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LEPTOSPIROSIS
Submitted by:
IGNACIO, Dianne Grace C.Group 3, BSN 4 – Barcelo
Submitted to:
Ms. Yolanda Borda, RNClinical Instructor
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OVERVIEW: Leptospirosis*DEFINITION
Leptospirosis is a complex bacterial disease that affects both humans and animals. It is caused byspiral shaped bacteria called spirochetes of the genus Leptospira. Two types of leptospirosis
present: Anicteric leptospirosis and Icteric leptospirosis. People get leptospirosis when brokenskin or mucous membranes (eyes, nose, mouth) comes in contact to either infected animal urine
or water, soil, or vegetation contaminated with such urine.
The bacteria survive best in warm water — 72°F (22°C) — that is fairly stagnant. Most reportedcases have occurred from swimming, wading, or splashing in pools, streams, or puddles
contaminated with infected dog or rat urine. The animals most commonly infected are rats, dogs,
swine, and raccoons. Leptospirosis occurs worldwide and is more common in the tropics. Most
cases occur in the summer.
Leptospirosis has two phases: The first phase starts suddenly with headaches, severe musclepains in the calves and thighs, chills, and fever, and lasts 6 to 15 days. The second phase starts afew days after your temperature has returned to normal. Fever will return, and you may getmeningitis because the bacteria will have spread to the lining of the spinal cord, causing
headaches and a stiff neck. Other serious symptoms include jaundice, mental confusion,
depression, or decreased urine output. The second phase lasts another seven to ten days.
*RISK FACTORS
Leptospirosis is a zoonosis of worldwide distribution. Leptospirosis infects many species of wild
and domestic animals that have been isolated from birds, fish and reptiles. The infected animalsexcrete spirochetes in urine for an extended period of time. The majority of human cases worldwide result from occupational exposure to rat contaminated water or soil. At risk are people who
work with animals, on farms, in rice paddies or sugar cane fields, or in sewers are most at risk.
Seventy-five percent of victims are male, from teenagers to young adults.
Water activity in endemic areas (Hawaii, Malaysia)
Fresh-water related activities such as farming or gardening, hiking across streams andswimming
*PATHOPHYSIOLOGY
Leptospires enter the host through abrasions in skin, or through mucus membrane, conjunctivaand nasal mucosa. Followingthe penetration, leptospirosis gain rapid access and circulate in the
blood stream through the lymphatics, resulting in leptospiremia and spread to all organs of the
body. The primary lesion causes damage to the endothelial lining of small blood vessels whichresults in ischemic damage to the liver, kidney, meninges and muscles.
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During acute infection, leptospires multiply in the small blood vessel endothelium, resulting in
damage and vasculitis. The major clinical manifestations of the disease are believed to besecondary to this mechanism, which can affect nearly any organ system.
In the kidneys, interstitial nephritis, tubular necrosis, and impaired capillary permeability,
as well as the associated hypovolemia, result in renal failure.
Liver involvement is marked by centrilobular necrosis and Kupffer cell proliferation,with hepatocellular dysfunction.
Pulmonary involvement is secondary to alveolar and interstitial vascular damage
resulting in hemorrhage. This complication is considered to be the major cause of leptospirosis-associated death.
The skin is affected by epithelial vascular insult.
Skeletal muscle involvement is secondary to edema, myofibril vacuolization, and vesseldamage.
The damage to the vascular system as a whole can result in capillary leakage,
hypovolemia, and shock. Many patients with leptospirosis may develop disseminated
intravascular coagulation (DIC), hemolytic uremic syndrome (HUS), thrombotic
thrombocytopenic purpura (TTP), and vasculitis. Thrombocytopenia indicates severedisease and should raise suspicion for a risk of bleeding.
After an incubation period of 6-15 days, an initial septicemic phase, leptospires can be isolated
from the blood; cerebrospinal fluid and other tissues. Initial symptoms: last for 2-7 days and a
second symptomatic or immune phase begins. The immune phase is associated with theappearance of circulating antibodies, despite the presence of these antibodies still leptospires can
be found in kidney and urine.
