LEPTOSPIROSIS (Preventive Medicine)
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Transcript of LEPTOSPIROSIS (Preventive Medicine)
Infectious disease caused by spirochete bacteria (Leptospira interrogans)
Acquired when coming in contact with flood
water contaminated by urine of animals such as rats, dogs, goats, and swine.
Common in tropical countries with heavy rainfall
“Leptospirosis is a bacterial disease that affects both humans and animals. The early stages of the disease
may include high fever, severe headache, muscle pain, chills, redness in the eyes, abdominal pain,
jaundice, haemorrhages in skin and mucous membranes (including pulmonary bleeding),
vomiting, diarrhea and a rash.”
Infection usually occurs in adolescents or young adults more common in men (male-to-female ratio of
4:1) ▪ peak incidence is in men aged 30 to 39 years
Leptospirosis is seen worldwide, except in the
polar regions human infection is endemic in most temperate and tropical
climates
(annual rates of infection )
In TEMPERATE CLIMATES:
0.1 -1 per 100,000 (WHO)
In TROPICAL CLIMATES (humid): 10-100 per 100,000
300,000 – 500,000 severe cases per year
As of September 2013 - 78% lower than 2012 cases
Most cases reported during rainy / typhoon season.
Median age affected: 30 y/o, but age
most affected > 40 y/o. 86% of cases were male * Top 5 areas most affected (from most
to least): NCR, Regions VI, III, XI, II. In NCR itself, Manila is most affected, followed by QC, Caloocan, Parañaque.
-DOH
I HEALTHY
INDIVIDUALS
III SYMPTOMATIC INDIVIDUALS
II ASYMPTOMATIC
INDIVIDUALS
IV OUTCOME
4 STAGES
Susceptible
Asymptomatic infection
Acute febrile illness
No sequelae
Uveitis
Other potential sequelae
Well’s Syndrome
Pulmonary Hemorrhage
Aseptic Meningitis
Other potential sequelae
Includes depression & other mental health problems
Death
HOST VECTOR AGENT
People who work outdoors or with animals and people in contact with infected water:
Veterinarians Farm and agricultural
workers Meat workers Sewage system
personnel Military personnel
Rodents
Dogs
Wild animals
Domesticated animals
Leptospira interrogans
ENVIRONMENT INFECTIVITY PATHOGENICITY
TROPICAL AND SUBTROPICAL
REGIONS
LEPTOSPIREMIA develops after Leptospires gain entry LEPTOSPIRES multiply in the blood and tissues and can be isolated from blood and CSF during first 4-10 days of illness damage walls of small blood vessels and cause vasculitis
Incubation period: average 5–14 days (range: 2-4 weeks)
Asymptomatic infection
Acute febrile illness
Uveltis
Other potential sequelae
Weil’s Syndrome
Pulmonary Hemorrhage
Aseptic Meningitis
Other potential sequelae
Death
Susceptible
Includes depression & other mental health problems
No sequelae
LEPTOSPIREMIC PHASE
Nonspecific flu-like symptoms includes
( headaches, muscle aches, eye pain with bright lights, followed by chills and fever, watering and redness of the eyes ) Lasts for 3-10 days Leptospires in the blood
IMMUNE PHASE
Fever not responsive to antibiotics and aching with stiffness of the neck Inflammation of the nerves of the eyes, brain and spinal column, RUQ abdominal pain Leptospires in the urine
WEIL’S SYNDROME • Fulminant type Jaundice, acute kidney
injury, hypotension, pulmonary hemorrhage, acute abdomen, myocarditis, hepatic injury
Complications:
Acute Kidney Injury
Respiratory problems
Chronic fatigue and other neuropsychiatric symptoms (headache, paralysis, depression, etc)
DEATH
I PRIMARY
III TERTIARY
II SECONDARY
Health education/awareness
Good sanitary practice Drinking of safe/potable
water (distilled/purified/boiled)
Proper drainage of water Avoiding contact with
flood waters Use of protective
covering (boots/gloves) when in contact with flood water
Pest/rodent control (rats/mice)
Doxycycline prophylaxis Vaccination (animals)
Mild leptospirosis
Moderate – severe
leptospirosis
Antibiotic therapy
- Doxycycline - Aamoxicillin
- Azithromycin dihydrate
- Penicillin G - Cefotaxime - Ceftriaxone - Parenteral Azithromycin
dihydrate
- 7 days - 3 days
(azithromycin dihydrate)
Philippine Society Of Microbiology and Infectious Diseases. Leptospirosis Clinical Practice Guidelines 2010
EARLY DIAGNOSIS
DIRECT METHODS INDIRECT METHODS Immunofluorescence
staining Immunoperoxidase staining Silver staining Various methods of
POLYMERASE CHAIN REACTION
various types of ELISA tests Spot agglutination test MICROSCOPIC
AGGLUTINATION TEST
Symptomatic rehabilitation
Rest kidneys –avoid lifting heavy weights, avoid contact sports, complete bed rest, if necessary
Maintain fluid and electrolyte homeostasis
Provide ample time for recovery
Environmental sanitation must be given importance Recognition of the signs and
symptoms is the key to prompt treatment necessary to prevent dreaded outcomes Leptospirosis is treated with
antibiotics and is rarely fatal Prevention is better than cure
ACCORDING TO WHO:
If Leptospirosis is detected early, antibiotics can be administered that can successfully treat the disease.
The plan: Establish accurate estimates of disease burden to better direct adequate intervention, control and prevention efforts.
If risk factors are identified, then interventions can be appropriately targeted at the individual and community level that can successfully prevent the disease.