Professional Documents
Culture Documents
Dr. SARTONO Sp PD
Leptospirosis :
Emerging infectious disease global importance
Outbreaks in Asia , Central / South America & the USA
Caused by pathogenic leptospires
Characterized by broad spectrum of clinical manifestation , from
mild form ( influeza like illness , headache , myalgia ) to severe
leptospirosis ( jaundice , renal dysfunction & hemorrhagic
diathesis called Weils syndrome ).
Etiologic Agents :
Leptospires belonging to the order of SPIROCHAETALES and
family LEPTOSPIRACEAE
Current designation : L. interrogan sensu lato &
L. biflexa sensu lato
LEPTOSPIRES :
- coiled , thin , highly motile with hooked ends & two
periplasmic flagella ( permit burrowing into tissue )
- 6 20 m long & 0,1 m wide
- poorly stained , but can be seen by dark-field examination
and after silver impregnated staining
- Require special media/condition for growth ; takes weeks.
EPIDEMIOLOGY :
Leptospirosis important zoonosis , world wide distribution ,
affecting 160 mammalian species.
Reservoir :
- most important : rodents ( especially rats )
- other : wild mammals / domestic & farm animals
Establish a symbiotic relationship with host & can persist in
the renal tubules for years.
Some serovars associated with particular animals e.g.
- Icterohemorrhagiae & Copenhageni rats
- Grippotyphosa voles
- Hardjo cattle
- Canicola dogs
- Pomona pigs ; but may occur in other animals.
PATHOGENESIS :
incompletely undestood
leptospires enter the host via skin abrasions or via intact
mucous membrane ( conjunctiva & lining of oro &
nasopharynx )
drinking contaminated water may introduce leptospires
through the mouth , throat & esophagus leptospiremia
all organs.
Mainly infect the kidney & liver, any organ may be affected.
In the kidney , migrates to the interstitium , renal tubules , &
tubular lumen interstitial nephritis & tubular necrosis.
Hypovolemia ( due to dehydration ) or altered capillary
permeability contribution of renal failure.
In the liver : centrilobular necrosis + proliferation of Kupffer
cells , but severe hepatocellular necrosis is not a
feature of leptospirosis.
Pulmonary involvement : due to hemorrhage and not of
inflamation.
Skeletal muscles swelling , vacuolation of myofibrils & focal
necrosis.
Severe leptospirosis vasculitis impair microcirculation &
increase capillary permeability -> fluid leakage & hypovolemia
CLINICAL MANIFESTATION
ANICTERIC LEPTOSPIROSIS
- jaundice
- renal dysfunction
- hemorrhagic diathesis
- pulmonary involvement
Mortality rate : 5 15 %
In Europe its frequently associated with serovar Ictero hemorrhagiae & Copenhageni.
The onset is about the same with less severe leptospirosis ;
after 4-9 days , jaundice/renal/vascular dysfunction develop.
Defervescence may be noted after the 1st week of illness , but
biphasic disease pattern (like in anicteric leptosp.), is lacking.
The jaundice is usually not associated with severe hepatic
necrosis.
DIAGNOSIS
1st 10 days and from urine for several weeks beginning at first
week .
Cultures often become positive after 2-4 weeks, with a range
of 1 week to 6 months.
Urine cultures remains pos. for months or years.
For isolation of leptospires from body fluids or tissues , EMJH
(Ellinghausen-Mc Cullough-Johson-Harris) medium is useful;
Other medium are Fletcher or Korthof medium.
Specimens can be mailed to a reference lab. for culture
remain viable in anticoagulated blood (heparin,EDTA,citrate) ,
up to 11 days.
Isolation of leptospires is important , since dark-field exam.
results in misdiagnosis.
DIFFERENTIAL DIAGNOSIS :
Leptospirosis should be differentiated from other febrile
illnesses ( associated with headache & muscle pain ) :
- Dengue
- Viral Hepatitis
- Malaria
- Hantavirus infection
- Enteric Fever
- Rickettsial Disease
Therapy
Purpose of drug
Administration
Treatment
Mild leptospirosis
Moderate/severe
leptospirosis
Chemoprophylaxis
Regimen
Doxicyclin 100mg orally, bid or
Ampicillin, 500-750mg orally qid
or
Amoxicillin, 500mg orally qid
Penicillin G, 1.5 million U IV qid
or
Ampicillin, 1 g IV qid or
Amoxicillin , 1g IV qid or
Ceftriazon, 1 g IV once daily or
Cefotaxime, 1g qid or
Erythromycin, 500 mg IV qid
Doxycyclin, 200 mg orally/week
PROGNOSIS
- Most Px recover
- Mortality rates, highest in elderly & Weils syndrome ; also
in those with pregnancy
PREVENTION
- Those who may be exposed (through occupation or
recreational water activities ) should be informed about the
risk.
- Avoidance of exposure to urine & tissues from infected
animals.
- Vaccination of animals and
- Rodent control