leptospirosis
TRANSCRIPT
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Leptospirosis
Presented by:
Pauline Teo Siew Chin
13th May, 2009
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OUTLINE Introduction Leptospira interrogans Transmission Clinical features Diagnosis Management Prevention Conclusion
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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 Synonyms: Rat fever, fish handler's
disease, mouse fever & rice field fever
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Leptospira interrogans Flexible, filamentous bacteria made up of
fine spirals with hook-shaped ends Gram -ve Spirochetes > 200 known serotypes Obligate aerobes Slow growing in culture Survives in a moist environment for
weeks-months
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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
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6Adapted from http://www.pasteur.fr/
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Clinical Features Incubation period: 2 - 30 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%
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Clinical Progression of Anicteric & Icteric Leptospirosis
(pigmented part of eye)
Anicteric LeptospirosisIcteric Leptospirosis
( Weil’s Syndrome)
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Clinical Features (con’t)
conjunctival suffusionpetechial rash
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Diagnosis
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Management1. General Close temperature, BP, PR & RR
monitoring, I/O chart Adequate hydration, keep temp <38oC
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Management (con’t)2. Antibiotics Most effective if initiated within 1 week of disease onset Mild:
treated as out-patient
given oral antibiotics
Drugs Adult Dose Children Dose
Doxycycline 100mg bd2 mg/kg/day in 2 equally
divided doses
Amoxycillin 1g qid 10 – 25 mg/kg tds
Ampicillin 1g qid 10 – 25mg/kg qid
Erythromycin 250 - 500 mg qid 10 - 25 mg/kg qid
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Management (con’t)2. Antibiotics (con’t) Severe:
intravenous antibiotics
Duration: 1 week A Jarisch-Herxheimer reaction can occasionally be triggered by penicillin therapy
Drugs Adult Dose Children Dose
Benzylpenicillin
(Penicillin G)1.5mU qid
250,000-400,000 units/kg/day in 4-6 divided doses
Ampicillin 500 mg – 1 g qid 10 – 25 mg/kg qid
Amoxycillin 500 mg – 1 g tds 10 – 25 mg/kg tds
Ceftriaxone 1 g od 80-100 mg/kg OD
Cefotaxime 1 g qid150-200 mg/kg/day in 3-4 equally
divided doses
Erythromycin 250mg qid20 - 50 mg/kg/day in 3 - 4 divided
doses
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3. Supportive ICU care in severe cases Fluid & electrolyte therapy Dialysis support for renal failure Ventilatory support for respiratory failure
Management (con’t)
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Vaccination of domestic mammals Avoid contact with potentially infected
animals and contaminated water & soil Protective clothing, boots & gloves Effective rat control Antimicrobial prevention
doxycycline 200mg/week
Prevention
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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
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REFERENCESAberg JA, Goldman MP, Gray LD & Long JK 2006. Infectious Disease Handbook
(6th edition). Lexi-Comp, IncAntony SJ. Leptospirosis- An emerging pathogen in travel medicine: A review of its
clinical mainifestations and management. J Travel Med 1996;3:113-118Howell D & Cole D. Leptospirosis: A waterborne zoonotic disease of global
importance. Georgia Epidermiology Report August 2006;22(08)Khairani-Bejo S, Norhamizah AR, Bahaman AR & Kadir AA 2006. Determination of
susceptibility of Malaysian Leptospira isolate to antimicrobial agents. Journal of Animal and Veterinary 2006;5(2):111-113
MacAllister C. Leptospirosis. Oklahoma Cooperative Extension Service.McBride AJA, Athanazio DA, Reis MG & Ko Al 2005. Leptospirosis. Current
Opinion in Infectious Diseases 2005;18:376-386Pappas 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
2007 UpToDate® Database
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THANK YOU!
13th May, 2009