia (CAP) is an infection of the lungs acquired outside of the hospital setting. This document provides guidelines for the diagnosis, treatment, and management of CAP. It recommends performing cultures for moderate to high risk CAP. Blood cultures should be done for moderate and high risk patients. Influenza and Legionella testing is recommended for high risk patients. Treatment depends on risk factors and comorbidities. Low risk CAP can be treated as outpatients. Moderate and high risk CAP require inpatient treatment with antibiotics effective against common and drug-resistant pathogens. Treatment should begin within 4 hours and last 5 days for uncomplicated cases.
Pulmonary Manifestations Of Systemic Lupus Erythematosus
COMPREHENSIVE PRESENTATION ON PULMONARY MANIFESTATIONS OF SLE
IT WILL BE VERY EASY TO UNDERSTAND AND LEARN AND TEACH THIS TOPIC
INCLUDE ALL NEW GUIDELINES AND MANAGMENT.SLE is an autoimmune disease in which the immune system attacks its own tissues, causing widespread inflammation and tissue damage in the affected organs. It can affect the joints, skin, brain, lungs, kidneys, and blood vessels.
Systemic inflammatory response syndrome (SIRS) is a clinical syndrome characterized by a dysregulated inflammatory response that can be caused by infectious or noninfectious processes. Sepsis is defined as SIRS caused by a confirmed or suspected infection. As sepsis progresses it can lead to severe sepsis, septic shock, and multiple organ dysfunction syndrome (MODS). Key aspects of managing sepsis include early identification of infection, administering antibiotics, and supporting vital organ function by correcting hypoxemia, hypotension, and hypoperfusion. Investigations should identify the source of infection and assess organ dysfunction, while priorities of treatment are stabilizing respiration and circulation followed by identifying and treating the underlying infection.
- The document discusses lupus nephritis, its incidence, presentation, pathogenesis, classification, and management.
- Renal biopsy is important for assessing disease activity and chronicity to guide treatment, which typically involves immunosuppressants like mycophenolate or cyclophosphamide combined with corticosteroids.
- Prognosis depends on the WHO classification - classes I-II have excellent prognosis while classes IV-VI have poorer renal outcomes if not treated aggressively.
The document provides information on common hospital-acquired infections including fever, sepsis, urinary tract infections, soft tissue infections like cellulitis, pneumonia, and Clostridium difficile infection. It discusses definitions, risk factors, clinical presentations, diagnostic testing, and treatment recommendations for each condition based on clinical severity and patient risk factors.
This document provides an overview of sepsis, including its epidemiology, etiology, signs and symptoms, diagnosis, management, and complications. It begins with an introduction defining sepsis as an unbalanced immune response to infection that can damage tissues and organs. It then discusses the typical bacterial causes of sepsis and risk factors. The document presents a case report of a child treated for sepsis and concludes that sepsis can damage multiple organs and in serious cases may require advanced organ support.
Pulmonary renal syndromes involve injury to both the lungs and kidneys and can be fatal if not treated quickly. The lungs and kidneys share similarities like microvasculature and material exchange barriers. Common causes are ANCA-associated vasculitis (60% of cases) and Goodpasture's syndrome (20% of cases). ANCA vasculitis includes Wegener's granulomatosis, microscopic polyangiitis, and Churg-Strauss syndrome. Goodpasture's syndrome is an autoimmune disorder causing lung bleeding and kidney failure. Timely treatment with steroids, immunosuppressants, and plasmapheresis is crucial for survival, especially if bleeding is occurring in both organs.
Lecture 6 -- Memory 2015.pptlearning occurs when a stimulus (unconditioned st...AyushGadhvi1
learning occurs when a stimulus (unconditioned stimulus) eliciting a response (unconditioned response) • is paired with another stimulus (conditioned stimulus)
- Video recording of this lecture in English language: https://youtu.be/Pt1nA32sdHQ
- Video recording of this lecture in Arabic language: https://youtu.be/uFdc9F0rlP0
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
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Based on the information provided, the most likely diagnosis is idiopathic nephrotic syndrome. Some key points:
- The child is 5 years old, which is a common age for nephrotic syndrome to present.
- There is generalized body swelling (edema), hypoalbuminemia (serum albumin 17), heavy proteinuria (4+ on urine dipstick), and hyperlipidemia (cholesterol 12), meeting the criteria for nephrotic syndrome.
- No obvious underlying cause is identified, so it is likely primary/idiopathic in nature.
