LEPTOSPIROSISPresented

by:Chai Min

Choo

27.03.2015

OUTLINE

Introduction Leptospira interrogans Transmission Clinical features Diagnosis Management Prevention Conclusion

What is leptospirosis? A zoonotic disease. Caused by Leptospira interrogans Geographically widespread Most common in tropical and subtropical

areas with high rainfall First detected in 1886 by Adolph Weil Generally it is transmitted by the

infected urine of rodent

Leptospirosis-synonyms

Weil disease, Swineherd's disease, fever paddy (Rice-field fever), fever Cutting sugar cane (Cane-cutter

fever), Swamp Fever, (mud fever) Fever City, Haemorrhagic jaundice, Stuttgart disease, Canicola fever

Leptospira Interrogans Flexible, filamentous

spirochetes made up of fine spirals with hook-shaped ends

Actively motile Gram –ve > 200 known serotypes Obligate aerobes Slow growing in culture Survives in a moist

environment

Transmission Wild & domesticated animal hosts Human Common reservoirs: rodents, dogs & farm animals Human: incidental, “dead-end” hosts Contact with soil, water & feed contaminated

by urine or tissue of infected animals Occupational exposure Recreational activities Enter through broken skin or mucous

membranes or conjunctiva

Adapted from: http://aeneary.myweb.uga.edu/lepto.htm

Clinical Features Incubation period: 2 - 20 days Clinical presentations range from a self- limited febrile illness to a severe illness associated with multi-organ damage Mortality rate in severe cases: 10-15%

SYMPTOMS Leptospirosis in humans may show a wide

variety of signs and symptoms including: fever; severe headache; myalgias; conjunctival suffusion; jaundice; general malaise; stiff neck; chills; abdominal pain; joint pain; anorexia; nausea; vomiting;

SYMPTOMS (con’t) – diarrhoea; – oliguria/anuria; – haemorrhages; – skin rash; – photophobia; – cough; – cardiac arrhythmia; – hypotension; – mental confusion; – psychosis; – delirium.

Clinical variety1. Mild / Anicteric (90%)• Presents with fever , myalgia

conjunctival suffusion & head ache. • Mortality rate <2%2. Severe (Weil’s syndrome ) / Icteric (10%)• Present with jaundice & renal failure

along with all features of mild cases• Multiple organ involvement manifest as

different complications.• Mortality rate 15%

Presenting with Jaundice is significant and Important, Serious Manifestation

Sequence of Leptospira Infection

Diagnosis

Management 1.Antibiotics Most effective if initiated within 1 week of

disease onset Mild: given oral antibiotics

Micromedex,Frank Shann

Drugs Adult Dose Children Dose

Doxycycline 100mg BD for 5-7 days

> 8 yo, 2mg/kg bd for 2 doses then daily

Amoxycillin 500mg TDS 25mg/kg TDSAmpicillin 500mg QID 25mg/kg QID Azithromycin 500mg OD 10mg/kg OD

Management (Con’t)1.Antibiotics (con’t) Severe: intravenous antibiotics

National Antibiotic Guideline 2008, Frank Shann

Drugs Adult Dose Children DoseBenzylpenicillin 2.4 Mega units QID

for 7 -10 days50,000 units/kg QID

Ceftriaxone 1g OD 60-80mg/kg ODCefotaxime 1g TDS 150-200mg/kg/dose

in 2-4 divided doses

Management (Con’t)

2.Supportive Adequate hydration Maintenance of electrolyte balance Dialysis support for renal failure ECG monitoring for cardiac arrhythmias

Prevention Avoid contact with potentially infected

animals and contaminated water & soil Protective clothing, boots & gloves during

outdoor activities Effective rat control Antimicrobial prevention for who have a high

risk of exposure. doxycycline 200mg/week Azithromycin 500mg/week (pregnant women)

Conclusion Leptospirosis or rat fever is caused by Leptospira interrogans which is found in

rodents, dogs, farm animals & wild mammals

Transmit through exposure to infected urine or contaminated water, soil or mud

Various antibacterial medications are useful in treatment of leptospirosis

REFERENCES

Antony SJ. Leptospirosis- An emerging pathogen in travel medicine: A review of its clinical mainifestations and management. J Travel Med 1996;3:113-118

Marta A. Guerr 2009. Leptospirosis. JAVMA 2009; 234(4):472-478

Pappas G & Cascio A. Optimal treatment of leptospirosis: queries and projections. International Journal of Antimicrobial Agents 2006;28:491-496

Saunders J 1979. Clinical features and management of leptospirosis in Malaysia. Malaysian J Pathol 1979;2:7-9

Soo HH, Lau LG & Chew PH 2005. Sarawak Handbook of Medical Emergencies (2nd edition). C.E. Publishing The Leptospirosis Information Center, viewed 23 September 2010, <http://www.leptospirosis.org>

2008 National Antibiotic Guidelines

2007 UpToDate® Database

THANK YOU.