Leptospirosis

Sung Chul Hwang

Dept. of Pulmonary and Critical Care Medicine
Ajou University School of Medicine
 Introduction
• Spirochetal disease, finely coiled, motile, 0
.1  x 6 – 20
• Systemic infection manifested as widespre
ad vasculitis
• Zoonosis
• L. interogans 23 serogroups and 187 sero
vars
• L. biflexa : non-pathogenic, saprophyte
 Historical back ground
• 1921 : Takaki 창경원 죽은 족제비 – L. ictero
hemorragiae 분리
• 1942 : sekiguchi – L. canicola from mouse
• 1951 : 미군 , 동경 401 의무 시험소 - 국내
들쥐로부터 ictohemorrhagiae 분리
• 1975 : 경기 강원 충북 , “ 출혈성 폐렴양 괴질”
• 1984 년 10 월 : 강원도 원주 , 괴질 환자에서
렙토스피라 균을 분리 동정
• 1984 년이후 : 매년 9-11 월 환자 및 야생쥐 -
leptospira 균이 동정됨
 Epidemiology
• Disease of the wild animals
• Incidental human infection by direct or
indirect contact with the animal
• 20-40s active males: farmers or soldiers in
harvest time
• 9-10 peak  into November
• 추수 , 탈곡 , 벌초 , 성묘 , 나무하기 ,
훈련 , 등
 Reservoires of Infection
• Rats
• Dogs
• Live stocks
• Rodents including rabbits
• Wild animals
• Cats
 Sources of Human Infections
• Contaminated Water or soil from infected
urine
• Direct animal contacts
• Occupational exposure : farmers, vets, ab
attoire workers
• Recreational exposure : campers, swimme
rs, visiting graveyards
 Routes of Infection
• Contact with water or soil contaminated animals
• Direct contact with the by urine from infected source,
farmer, vets, butchers, recreational activities
• Rodents carry EH fever, scrub typhus, paratyphus, le
ptospirosis
• Factors for high incidence : rain during harvest tim
e, carrier rate in rodents
• Spirochetes survive longer in wet swampy conditions
 국내 주민의 항체 보유율

• 1985.2 – 1986.7 : 11.69%

• 1987.2 – 1987. 7 : 5.9 %
• 1985 in febrile patients : 20%
• 1986- 1987 in febrile patients : 11.6%
 국내 야생쥐의 균 보유율

• 1984 : 15.5%
• 1985 : 14.9%
• 1986 : 16%
• 1987 : 30.9% ( 파주 , 여주 )
 Microbiology and distribution
• Mainly serogroup ictohemorrhagiae an
d canicola
• 전북 , 서울 , 강원 , 충북 , 충남
• CH-48 : 춘천지방 , 혈청형 미상
• Serovar : mainly lai
 Pathogenesis
• Entry sites : skin wounds or abrasions in hand and
feet and mucous membranes, conjunctiva, nasal, o
ral
• Bacteremia involving the entire body including ey
e, CSF
• Systemic effect and vasculitis due to endotoxin (hy
aluronidase) and burrowing motility
• Hemorrhagic necrosis esp. in liver, lung, and kidn
eys  jaundice, ARF, hemorrhages
 Clinical types
Types 1986 1987
Pneumonitis 33% 57.7%
Rash type 17%
Weil’s disease 15%
Renal failure 13% 53.8%
“Flue-like” 15% 13.5%
Acute Hepatitis 8%
Combination 86.5%
 Phase I (Septicemic)

• Following incubation period of 7-10 days

• High spiking fever, headaches, myalgia, arthra
lgias
• Lasting 4 – 7 days
• Proteinuria and increased creatinnine
• Organism detectable but serologic diagnosis no
t possible
 Phase II (Immune)

• Much more variable

• Induction of IgM Antibodies
• 1- 3 day freedom  recurrence of sympto
ms
• Lower fever, CNS signs
• Maybe cultured from urine but not from
blood or CSF
 Weil’s Disease
• Less common but severe form
• Mild phase I, initially
• Followed by severe Jaundice , Azotemia,
and Hemorrhage from Lungs, GI tract, a
nd other organs (3-6 day)
• Oliguric renal failure and Liver dysfuncti
on dominate the clinical picture
 Clinical Signs of Leptospirosis
• Pulmonary infiltrates, pneumonitis, hemorrhages
• Conjunctival injection
• Jaundice
• Muscle tenderness
• Abdominal tenderness
• CVA tenderness
• Abnormal auscultation
• Erythema, petechiae, neck stiffness, adenopathy
 Lab. Diagnosis
• Microbiologic identification : Blood or CS
F  first 10 days Urine  second week (Fl
etcher’s, EMJH Medium)
• Serology: screeningMicroscopic Slide A
gglutination (MST), titration & serogroup id
entification  Microscopic Agglutination
(MAT), detection of IgM (ELISA)
 Chest X-rays
• 33 – 64 % of patientssjows abnormality
• Bilateral nodules, rosette densities
• Diffuse ill-defined infiltrates
• Massive confluent consolidation
• Bilateral, Non-lobar, peripheral predominance
• Rare pleural reaction
• Complete resolution within 5 to 10 days
 Treatment
• Early anti-microbial therapy is important
shorten the course and prevent carrier stat
e
• Choice : Penicillin G, Ampicillin
• May cause “ Jarish-Huxheimer type reacti
on”
• Mild cases oral Doxycycline or Amoxicillin
 Prevention
• Vaccination of domestic animals
• Rodent control
• Protective gloves and boots
• Avoid swimming in contaminated waters
• Vaccination in endemic region
 Differential Diagnosis
• EH fever
• Rickettsial disease : Scrub typhus, murine
typhus
• Acute viral hepatitis
• Sepsis
• Influenza
• Aseptic Meningitis
Conjunctival hemorrhage
in leptospirosis