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LEPTOSPIROSIS
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Leptospirosis is an infectious disease caused bypathogenic bacteria called leptospires.
Leptospires are bacteria which can be eitherpathogenic(i.e. having the potential to causedisease in animals and humans) or saprophytic(i.e. free living and generally considered not tocause disease).
Pathogenic leptospires are maintained in naturein the renal tubules of certain animals.
Saprophytic leptospires are found in many typesof wet or humid environments ranging from
surface waters and moist soil to tap water.Saprophytic halophilic (salt-loving) leptospires arefound in seawater.
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Transmitted directly or indirectly from animals to humans
a zoonosis.
The disease is found mainly wherever humans come into
contact with the urine of infected animals or a urine-
polluted environment.
Leptospirosis occurs worldwide but is most common in
tropical and subtropical area with high rainfall.
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History :
Adolf Weil described leptospirosis as a disease
entity in 1886. His name is still attached to aserious form of leptospirosis called Weil's disease
Morphology : Leptospires are corkscrew-shaped bacteria,
which differ from other spirochaetes by the
presence of end hooks.
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Klasifikasi ilmiah
Kerajaan: Bakteri
Filum: Spirochaetes
Kelas:
Spirochaeates
Ordo: Spirochaetales
Famili: Leptospiraceae
Genus: Leptospira
Serovar[2]
Leptospira interogans
Lepstospira australis
Leptospira autumnalis
Leptospira ballum Leptospira icterohemorrhagica
Leptospira canicola
Leptospira grippotyphosa
Leptospira pomona
http://id.wikipedia.org/wiki/Klasifikasi_ilmiahhttp://id.wikipedia.org/wiki/Bakterihttp://d/user/amy/BLOK%20GIT%201112/Leptospirosis.htmhttp://d/user/amy/BLOK%20GIT%201112/Leptospirosis.htmhttp://id.wikipedia.org/wiki/Bakterihttp://id.wikipedia.org/wiki/Klasifikasi_ilmiah8/21/2019 LEPTOSPIROSIS bahan kuliah
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Serovars having antigenic similarities are formed
into serogroups, and over 200 pathogenic
serovars divided into 25 serogroups have beendescribed.
It is of epidemiological importance. A certain
serovar may develop a commensal orcomparatively mild pathogenic relationship with a
certain animal host species. For instance, cattle
are often associated with serovar hardjo, dogs
with canicola and rats with icterohaemorrhagiae
and copenhageni
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Patophysiology:
A host that becomes infected by accident orincidentally with a serovar for which the animal is nota natural maintenance host is called an accidental orincidental host
After infection, leptospires appear in the bloodandinvade practically all tissues and organs. They are
subsequently cleared from the body by the host'simmune response to the infection.
However, they may settle in the onvoluted tubules ofthe kidneys and be shed in the urine for a period of a
few weeks to several months and occasionally evenlonger. They are then cleared from the kidneys andother organs but may persist in the eyes for muchlonger.
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Typically, the disease presents in four broad
clinical categories:
1. a mild, influenza-like illness;
2. Weil's syndrome characterized by jaundice,
renal failure, haemorrhage and myocarditis
with arrhythmias;
3. meningitis/meningoencephalitis;
4. pulmonary haemorrhage with respiratory
failure.
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AKI : Acute Kidney Injury
ATN : Acute Tubular Necrosis
AIN : Acute Interstitial Nephritis
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Clinical diagnosis is difficult because of the
varied and non-specific presentation.
Confusion with other diseases, e.g. dengueand other haemorrhagic fevers, is particularly
common in the tropics
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Leptospirosis may be underdiagnosed because:
the diagnosis is difficult to confirm
it may be confused with other diseases
the disease may be mild and not be
investigated in the laboratory
Important causes of death include renal failure,
cardiopulmonary failure, and widespread
haemorrhage.
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The incubation period is usually 514 days, with a
range of 230 days.
The virulence factors in leptospires are poorly
understood. Some serovars generally tend to cause
mild disease and others severe disease. However,
there are no serovar-specific presentations of
infection and any serovar may cause mild or severe
disease in different hosts. Patient factors such as old
age and multiple underlying medical problems areoften associated with more severe clinical illness and
increased mortality
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Laboratory support is needed
To confirm the diagnosis. Leptospirosis is
difficult to distinguish from a number of otherdiseases on clinical grounds.
Laboratory methods help to confirm
leptospirosis where the disease is suspectedon clinical grounds
The disease is usually diagnosed in the
laboratory by detecting antibodies(serodiagnosis) and by culturing the bacteria
from blood, urine or tissues
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Leptospires usually circulate in the blood of the
patient for about 10 days after the onset of the
disease. They also appear in other body fluids, suchas urine and cerebrospinal fluid, a few days after the
onset of disease and penetrate internal organs
during this time.
Detectable titres of antibodies appear in the bloodabout 510 days after the onset of disease, but
sometimes later, especially if antibiotic treatment is
instituted
The microscopic agglutination test (MAT) is
considered the "gold standard
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Leptospires grow in a variety of culture media
Their growth is relatively slow, with a doubling
time of about 68 hours at best. Optimal
temperatures for growth are 2830C.
A blood sample is usually examined.
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Treatment with effective antibiotics should be
initiated as soon as the diagnosis of leptospirosis
is suspected and preferably before the fifth day
after the onset of illnes
Severe cases of leptospirosis should be treated
with high doses of intravenous penicillin.
Less severe cases can be treated with oral
antibiotics such as amoxycillin, ampicillin,
doxycycline or erythromycin.
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