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Leptospirosis

Dr. Bambang SN, Sp.PD

Leptospirosis - Zoonosis
Leptospirosis is an acute anthropo-zoonotic
infection of worldwide significance caused by
spirochaete Leptospira interrogans which has 23
serogroups and >200 serovars.
Various factors influencing the animal activity,
suitability of the environment for the survival of
the organism and behavioral and occupational
habits of human beings can be the determinants
of incidence and prevalence of the disease.

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
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


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

What causes Leptospirosis


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.

Scientific Beginning
It was first described by Adolf Weil in 1886
when he reported an "acute infectious
disease with enlargement of spleen,
jaundice and nephritis". Leptospira was
first observed in 1907 from a post mortem
renal tissue slice.

Pathogenic strains x Non pathogenic


Leptospirosis
There are several species of Leptospira only few
are pathogenic to Humans, rest to some Animals
and Many in Nature as saprophytes
Leptospira Interrogans is Pathogenic there are
200 serovars.
Leptospira biflexa Non Pathogenic there are 60
serovars
Further classifications are made on shared
antigens

Genomic based classification


DNA DNA hybridization studies proved
more specific
The traditional serologic classification has
limitations at Molecular level, but useful at
Epidemiological studies.

Morphology
The Leptospira appear
tighly coiled thin flexible
Spritochetes 5 15
microns long.
Fine spiral of 0.1 0.2
microns
One end appears bent
forms a hook.
Actively motile
Seen best with dark field
Microscopy.

Greater Understanding with


Electron Microscopy
Electron Microscopy
show thin axial
filament and a
delicate membrane
In dark field it may
appear as chain of
miniature cocci.

Comparative Morphology of
Spritochetes

Culturing of Leptospira
Leptospira growths best
under aerobic conditions
at 280 to 300c best
demonostrated in
Semisolid agar media
Optimal Media
Fletchers Media
Stuarts Media
Optimal growth after 1 2
weeks

Growth requirements
Leptospira derive
energy from oxidation
of long chain fatty
acids, and cannot use
or carbohydrates or
amino acids as major
energy source.

Antigenic structure
All isolates of L.inttterogans from different parts
of the world are serologically related and exhibit
cross reactions in serologic tests.
Overlapping of Antigens do occur in different
species.
Outer envelop contains large amount of
Lipopolysaccharides ( LPS )
Antigenic structure varies from one strain to
other
This variation forms the basis of serologic
classification

Genome of Leptospira
L. interrogans serogroup Icterhaemorrhagiae
consists of a 4.33 megabase large chromosome
and a 359 kilobase small chromosome, totaling
4,768 predicted genes. A series of genes have
been discovered that could potentially be related
to adhesion. This genome differs from the two
other pathogenic spirochaete (Treponema
palladium and Borrelia burgdorferi), though
some similar genes are visible (CHGC, 2004).

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

Sequence of Leptospira Infection

May present with


Jaundice
Hemorrhage
Nitrogen retention
The Illness is Biphasic with initial temperature
when the second phase comes with raise of IgM
titers raise
Aseptic meingitis initial headache, stiffness of
neck, pleocytosis of Cerebro spinal fluid

Presenting with Jaundice is


significant and Important,
Serious Manifestation

May present with Major


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

Weils Syndrome
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
Hepatitis is the
frequent complication
Elevation of serum
creatine phosphilipae
enzyme raise
differentiates from
Viral hepatitis where
the enxyme is not
raised

Nephritis - Leptospirosis
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
Human urine also contain
Spirochetes in the second
and third week of
infection

Early and Prompt Diagnosis is


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

Culturing Leptospira
Blood and Urine be cultured
in Fletchers 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
Agglutinating
antibodies raise to
very high titers
1 : 10,000 or higher
occurs 5 10 weeks
after onset of infection

Serology - ELISA
Several
Immunoassays are
available as
commercial kits
Detection of IgM and
razing titers of IgG will
guide in association
with clinical history
will help in Diagnosis

Treatment
Antibiotic of choice is Benzyl Pencillin
given by injection in doses of 5 mega units
in a day, for 5 days.
If the patients are genuinely
hypersensensitive to Pencillin opted with
Erythromycin 250mgs four times a day for
a period of 5 days.

Treatment - Other alternatives


The leptospirosis can be effectively
treated with
Doxycycline
Ampicillin
Amoxicillin
Severe patients need administration
Intravenous Pencillin or Amoxcillin

Epidemiology
Leptospirosis causes several animal infections
Most wide spread zoonotic infection in Nature
Human infections are accidental associated with
contamination of water, other materials
contaminated with excreta and animal flesh.
Animal carriers often excrete upto 100million
leptospirosis per ml of urine

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

How Man gets Infected


Water the great source
Drinking
Swimming
Bathing, as the urine of
Rodents chronically
infected contaminate
water sources
Children get infected
when in contact with
infected Dogs

Control of Leptospirosis
Rodent control is
most important.
Humans should avoid
contact with water
contaminated with
animal contact.

Chemoprophylaxis

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

Vaccination in humans
Vaccination for humans is justified where they
cannot be separated from animal sources or
where the animals cannot be immunized
successfully
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.
Yet no universally accepted vaccine is
available for humans

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

New Vaccine trails - Leptospira

Created for Health


awareness on Leptospirosis
THANK YOU FOR ATTENTION