The main possible etiologies/causes of nephrotic syndrome include minimal change disease, focal segment
This document discusses lupus nephritis (LN), a serious complication of systemic lupus erythematosus (SLE) where the kidneys are affected. It covers the presentation, diagnosis, classification, histopathology, and treatment of LN. Renal involvement is common in SLE, with proteinuria and cellular casts seen on urinalysis and renal biopsy used to classify LN into six classes based on immune complex-mediated glomerular disease pathology. Treatment varies by class but often involves steroids with immunosuppressants like mycophenolate mofetil or cyclophosphamide to induce remission. Renal biopsy is important for diagnosis and guiding optimal treatment to improve outcomes in LN.
Pulmonary sarcoidosis is a multisystem inflammatory disease of unknown etiology characterized by non-caseating granulomas. It most commonly affects the lungs, skin, eyes and lymph nodes. The pathogenesis involves accumulation of inflammatory cells and T lymphocytes forming granulomas that can damage tissues. Diagnosis is based on clinical features, radiological evidence of non-caseating granulomas on biopsy with other causes excluded. Treatment depends on severity and organ involvement but may include corticosteroids.
This document provides information on sepsis for EMS providers, including causes and risk factors, signs and symptoms, treatment guidelines, and case studies. Sepsis is a serious condition that can lead to septic shock and organ failure if not treated quickly. The guidelines describe identifying septic patients in the field using specific criteria and initiating fluid resuscitation and transport to the hospital for early goal directed therapy to improve outcomes. Case studies demonstrate application of the guidelines and emphasize importance of early recognition and treatment.
Leptospirosis is a worldwide public health problem. In humid tropical and subtropical areas, where most developing
countries are found, it is a greater problem than in those with a temperate climate. The magnitude of the problem in
tropical and subtropical regions can be largely attributed to climatic and environmental conditions but also to the
great likelihood of contact with a Leptospira-contaminated environment caused by, for example, local agricultural
practices and poor housing and waste disposal, all of which give rise to many sources of infection. In countries with
temperate climates, in addition to locally acquired leptospirosis, the disease may also be acquired by travellers
abroad, and particularly by those visiting the tropics.
Leptospirosis is a potentially serious but treatable disease. Its symptoms may mimic those of a number of other
unrelated infections such as influenza, meningitis, hepatitis, dengue or viral haemorrhagic fevers. Some of these
infections, in particular dengue, may give rise to large epidemics, and cases of leptospirosis that occur during such
epidemics may be overlooked. For this reason, it is important to distinguish leptospirosis from dengue and viral
haemorrhagic fevers, etc. in patients acquiring infections in countries where these diseases are endemic. At present,
this is still difficult, but new developments may reduce the technical problems in the near future. It is necessary,
therefore, to increase awareness and knowledge of leptospirosis as a public health threat.
1) Acute Poststreptococcal Glomerulonephritis (APSGN) is caused by certain strains of Group A streptococci that lead to the formation of immune complexes and activation of the complement system, causing inflammation in the glomeruli.
2) It typically presents with hematuria, edema, hypertension, and sometimes acute renal failure. Treatment involves bed rest, antibiotics, controlling hypertension and edema, and dialysis in severe cases.
3) The prognosis is generally good, with over 95% of patients making a full recovery without long-term effects on kidney function. However, a small percentage can develop chronic kidney disease if the acute phase is severe.
Leptospirosis - clinical manifestations and diagnosis.pdfJim Jacob Roy
Leptospirosis is a commonly encountered infection , especially in tropical regions.
In this document , the clinical manifestations and diagnosis of leptospirosis is described.
The modified FAINE'S criteria is also described at the end.
Acute Poststreptococcal Glomerulonephritis (APSGN) is caused by certain strains of Group A streptococci that infect the throat or skin. It presents with hematuria, edema, hypertension, and sometimes acute renal failure. The kidneys show enlarged glomeruli with immune complex deposition on the glomerular basement membrane. Treatment focuses on supportive care with bed rest, salt restriction, diuretics for hypertension or edema, and antibiotics to limit spread of infection. The condition usually resolves spontaneously within a few weeks.
1) A 55-year-old diabetic female presented to the emergency room complaining of epigastric pain and vomiting for 12 hours. Laboratory and imaging findings confirmed acute pancreatitis.
2) Her condition deteriorated rapidly and she developed septic shock, requiring intensive care unit admission, mechanical ventilation, vasopressors, and renal replacement therapy.
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- Sepsis cases and deaths are increasing worldwide, with the highest incidence among Black males, older adults, and in winter months. Regional disparities exist with most cases in low-income countries.
- Common infectious organisms include gram-positive bacteria and opportunistic fungi/viruses in immunocompromised patients. Culture-negative sepsis occurs in around half of cases.
- Sepsis diagnosis is based on life-threatening organ dysfunction caused by infection, as indicated by a SOFA score ≥2. Septic shock requires vasopressors to maintain blood pressure.
