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LEPTOSPIROSIS


http://crisbertcualteros.page.tl
 Leptospirosis is a globally important zoonotic
  disease caused by spirochetes of the genus
  Leptospira
 Weil's disease: a severe leptospirosis
  characterized by: fever, jaundice, acute renal
  injury, refractory shock, and hemorrhage
  (especially pulmonary hemorrhage).
   The global burden of leptospirosis is hard to quantify because of the
    difficulties encountered in its clinical diagnosis and the lack of efficient
    confirmatory laboratory testing, which limits public health reporting.
leptospirosis

 a zoonotic disease
 Human-to-human transmission does not occur
 sources of transmission to humans: rats, dogs,
  cattle, and pigs.
 Transmission:
1. indirect contact with contaminated animal
   urine through surface waters, moist soil, or
   other wet environments
2. direct contact with urine and other excreta
   (e.g., products of parturition, placenta) of
   infected animals
Pathogenesis

    • infects the mucosa (conjunctival, oral or tonsillar)
      or through macerated, punctured, or abraded skin



    • resist innate immune defenses



    • Proliferate to bloodstream or extracellularly within
      organs
Etiologic Agent
 Leptospires are difficult to culture from
  blood, urine, and (CSF), although certain
  species and serovars (e.g., L. interrogans
  serovar Copenhageni) are grown more easily
  than others.
 Rat-associated L. interrogans serovars
  Icterohaemorrhagiae and Copenhageni are
  mostly commonly associated with Weil's
  disease
 Incubation period: average: 5–14 days
                       range: 2–30 days
Cycle of leptospirosis
Leptospirosis Clinical Manifestations, Diagnosis, Treatment and Prevention
Clinical Manifestations
Physical examination
 conjunctival suffusion (dilated conjunctival blood
  vessels in the absence of discharge)
 pharyngeal erythema without exudate
 muscle tenderness
 rales on lung auscultation or dullness on chest
  percussion over areas of pleural hemorrhage
 rash (macular, maculopapular, erythematous,
  petechial, or ecchymotic)
 Jaundice
 Meningismus
 hypo- or areflexia, particularly in the legs.
Phases of Leptospirosis

A. Mild uncomplicated leptospirosis usually ends
   in spontaneous resolution within 7–10 days
   without sequelae
B. Immune phase:
1. return of fever, headache, other systemic
   symptoms after 3–10 days associated with
   clearance of leptospires from the blood and the
   appearance of antibodies
2. this phase does not respond to antibiotic
   therapy
C. Weil's disease:
1. characterized by variable combinations of
   jaundice, acute kidney injury, hypotension,
   and hemorrhage—most commonly the
   lungs
2. also affects the git, retroperitoneum,
   pericardium, and brain
Diagnosis
 has been immersed in or has had mucosal or
  percutaneous exposure to contaminated animal
  urine
 Hematologic abnormalities are variable but
  common: leukocytosis (typical in severe disease),
  leukopenia, hemolytic anemia, mild to moderate
  anemia, and thrombocytopenia.
 Classic Weil's disease: suggested by elevated
  BUN and serum creatinine with mixed
  conjugated and unconjugated
  hyperbilirubinemia with SGPT elevation to less
  than five times the upper limit of normal
 Definitive DX: presence of the organism by
  culture isolation, detection of nucleic acids or
  antigen in body fluids, or
  immunohistochemical visualization in tissue
 Leptospiral cultures do not become positive
  for weeks and therefore cannot guide clinical
  care.
 PCR–based assays have been used in research
  laboratories to detect leptospiral DNA
 Gold standard: microscopic agglutination test
  (MAT)—performed only at the CDC
 Leptospires can be cultured from blood and
  CSF during the first 7–10 days of illness and
  urine beginning in the 2nd week
 Urine cultures can remain positive for months
  or years despite antibiotic therapy
Treatment
Prognosis

 Severity of illness: pulmonary and renal
  dysfunction is the most important
  determinant of prognosis
 Advanced age, pulmonary involvement,
  elevated serum creatinine, oliguria, and
  thrombocytopenia are associated with a poor
  prognosis
Prevention
 No vaccine is available for human
  leptospirosis
 Prophylaxis: Doxycycline - variably effective
  in different settings
 Anticipated short-term, well-defined
  exposures (military training or specific
  adventure travel)-can be considered
 Long-term antibiotic prophylaxis has not
  been shown to be effective in preventing
  infection in high-transmission endemic
  settings
 General sanitation approaches and avoidance
  of swimming in potentially contaminated
  places are recommended….




