Leptospirosis Dr.T.V.

Rao MD

Leptospirosis - Zoonosis Leptospirosis is an acute anthropozoonotic infection of worldwide significance c aused by spirochaete Leptospira interrogans which has 23 serogroups and >200 ser ovars. Various factors influencing the animal activity, suitability of the envir onment for the survival of the organism and behavioral and occupational habits o f human beings can be the determinants of incidence and prevalence of the diseas e.

What is leptospirosis? Leptospirosis, also known as canicola fever, hemorrhagic jaundice, infectious ja undice, mud fever, spirochetal jaundice, swamp fever, swineherd's disease, caver 's flu or sewerman's flu, is a bacterial infection resulting from exposure to th e Leptospira interrogans bacterium. There is an acute form of human infection kn own as Weil's disease, where the patient suffers from jaundice, though this term is often (incorrectly) used to describe any case of infection..

Leptospirosis A Major Zoonotic Infection Weil's disease is comparatively rare, though 'mild' cases of leptospirosis happe n everywhere there are carriers, and it is believed that leptospirosis is one of the most common zoonotic infections in the world. Millions of people are infect ed each year, but information and treatment can be limited, especially in the de veloped world where cases are considered 'rare' by the medical community.

Animals spread Leptospirosis Rats, Mice, Wild Rodents, Dogs, Swine, Cattle are principle source of infection The above animals excrete Leptospira both in active infection and Asymptomatic s tage The Leptospira survive and remain viable for several weeks in stagnant wate r.

What causes Leptospirosis Leptospirosis is a bacterial disease that affects humans and animals. Leptospira bacteria are found worldwide and there are many different types or serovars cap able of causing disease. Disease caused by Leptospira bacteria is most common in temperate or tropical climates and appears to be rare in North America.

Scientific Beginning It was first described by Adolf Weil in 1886 when he reported an "acute infectio us disease with enlargement of spleen, jaundice and nephritis". Leptospira was f irst observed in 1907 from a post mortem renal tissue slice.[2]

Pathogenic strains x Non pathogenic Leptospirosis There are several species of Leptospira only few are pathogenic to Humans, rest to some Animals and Many in Nature as saprophytes Leptospira Interrogans is Path ogenic there are 200 serovars. Leptospira biflexa Non Pathogenic there are 60 se rovars Further classifications are made on shared antigens

Genomic based classification DNA DNA hybridization studies proved more specific The traditional serologic cla ssification has limitations at Molecular level, but useful at Epidemiological st udies.

Morphology The Leptospira appear tighly coiled thin flexible Spritochetes 5 15 microns long . Fine spiral of 0.1 0.2 microns One end appears bent forms a hook. Actively mot ile Seen best with dark field Microscopy.

Greater Understanding with Electron Microscopy Electron Microscopy show thin axial filament and a delicate membrane In dark fie ld it may appear as chain of miniature cocci.

Comparative Morphology of Spritochetes

Culturing of Leptospira Leptospira grwos best under aerobic conditions at 280 to 300c best demonostrated in Semisolid agar media Optimal Media Fletchers Media Stuarts Media Optimal gro wth after 1 2 weeks

Growth requirements Leptospira derive energy from oxidation of long chain fatty acids, and cannot us e or carbohydrates or amino acids as major energy source.

Antigenic structure All isolates of L.inttterogans from different parts of the world are serological ly related and exhibit cross reactions in serologic tests. Overlapping of Antige ns do occur in different species. Outer envelop contains large amount of Lipopol ysaccharides ( LPS ) Antigenic structure varies from one strain to other This va riation forms the basis of serologic classification

Genome of Leptospira L. interrogans serogroup Icterhaemorrhagiae consists of a 4.33 megabase large ch romosome and a 359 kilobase small chromosome, totaling 4,768 predicted genes. A series of genes have been discovered that could potentially be related to adhesi on. This genome differs from the two other pathogenic spirochaete (Treponema pal ladium and Borrelia burgdorferi), though some similar genes are visible (CHGC, 2 004).