- Management
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Systemic lupus erythmatosus is an autoimmune disease affecting multiple organ systems. This presentation almost describes everything you need to know about this disease. A proper knowledge of this disease is necessary for healthcare professionals specially those related to medicine and rheumatology.
Community acquired pneumonia (CAP) is an infection of the lungs acquired outside of the hospital setting. This document provides guidelines for the diagnosis, treatment, and management of CAP. It recommends performing cultures for moderate to high risk CAP. Blood cultures should be done for moderate and high risk patients. Influenza and Legionella testing is recommended for high risk patients. Treatment depends on risk factors and comorbidities. Low risk CAP can be treated as outpatients. Moderate and high risk CAP require inpatient treatment with antibiotics effective against common and drug-resistant pathogens. Treatment should begin within 4 hours and last 5 days for uncomplicated cases.
Pulmonary Manifestations Of Systemic Lupus Erythematosus
COMPREHENSIVE PRESENTATION ON PULMONARY MANIFESTATIONS OF SLE
IT WILL BE VERY EASY TO UNDERSTAND AND LEARN AND TEACH THIS TOPIC
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2. INTRODUCTION
Leptospirosis is a zoonotic disease with protean manifestations
Common synonyms include weils disease , rice field fever
Mild disease to extremely fatal
Imperative to suspect and treat early in order to prevent complications
3. EPIDEMIOLOGY
Occurs most commonly in tropics and sub tropics
Around 1 million cases reported yearly worldwide with mean case fatality rate
of about 10%
4. AGENT
Leptospira (thin,spiral ) are spirochetes belonging to the order spirochaetales
Nearly 64 species have been identified ,divided into 2 clades and 4 sub clades
(p1,p2,s1,s2)
Traditionally classified as pathogenic (l.Interrogans) and free living (l. Biflexa)
260 serovars
5. LEPTOSPIROSIS
1.6- 20 micron long and 0.1 micron
wide
2. Two polar extrusions
3.Dark field microscopy / silver
impregnation staining
4.Special culture media ( fletcher's
, Ellinghausen mccullough – johnson-
harris , or polysorbate 80)
6. HOST
Mammals are natural host
Humans are incidental hosts ( animal or environmental exposure)
Rodents can persistently shed leptospires in urine throughout their lifespan
7. HOST – RISK FACTORS
Men are more commonly infected
Low socioeconomic status - overcrowding and unhygenic
Barefoot walking (cuts/abrasions)
Recreational exposure - rafting , fresh water swimming
Occupational exposure - farmers , sewage workers
Domestic animal exposure
Travel to endemic areas
12. CLINICAL FEATURES MILD DISEASE
Majority of cases are mild and go undiagnosed
Acute febrile illness / flu like syndrome
Fever,headache,rigors,cough
Myalgia- calves,backand abdomen
15. SEVERE LEPTOSPIROSIS
Hemorrhage
Acute renal failure
Acute respiratory failure
Multiorgan failure
Weil syndrome – Triad of hemorrhage , jaundice and
acute kidney injury
SHOCK – common presenting sign (45%) due to
hypovolemia and microvascular dysregulation
16. CIRCULATORY DYSFUNCTION
Hypovolemia occurs in sepsis causes vascular leakage or
occur as a consequence of hemorahage
Shock
Multiorgan dysfunction
Hemorrhage manifests due to thrombocytopenia ,
coagulopathy,vascular endothelial damage
17. RENAL INVOLVEMENT
Renal impairment attenuated by dehydration from low fluid intake and high fever
Occurs together with jaundice within first 3-4 days presents as non-oliguric
,oliguric or anuric
Hyponatremia and hypokalemia due to tubulopathy involving NA-K-2Cl
cotransporter
Hypokalemia due to impairment of sodium transporter in proximal tubules and
spared distal tubules is more common
Hypomagnesemia
18. RENAL INVOLVEMENT
POLYURIC PHASE:
Develop after 10-18 days
S.creatinine begins to fall at the end of second
week and normalizes within 3-5 weeks
In mild cases the only abnormal findings are in
urinary sediment includes albuminuria,
microscopic hematuria,pyuria and granular casts
19. PULMONARY INVOLVEMENT
Occurs in 20-70% of cases
Most common symptom is cough
Blood tinged sputum or obvious hemoptysis occur
Pulmonary hemorrhage – minimal or severe diffused leading to respiratory
failure
