LEPTOSPIROSIS

Dr.Gireesh Kumar.K.P Dept of Internal Medicine AIMS Cochin

Organism
Lepto = Thin , Spira = coiled Most common zoonotic disease Favoured by tropical climate and flooding during monsoon Leptospira interrogans, it is a spirochete, a tightly coiled, thread like organism which is actively motile

Spread
Reservoir Rodents (Common rats) are main reservoirs Lepptospira lives in convoluted tubule of kidney with out causing disease and get excreted in urine for many years

Spread
It can survive in water for months Direct contact with urine (water containing urine), blood or tissue of an infected animal

It can also spread by mucous membrane , conjunctiva or inhalation

Clinical Features
Incubation period 1-2 weeks More than 90% of symptomatic patients have a relatively mild disease Anicteric form / Leptospiremic phase Immune phase Antibody mediated phase

Anicteric form / Leptospiremic phase

Fever, chills, cough,pharyngitis Severe headache, Nausea, vomiting, abdominal pain Myalgia and muscle tenderness(calf & lumbar areas), Photophobia, cough, chest pain, Conjunctival suffusion without purulent discharge

Immune phase Antibody mediated phase

Most of the clinical features are due to Vasculitis damage of the walls of small vessels. It will lead to leakage and extravasation of cells including hemorrhages Jaundice , Renal failure, Cardiac arrhythmias, Pulmonary symptoms / (ARDS) Adenopathy , Hepatosplenomegaly

Immune phase -Aseptic meningitis

Aseptic meningitis - 80% Many patients in this phase will develop CSF abnormality (increased WBC in CSF). < 15% of cases may develop features of meningitis Headache with or without delirium

Severe leptospirosis (Weils Syndrome)

Jaundice, Hepatomegaly, hepatic tenderness, Liver failure, Splenomegaly (20%) Renal failure, mainly seen in second week of disease Pulmonary hemorrhage, ARDS Pericarditis, Myocarditis, Congestive Cardiac Failure, Shock, Rhabdomyolysis, hemolysis Weils Syndrome mainly occurs due to infection by serovar leptospira ictero hemorrhagica / copenhageni

Risk of death
Age > 40years Altered mental status Acute renal failure Hypotension Respiratory failure Cardiac arrhythmias

Investigations
CBC Neutrophil leucocytosis, thrombocytopenia(50%) Serum creatinine(ATN) LFT Creatinine kinase Urine Albumin, RBC and casts CXR ARDS, Pulmonary hemorrhage

CXR

Diagnosis
Urine dark field microscopy of fresh urine sample demonstrate live spirochetes PCR can detect leptospiral DNA in early phase itself Leptospira IgM ELISA may be positive by the end of first week

Treatment
Doxycycline 100 mg BD in mild diseases for 7 days IV Penicillin G 1.5 million units QID for 7 days Amoxycillin Erythromycin Ceftriaxone

Prophylaxis
Doxy 200 mg /week