Pathogenesis Leptospira are present in the water bodies Enter through breaks in the skin ( cu ts and abrasions ) and mucous membranes Enters through Mouth Nose Conjunctive Ra rely enters though ingestion. Incubation period 1 2 weeks When multiples blood s tream produces fever. May establish organ involvement in Kidney and Liver, May p roduce hemorrhage and necrosis in the tissues and initiates dysfunction of these organs

Sequence of Leptospira Infection

May present with Jaundice Hemorrhage Nitrogen retention The Illness is Biphasic with initial temp erature when the second phase comes with raise of IgM titers raise Aseptic meing itis initial headache, stiffness of neck, pleocytosis of Cerebro spinal fluid

Presenting with Jaundice is significant and Important, Serious Manifestation

May present with Major Complications Nephritis Hepatitis. Manifestations in eye Muscular lesions Many infections are mild and subclinical

Weils Syndrome Weil's syndrome is a severe form of leptospirosis that causes a continuous fever , stupor, and a reduction in the blood's ability to clot, which leads to bleedin g within tissues. Blood tests reveal anemia. By the third to sixth day, signs of kidney damage and liver injury appear. Kidney abnormalities may cause blood in the urine and painful urination. Liver injury tends to be mild and usually heals completely.

Hepatitis - Leptospirosis Hepatitis is the frequent complication Elevation of serum creatine phosphilipae enzyme raise differentiates from Viral hepatitis where the enxyme is not raised

Nephritis - Leptospirosis Kidney involvement in animals produce chronic disease of the kidney and the infe cted animal starts shedding large number of leptospira and main source of enviro nmental contamination of bacteria and results I human infections Human urine als o contain Spirochetes in the second and third week of infection

Early and Prompt Diagnosis is Highly Essential The development of simpler, rapid assays for diagnosis has been based largely on the recognition that early initiation of antibiotic therapy is important in acu te disease but also on the need for assays which can be used more widely.

Laboratory Diagnosis Specimens 1 Blood to be collected in a heparin tube 2 CSF, Tissues Microscopic examination 3 Urine to be collected with great care to avoid contamination 4 Serum for aggl utination tests

Culturing Leptospira Blood and Urine be cultured in Fletchers semisolid agar or other media chemically defined protein-free media for the growth of leptospires have been proposed. In order to obtain the desired rapid and abundant growth of organisms necessary fo r the efficient production of vaccines, it has been necessary to supplement such media with a source of

Serology Agglutinating antibodies raise to very high titers 1 : 10,000 or higher occurs 5 10 weeks after onset of infection

Serology - ELISA Several Immunoassays are available as commercial kits Detection of IgM and razin g titers of IgG will guide in association with clinical history will help in Dia gnosis

Treatment Antibiotic of choice is Benzyl Pencillin given by injection in doses of 5 mega u nits in a day, for 5 days. If the patients are genuinely hypertensive to Pencill in opted with Erythromycin 250mgs four times a day for a period of 5 days.

Treatment - Other alternatives The leptospirosis can be effectively treated with Doxycycline Ampicillin Amoxici llin Severe patients need administration Intravenous Pencillin or Amoxcillin

Epidemiology Leptospirosis causes several animal infections Most wide spread zoonotic infecti on in Nature Human infections are accidental associated with contamination of wa ter, other materials contaminated with excreta and animal flesh. Animal carriers often excrete upto 100million leptospirosis per ml of urine

Epidemiology Occupation Certain occupational groups such as agriculture workers in rice and cane fields, miners and sever cleaners are potential victims

How Man gets Infected Water the great source Drinking Swimming Bathing, as the urine of Rodents chroni cally infected contaminate water sources Children get infected when in contact w ith infected Dogs

Control of Leptospirosis Rodent control is most important. Humans should avoid contact with water contamin ated with animal contact.

Chemoprophylaxis Doxycycline 200 mg orally once a week is simple effective measure. When heavy ex posure is anticipated

Vaccination in humans Vaccination for humans is justified where they cannot be separated from animal s ources or where the animals cannot be immunized successfully Necessity of human vaccinated will arise where people live and work in proximity to rodents in wet, tropical conditions, in wet rice planting and harvesting, in military operation s, or working in sewers. Yet no universally accepted vaccine is available for hu mans

Vaccination of Animals Vaccinating animals have a dual purpose 1 Protecting animals 2 Protecting humans who may contract leptospirosis from them It is probably true as that immunizati on of animals will prevent leptospirosis in people in contact with them. It prov ed true in 1980 when extensive vaccination of dairy cows in New Zealand lead to marked decreased incidence in Humans. Animals immunized experimentally with poly saccharide derived from Leptospira LPS linked to diphtheria Toxoid were protecte d against challenges

New Vaccine trails - Leptospira

Created for Health awareness on Leptospirosis Dr.T.V.Rao MD Email doctortvrao@gmail.com