 Salamat…..

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Leptospirosis Clinical Manifestations, Diagnosis, Treatment and Prevention

  • 2.  Leptospirosis is a globally important zoonotic disease caused by spirochetes of the genus Leptospira  Weil's disease: a severe leptospirosis characterized by: fever, jaundice, acute renal injury, refractory shock, and hemorrhage (especially pulmonary hemorrhage).  The global burden of leptospirosis is hard to quantify because of the difficulties encountered in its clinical diagnosis and the lack of efficient confirmatory laboratory testing, which limits public health reporting.
  • 3. leptospirosis  a zoonotic disease  Human-to-human transmission does not occur  sources of transmission to humans: rats, dogs, cattle, and pigs.  Transmission: 1. indirect contact with contaminated animal urine through surface waters, moist soil, or other wet environments 2. direct contact with urine and other excreta (e.g., products of parturition, placenta) of infected animals
  • 4. Pathogenesis • infects the mucosa (conjunctival, oral or tonsillar) or through macerated, punctured, or abraded skin • resist innate immune defenses • Proliferate to bloodstream or extracellularly within organs
  • 5. Etiologic Agent  Leptospires are difficult to culture from blood, urine, and (CSF), although certain species and serovars (e.g., L. interrogans serovar Copenhageni) are grown more easily than others.  Rat-associated L. interrogans serovars Icterohaemorrhagiae and Copenhageni are mostly commonly associated with Weil's disease  Incubation period: average: 5–14 days range: 2–30 days
  • 9. Physical examination  conjunctival suffusion (dilated conjunctival blood vessels in the absence of discharge)  pharyngeal erythema without exudate  muscle tenderness  rales on lung auscultation or dullness on chest percussion over areas of pleural hemorrhage  rash (macular, maculopapular, erythematous, petechial, or ecchymotic)  Jaundice  Meningismus  hypo- or areflexia, particularly in the legs.
  • 10. Phases of Leptospirosis A. Mild uncomplicated leptospirosis usually ends in spontaneous resolution within 7–10 days without sequelae B. Immune phase: 1. return of fever, headache, other systemic symptoms after 3–10 days associated with clearance of leptospires from the blood and the appearance of antibodies 2. this phase does not respond to antibiotic therapy
  • 11. C. Weil's disease: 1. characterized by variable combinations of jaundice, acute kidney injury, hypotension, and hemorrhage—most commonly the lungs 2. also affects the git, retroperitoneum, pericardium, and brain
  • 12. Diagnosis  has been immersed in or has had mucosal or percutaneous exposure to contaminated animal urine  Hematologic abnormalities are variable but common: leukocytosis (typical in severe disease), leukopenia, hemolytic anemia, mild to moderate anemia, and thrombocytopenia.  Classic Weil's disease: suggested by elevated BUN and serum creatinine with mixed conjugated and unconjugated hyperbilirubinemia with SGPT elevation to less than five times the upper limit of normal
  • 13.  Definitive DX: presence of the organism by culture isolation, detection of nucleic acids or antigen in body fluids, or immunohistochemical visualization in tissue  Leptospiral cultures do not become positive for weeks and therefore cannot guide clinical care.  PCR–based assays have been used in research laboratories to detect leptospiral DNA
  • 14.  Gold standard: microscopic agglutination test (MAT)—performed only at the CDC  Leptospires can be cultured from blood and CSF during the first 7–10 days of illness and urine beginning in the 2nd week  Urine cultures can remain positive for months or years despite antibiotic therapy
  • 16. Prognosis  Severity of illness: pulmonary and renal dysfunction is the most important determinant of prognosis  Advanced age, pulmonary involvement, elevated serum creatinine, oliguria, and thrombocytopenia are associated with a poor prognosis
  • 17. Prevention  No vaccine is available for human leptospirosis  Prophylaxis: Doxycycline - variably effective in different settings  Anticipated short-term, well-defined exposures (military training or specific adventure travel)-can be considered  Long-term antibiotic prophylaxis has not been shown to be effective in preventing infection in high-transmission endemic settings
  • 18.  General sanitation approaches and avoidance of swimming in potentially contaminated places are recommended….  Salamat…..