Leptospirosis

Presented by:
Pauline Teo Siew Chin

13th May, 2009

OUTLINE
 Introduction
 Leptospira interrogans
 Transmission
 Clinical features
 Diagnosis
 Management
 Prevention
 Conclusion

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Leptospirosis
 A zoonotic disease
 Caused by Leptospira interrogans
 Geographically widespread
 Most common in tropical and subtropical
areas with high rainfall
 First detected in 1886 by Adolph Weil
 Synonyms: Rat fever, fish handler's
disease, mouse fever & rice field fever

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Leptospira interrogans
 Flexible, filamentous bacteria made up of
fine spirals with hook-shaped ends
 Gram -ve
 Spirochetes
 > 200 known serotypes
 Obligate aerobes
 Slow growing in culture
 Survives in a moist environment for
weeks-months
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Transmission
 Wild & domesticated animal hosts  Human
 Common reservoirs: rodents, dogs & farm
animals
 Human: incidental, “dead-end” hosts
 Contact with soil, water & feed contaminated by
urine or tissue of infected animals
 Occupational exposure
 Recreational activities
 Enter through broken skin or mucous membranes
or conjunctiva
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Adapted from http://www.pasteur.fr/
 Clinical Features
 Incubation period: 2 - 30 days
 Clinical presentations range from a self-
limited febrile illness to a severe illness
associated with multi-organ damage
 Mortality rate in severe cases: 10-15%

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Clinical Progression of Anicteric &
Icteric Leptospirosis
Icteric Leptospirosis
Anicteric Leptospirosis
( Weil’s Syndrome)

(pigmented
part of eye)

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Clinical Features (con’t)

petechial rash conjunctival suffusion

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Diagnosis

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Management
1. General
 Close temperature, BP, PR & RR
monitoring, I/O chart
 Adequate hydration, keep temp <38oC

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 Management (con’t)
2. Antibiotics
 Most effective if initiated within 1 week of disease onset
 Mild:
 treated as out-patient
 given oral antibiotics
Drugs Adult Dose Children Dose
2 mg/kg/day in 2 equally
Doxycycline 100mg bd
divided doses

Amoxycillin 1g qid 10 – 25 mg/kg tds

Ampicillin 1g qid 10 – 25mg/kg qid

Erythromycin 250 - 500 mg qid 10 - 25 mg/kg qid

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 Management (con’t)
2. Antibiotics (con’t)
 Severe:
 intravenous antibiotics

Drugs Adult Dose Children Dose

Benzylpenicillin 250,000-400,000 units/kg/day in 4-6
1.5mU qid
(Penicillin G) divided doses
Ampicillin 500 mg – 1 g qid 10 – 25 mg/kg qid
Amoxycillin 500 mg – 1 g tds 10 – 25 mg/kg tds
Ceftriaxone 1 g od 80-100 mg/kg OD
150-200 mg/kg/day in 3-4 equally
Cefotaxime 1 g qid
 Duration: 1 week divided doses
 A Jarisch-Herxheimer reaction can occasionally be triggered by penicillin therapy
20 - 50 mg/kg/day in 3 - 4 divided
Erythromycin 250mg qid
doses

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Management (con’t)
3. Supportive
 ICU care in severe cases
 Fluid & electrolyte therapy
 Dialysis support for renal failure
 Ventilatory support for respiratory failure

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Prevention
 Vaccination of domestic mammals
 Avoid contact with potentially infected
animals and contaminated water & soil
 Protective clothing, boots & gloves
 Effective rat control
 Antimicrobial prevention

 doxycycline 200mg/week

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Conclusion
 Leptospirosis or rat fever is caused by
Leptospira interrogans which is found in rodents,
dogs, farm animals & wild mammals
 Transmit through exposure to infected urine or
contaminated water, soil or mud
 Various antibacterial medications are useful in
treatment of leptospirosis

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 REFERENCES
Aberg JA, Goldman MP, Gray LD & Long JK 2006. Infectious Disease Handbook
(6th edition). Lexi-Comp, Inc
Antony SJ. Leptospirosis- An emerging pathogen in travel medicine: A review of its
clinical mainifestations and management. J Travel Med 1996;3:113-118
Howell D & Cole D. Leptospirosis: A waterborne zoonotic disease of global
importance. Georgia Epidermiology Report August 2006;22(08)
Khairani-Bejo S, Norhamizah AR, Bahaman AR & Kadir AA 2006. Determination of
susceptibility of Malaysian Leptospira isolate to antimicrobial agents. Journal
of Animal and Veterinary 2006;5(2):111-113
MacAllister C. Leptospirosis. Oklahoma Cooperative Extension Service.
McBride AJA, Athanazio DA, Reis MG & Ko Al 2005. Leptospirosis. Current
Opinion in Infectious Diseases 2005;18:376-386
Pappas G & Cascio A. Optimal treatment of leptospirosis: queries and projections.
International Journal of Antimicrobial Agents 2006;28:491-496
Saunders J 1979. Clinical features and management of leptospirosis in Malaysia.
Malaysian J Pathol 1979;2:7-9
Soo HH, Lau LG & Chew PH 2005. Sarawak Handbook of Medical Emergencies
(2nd edition). C.E. Publishing
2007 UpToDate® Database
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THANK YOU!

13th May, 2009