Leptospirosis

o Leptospirosis is an acute anthropo-zoonotic infection of worldwide significance

caused by spirochaete Leptospira interrogans

What is leptospirosis?

Leptospirosis, also known as canicola fever, hemorrhagic jaundice, infectious jaundice,

mud fever, spirochetal jaundice, swamp fever, swineherd's disease,
caver's flu or sewerman's flu, is a bacterial infection resulting from
exposure to the Leptospira interrogans bacterium. There is an acute form of human
infection known as Weil's disease, where the patient suffers from jaundice,
though this term is often (incorrectly) used to describe any case of infection..

Leptospirosis – A Major Zoonotic Infection

o Weil's disease is comparatively rare, though 'mild' cases of

leptospirosis happen everywhere there are carriers, and it is believed that leptospirosis
is one of the most common zoonotic infections in the world. Millions of people are
infected each year, but information and treatment can be limited, especially in the
developed world where cases are considered 'rare' by the medical
community.

Animals spread Leptospirosis

o Rats, Mice, Wild Rodents, Dogs, Swine, Cattle are principle source of infection
o The above animals excrete Leptospira both in active infection and Asymptomatic
stage
o The Leptospira survive and remain viable for several weeks in stagnant water.

What causes Leptospirosis

o Leptospirosis is a bacterial disease that affects humans and animals. Leptospira

bacteria are found worldwide and there are many different types or serovars capable of
causing disease. Disease caused by Leptospira bacteria is most common in temperate
or tropical climates and appears to be rare in North America.

Pathogenesis

o Leptospira are present in the water bodies

o Enter through breaks in the skin ( cuts and abrasions ) and mucous membranes
o Enters through Mouth – Nose – Conjunctive
o Rarely enters though ingestion.
o Incubation period 1 – 2 weeks
o When multiples blood stream produces fever.
o May establish organ involvement in Kidney and Liver,
o May produce hemorrhage and necrosis in the tissues and initiates dysfunction of
these organs

Sequence of Leptospira Infection

May present with

o Jaundice
 o Hemorrhage
o Nitrogen retention
o The Illness is Biphasic with initial temperature when the second phase comes with
raise of IgM titers raise
o Aseptic meingitis – initial headache, stiffness of neck, pleocytosis of Cerebro spinal
fluid
o Presenting with Jaundice is significant and Important, Serious Manifestation

May present with Major Complications

o Nephritis
o Hepatitis.
o Manifestations in eye
o Muscular lesions
o Many infections are mild and subclinical

Weil’s Syndrome

o Weil's syndrome is a severe form of leptospirosis that causes a continuous

fever, stupor, and a reduction in the blood's ability to clot, which leads to bleeding
within tissues. Blood tests reveal anemia. By the third to sixth day, signs of kidney
damage and liver injury appear. Kidney abnormalities may cause blood in the urine and
painful urination. Liver injury tends to be mild and usually heals completely.

Hepatitis - Leptospirosis

o Hepatitis is the frequent complication

o Elevation of serum creatine phosphilipae enzyme raise differentiates from Viral
hepatitis where the enxyme is not raised

Nephritis - Leptospirosis

o Kidney involvement in animals produce chronic disease of the kidney and the
infected animal starts shedding large number of leptospira and main source of
environmental contamination of bacteria and results I human infections
o Human urine also contain Spirochetes in the second and third week of infection

Early and Prompt Diagnosis is Highly Essential

o The development of simpler, rapid assays for diagnosis has been based largely on
the recognition that early initiation of antibiotic therapy is important in acute disease but
also on the need for assays which can be used more widely.

Laboratory Diagnosis

o Specimens
o 1 Blood to be collected in a heparin tube
o 2 CSF, Tissues
o Microscopic examination
o 3 Urine to be collected with great care to avoid contamination
o 4 Serum for agglutination tests

Culturing Leptospira
 o Blood and Urine be cultured in Fletcher’s semisolid agar or other media chemically
defined protein-free media for the growth of leptospires have been proposed. In order to
obtain the desired rapid and abundant growth of organisms necessary for the efficient
production of vaccines, it has been necessary to supplement such media with a source
of fatty acids,

Serology

o Agglutinating antibodies raise to very high titers

o 1 : 10,000 or higher
o occurs 5 – 10 weeks after onset of infection

Serology - ELISA

o Several Immunoassays are available as commercial kits

o Detection of IgM and razing titers of IgG will guide in association with clinical
history will help in Diagnosis

Treatment

o Antibiotic of choice is Benzyl Penicillin given by injection in doses of 5 mega units

in a day, for 5 days.
o If the patients are genuinely hypertensive to Penicillin opted with Erythromycin
250mgs four times a day for a period of 5 days.

Treatment - Other alternatives

o The leptospirosis can be effectively treated with

o Doxycycline
o Ampicillin
o Amoxicillin
o Severe patients need administration Intravenous Pencillin or Amoxcillin

Epidemiology

o Leptospirosis causes several animal infections

o Most wide spread zoonotic infection in Nature
o Human infections are accidental associated with contamination of water, other
materials contaminated with excreta and animal flesh.
o Animal carriers often excrete up to 100million leptospira per ml of urine

Epidemiology - Occupation

o Certain occupational groups such as agriculture workers in rice and cane fields,
miners and sever cleaners are potential victims

How Man gets Infected

o Water the great source

o Drinking
o Swimming
o Bathing, as the urine of Rodents chronically infected contaminate water sources
o Children get infected when in contact with infected Dogs
Control of Leptospirosis

o Rodent control is most important.

o Human’s should avoid contact with water contaminated with animal contact.

Chemoprophylaxis

o Doxycycline 200 mg orally once a week is simple effective measure. When heavy
exposure is anticipated

Vaccination in humans

o Vaccination for humans is justified where they cannot be separated from animal
sources or where the animals cannot be immunized successfully
o Necessity of human vaccinated will arise where people live and work in proximity to
rodents in wet, tropical conditions, in wet rice planting and harvesting, in military
operations, or working in sewers.
o Yet no universally accepted vaccine is available for humans

Vaccination of Animals

o Vaccinating animals have a dual purpose

o 1 Protecting animals
o 2 Protecting humans who may contract leptospirosis from them
o It is probably true as that immunization of animals will prevent leptospirosis in
people in contact with them.
o It proved true in 1980 when extensive vaccination of dairy cows in New Zealand
lead to marked decreased incidence in Humans.
o Animals immunized experimentally with polysaccharide derived from Leptospira
LPS linked to diphtheria Toxoid were protected against challenges
o Several other vaccines in use to suit local needs.