*CLINICAL MANIFESTATIONS
The course of the disease is a 6-15 days asymptomatic incubation period followed by roughly a
7-day period of flue-like symptoms where the patient is febrile and experiences chills, severeheadache, chills, muscle aches, and vomiting, and may include jaundice (yellow skin and eyes),
red eyes, abdominal pain, diarrhea, or a rash. If the disease is not treated, the patient could
develop kidney damage, meningitis (inflammation of the membrane around the brain and spinalcord), liver failure, and respiratory distress. There is a brief asymptomatic period as the first
phase resolves, and then the second, more dangerous phase commences. During this phase, the
disease mounts an attack on vascular linings, liver, generates a high fever, and can complicateinto meningitis.
Anicteric Leptospirosis (90% of cases)
Phase 1: Initial septicemic phase (lasts 3-7 days)
Headache
High fever
Myalgia
Conjunctivitis
Maculopapular rash
Hepatomegaly
Splenomegaly
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Phase 2 (follows brief improvement from phase 1)
Meningitis
Uveitis
Chorioretinitis
Icteric Leptospirosis (Weil's Syndrome, 10% of cases)
Much more severe than anicteric form Fever
Jaundice
Azotemia
Hypotension
Hemorrhagic Vasculitis
*LABORATORY AND DIAGNOSTIC TESTS
Samples of blood, urine, or fluid from around the spinal cord will grow bacteria on special
culture plates. The blood can also be sent to state laboratories for antibody testing.
Some people with leptospirosis have no symptoms at all, others have a mild illness, and still
others have a severe illness with meningitis and liver failure. It depends upon what type of
leptospire infects you.
Culture (Growth may require 16 weeks)
Blood Culture
Urine Culture
Cerebrospinal Fluid Culture
*NURSING MANAGEMENT
Monitor vital signs
Monitor fluid intake and output strictly Advise patient to rest
Treat the fever with acetaminophen (antipyretic) as prescribed
Inform the doctor if the following signs and symptoms occur:
Headache
Stiff neck
Changes in amount or color of urine
Jaundice Nausea
Bruising or hemorrhage
Rashes
Dyspnea
Oliguria Change in consciousness
Advise client to avoid swimming or wading in warm waters that may be contaminated by
animal urine (such as dog or rats)
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Daily weight and abdominal girth should be taken for the patients with ascites
Severely ill patients should be nursed in propped-up position to lessen the risk of secondary pulmonary complications.
Patients with vomiting should be managed by I/V fluids and electrolyte replacement.
*NURSING DIAGNOSIS
Impaired nutritional needs related to anorexia
Give small, frequent mealsAssess eating patterns
Give warm meal
Measure patients body weight dailyHyperthermia related to increased metabolic diseases
Give warm compress, avoid alcohol use
Instruct patient to drink plenty of fluids
Administer antipyretic as ordered
Knowledge DeficitActivity Intolerance
Risk for fluid volume imbalance
*MEDICAL MANAGEMENT
Leptospira are sensitive to Penicillin given through IV; Tetracycline and Erythromycin, and
Doxycycline given by mouth for 5 to 7 days
Treatment within first few days of illness may reduce the severity of disease but has littleeffect if started later on.
These antibiotics are usually given for 10 days.
Symptomatic and supportive care is initiated particularly for renal and hepatic failure.
*COMPLICATIONS
Weil’s syndrome is a severe form of leptospirosis that affects the liver and kidneys, causing jaundice, decreased urine (Oliguria), azotemia, jugular vein distention, orthostatic hypotension,
change in consciousness, fever, internal bleeding (GI bleeding), and anemia due to hemolysis,and thrombocytopenia.
*PREVENTION Avoid the use of contaminated water and soil,
Use rodent control measures.
Immunization of dogs and other domestic animals and birds.
Good environmental sanitation
Immunization/antimicrobial prophylaxis with doxycycline.may be,of value to certain
high risk occupational groups
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