Thursday, September 29, 2011

LEPTOSPIROSIS

Other Terms:

Ø  Weil’s Disease
Ø  Mud Fever
Ø  Canicola Fever
Ø  Food Fever
Ø  Swineherd’s Disease
Ø  Japanese Seven Days Fever
Ø  Icterohemorrhagica
Ø  Trench Fever
Ø  Spinochetal Jaundice


Definition
            Leptospirosis is an infectious seasonal disease caused by bacteria of the genus Leptospirae that affect human and variety of animals like pig, dog, and skunk rat. The disease may be transmitted to human whose work brings them into contact with these infected animals. Rat is considered the main host for the disease. Leptospirosis is most common on rainy season and affects male more than female ages below 15 years old.
It was first explained in 1886 by Adolf Weil in his report entitled “Acute Infectious Disease with Enlargement of Spleen, Jaundice and Nephritis”
Hepatic failure is usually the common cause of death in Leptospirosis. It last 1-3 weeks however may be extended and in addition relapse may occur.
Causative Agent
Ø  Normally found:
o   Leptospira Interrogans (found in moist humid soil)
o   Leptospira pyrogenes
o   Leptospira Manilae
Ø  And other species like:
o    L. Icterohemorrhagica
o   L. Canicola, L. Batavia
o   L. Pomona, L. Javinica
Stages
1.      Leptospiremic Stage
Stage wherein the causative agent enters the blood circulation which may affect the Central Nervous System as manifested by sudden onset of high ever, headache, nausea and vomiting, calf pain, and conjunctivitis
2.      Toxic Stage or the immune stage
In this stage the patient may or may not have fever. Rashes will set in followed by an inflammation of the iris (iritis), meningial irritation, damage to the liver which causes jaundice and lastly Kidney Failure (Leptospiuria). It is important to know that the urine of a person having a Leptospirosis is an infectious substance.
Mode of Transmission
·         Direct inoculation into broken skin, mucus membrane. E.g. bathing in flooded water
·         Ingestion of urine/ fecally contaminated food & water
Source of Infection
Infection comes form contaminated food and water, and infected wild life and domestic animals especially rodents.
Ø  Rats (L. leterohemoragiae) are the source of Weil’s disease commonly observed among miners, sewer, and abattoir workers.
Ø  Dogs (L. Canicola) can also be the source of infection along with veterinarians, breeders, and owners of dogs.
Ø  Mice (L. grippotyphosa) may as well be a source of infection that attacks farmers and flax workers.
Ø  Rats (L. bataviae) are the source of infection that attacks rice field workers.

Incubation period – 7 – 13 days or 1-3 weeks

Signs and Symptoms
  • Abrupt onset with chills, vomiting & headache followed by a high fever and severe pains in the extremities (Myalgia).
  • Intense itching of the conjunctivae – orange eyes
  • Myalgia/myosites particularly calf pain
  • Abdominal pain
  • In some cases, acute renal failure and meningitis – complications

Diagnostic Exam:
    1. Blood culture
    2. Urine culture
    3. CSF Culture (for the CNS affection)
    4. LAT – leptospira Agglutination Test
LAAT – Leptospira Antigen Antibody test
Nursing Care- supportive and symptomatic Prevention:
  • Eradication or rodents
  • Environmental sanitation
  • Urine precaution

Treatment:
Pharmacologic Treatment
Ø  First line: Aqueous penicillin G (50,000 units/kg/day in 4-6 divided doses intravenously for 7-10 days Antiserum or convalescent serum
Ø  Antiserum or convalescent serum
Ø  Second line: Erythromycin, or Tetracycline (20-40 mg/kg/day in 4 doses); may not be given to children < 8 years old
Ø  Doxycycline (Vibramycin)
      Symptomatic & supportive care
Ø  IVF for the replacement of fluid and electrolytes loss.
Ø  Dialysis particularly peritoneal dialysis for kidney failure.

High Risk
            Leptospirosis is common among:
ü  Miners
ü  Farmers
ü  Veterinarian
ü  Sewer workers
ü  Swimmers


Synonym:
Weil’s Dse, Mud fever, Canicola fever, Flood fever,
Swineherd’s Dse, Japanese Seven Days fever
Definition & Background:
  • a bacterial zoonotic disease caused by spirochaetes of the genus Leptospira that affects humans and a wide range of animals, including mammals, birds, amphibians, and reptiles

  • first described by Adolf Weil in 1886 when he reported an “acute infectious disease with enlargement of spleen, jaundice and nephritis”
Causative Agent:
  • Leptospira-genus bacteria was isolated in 1907 from post mortem renal tissue slice
  • commonly found: Leptospira pyrogenes, Leptospira manilae, & other species like L. icterohemorrhagiae, L. canicola, L. batavia, L. Pomona, L. javinica
  • in animals often is subclinical; an infected animal may appear healthy even as it sheds leptospires in its urine; humans are dead-end hosts for the leptospire
Predisposing Factors:
  • age: < 15 years of age
  • sex: male
  • season: rainy months
  • geographic: prevalent in slum areas
Source of Infection
Infection comes form contaminated food and water, and infected wild life and domestic animals especially rodents.
  1. Rats ( L. leterohemoragiae) are the source of Weil’s disease frequently observed among miners, sewer, and abattoir workers.
  2. Dogs (L. canicola) can also be the source of infection among veterinarians, breeders, and owners of dogs.
  3. Mice (L. grippotyphosa) may alos be a source of infection that attacks farmers and flax workers.
  4. Rats (L. bataviae) are the source of infection that attacks ricefield workers.
Modes of Transmission
Incubation Period:
  • 6 – 15 days/ 2 – 8 weeks
Clinical Manifestations:
1st stage:    Septicemic/ Leptospiremic Phase (4 – 7 days)
-    onset of high remittent fever, chills, headache, anorexia, nausea & vomiting, abdominal pain, joint pains, muscle pains, myalgia, severe prostration, cough, respiratory distress, bloody sputum.
2nd stage:    Immune/ Toxic Phase (4 – 30 days)
-    if severe, death may occur between the 9th & 16th day
2 types:
  • Anicteric (without jaundice) – return of fever of a lower degree with rash, conjunctival injection, headache, meningeal manifestations like disorientation, convulsions & signs of meningeal irritations (with CSF finding of aseptic meningitis)
  • Icteric (with jaundice) – Weil syndrome; hepatic & renal manifestations: hemorrhage, hepatomegaly, hyperbilirubinemia, oliguria, anuria with progressive renal failure; shock, coma & congestive heart failure in severe cases
3rd stage:    Convalescence Phase
-    Relapses may occur during 4th or 5th week
Diagnosis:
  • culture:    blood (1st week)
CSF (5th to 12th day)
Urine (after 1st wk til pd of convalescence)
  • agglutination tests ( 2nd or 3rd week)
PATHOPHYSIOLOGY
Complications:
  • pneumonia
  • iridocyclitis, optic neuritis
  • peripheral neuritis

Prognosis:

  • cause of death: renal & hepatic failure
  • dse usually last 1 – 3 weeks but may be more prolonged; relapse may occur
Treatment:
  • specific measures: beneficial if done < 4 days of dse
  • Aqueous penicillin G (50,000 units/kg/day in 4-6 divided doses intravenously for 7-10 days
  • Tetracycline (20-40 mg/kg/day in 4 doses); may not be given to children < 8 years old
  • general measures
  • symptomatic & supportice care
  • administration of fluid, electrolytes & blood as indicated
  • peritoneal dialysis (for renal failure)

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