Pulmonary edema with cardiomegaly due to volume overload or congestive
heart failure from myocarditis
Diffuse ground glass opacities without cardiomegaly - ARDS
20. CARDIAC INVOLVEMENT
Most commonly non specific st-t changes
Myocarditis
Conduction abnormality
Repolarization abnormalities and arrhthmias
21. CNS INVOLVEMENT
Aseptic lymphocytic meningitis
Leptospira can be isolated from CSF within 5 days
after onset of fever
Raised CSF opening pressure Raised protein with
normal CSF glucose level
Lymphocytic pleocytosis
Encephalomyelitis
Guillain –Barre syndrome
Mononeuritis multiplex
Cranial nerve palsy
Psychiatric syndrome – Mania
22. LABORATORY DIAGNOSIS
Complete Blood Count
Renal Function Tests
Liver Function Tests
CPK
CSF Analysis
Urine Analysis
CXR,ECG
PT,APTT
TESTS FOR DIAGNOSIS OF LEPTOSPIROSIS
26. LABORATORY DIAGNOSIS - SPECIFIC
Direct isolation
PCR - sensitivity 45-55%
Specificity 99-100%
Can detect even in first five days of illness
Can be done in blood /urine/csf
Culture - specificity- 100%
Sensitivity - 25%
Requires special media
Time consuming
Blood /csf - first 10 days
Urine - 2nd week to 30 days after resolution of illness
27. SEROLOGICAL DIAGNOSIS
Microscopic agglutination test (mat)
Four fold rise in titre or single value of 1:800
Sensitivity – 16-20%
Igm-elisa
Simple , sensitive
Single positive sample adequate for diagnosis becomes positive earlier than mat
Indicates current infection
Commonly performed
Antigen detection:
Using monoclonal anti –lipl32 antibody based antigen capture ellisa- a cost effective alternative to
pcr.
28.
29. LAB CRITERIA FOR DIAGNOSIS OF CURRENT
LEPTOSPIROSIS
CULTURE –POSITIVE
MAT-SEROCONVERSION
ELISA -POSITIVE
31. Presumptive diagnosis of leptospirosis is made of:
Part A or Part A + B Score : 26 or more
Part A+B+C (Total) : 25 or more
A score between 20 and 25 suggests Leptospirosis as a possible
diagnosis.
Part A+B is useful for diagnosis in the first week as lab tests would be
negative.
Part A+B+C is valuable in the second week as lab tests would become
positive.
It is always necessary to confirm the diagnosis with laboratory tests.
32. Reason for Modification
Most cases of leptospirosis are reported in the monsoon and post
monsoon seasons. Therfore factors such as rainfall,and contact with
contaminated environment have been incorporated with appropriate
scores Part (B)
ELISA and SAT measures IgM antibodies becomes positive by 5th
day ,they are the test of choice for diagnosis of current infection and
more over a single sample is adequate . High titres and rising titres of
MAT have been given appropriate scores Part (C)
33. MANAGEMENT
MILD LEPTOSPIROSIS:
FIRST LINE - Doxycycline 100mg BID PO for 10 days
ALTERNATIVE –
Amoxicillin 500mg QID OR 1g q8h
OR
AMPICILLIN 500MG PO tid
OR
Azithromycin 1g initially followed by 500 mg OD for 2
more days
34. SEVERE LEPTOSPIROSIS(WEIL SYNDROME)
PRIMARY :
Penicillin G 1.5 million units IV q 6 hrs for 7 days
Ceftriaxone 1gm IV OD for 7 days
ALTERNATIVE :
Ampicillin 0.5-1 gm q6h
Azithromycin 500mg OD for 5 days
Cefotaxime 1gm q6h
Doxycycline 200mg iv loading dose followed by 100mg iv q12h
35. ROLE OF STEROIDS
WHY
To reduce or delay the need for ventillatory support
To reduce mortality
WHOM
Patients at high risk of pulmonary hemorrhage
AKI plus any of the following
Platelet count < 1 lakh
MAP < 65 mm of Hg
Prolonged PT/APTT
Need for ionotropes
When
Initiate as soon as first sign of pulmonary leptospirosis is detected (
tachypnea, hemoptysis, dyspnea)
36. STEROID REGIMENS
Methylprednisolone 500mg IV OD for 3 days with first
dose given as bolus within first 12 hrs of onset of
respiratory involvement
For those with renal failure – Methylprednisolone 500mg IV
after HD OD for 3 days.
After 3rd MP dose or after any episode of hemoptysis give
Cyclophosphamide 1g IV as single dose
Bolus Methylprednisolone 1g IV OD for 3 das followed b
1mg/kg/day of oral prednisolone for 7 days
37. PREVENTION AND CONTROL
Avoid swimming,bathing ,swallowing or submersing head in potentially
contaminated freshwater especially after periods of heavy rainfall or
flooding
Rodent control measures
Chemoprophylaxis with weekly doxycycline 200 mg once weekly
for 6 weeks
Proper drainage of water bodies
Vaccination of domestic animals
General protective measures ( proper footwear,eyewear,bandage of
cuts ,etc)