Leptospirosis

Leptospirosis is a zoonosis that occurs in many parts of the world but most frequently in
tropical and subtropical regions. Most cases are mild or asymptomatic but the most severe
illness, often referred to as Weils disease, characterized by a severe febrile illness with
bleeding, jaundice and renal failure, may be associated with death through renal failure or
pulmonary haemorrhage.
It is known by many different local names (e.g. mud, swamp, sugar cane, Fort Bragg and
Japanese autumnal fevers).
Overall, the major maintenance hosts are rodents and the organism is passed in their urine for
long periods of time, even for the lifetime of the animal. Leptospires can survive for up to a
few weeks in fresh water depending on the pH, but they remain viable for a much shorter
period in brackish water. Humans are infected through direct or indirect contact with the
urine of infected animals.
ETIOLOGY
The organism
The causative agents belong to the genus Leptospira, fine spiral bacteria of 0.1 m in
diameter and 620 m in length. Under dark ground microscopy, the organism appears
straight with one or both ends hooked (Figure 70.1). Spinning motility around their long axis
may disguise the spiral nature of the organisms.

Classification
The family of Leptospiraceae has been subdivided into three genera the Leptospira,
Leptonema and Turneria (previously Leptospira parva). The genus Leptospira comprises two
species: L. Interrogans (pathogenic) and L. biflexa (saprophytic).
The species L. interrogans is divided into serogroups (e.g. canicola) and then into many
serovars, and strains are identified by cross-agglutination absorption with known strains
using homologous antisera raised in rabbits.
L. interrogans comprises the parasitic and pathogenic strains that can cause disease in
humans and animals, whereas L. bifl exa includes those that are considered non-pathogenic.
The species L. interrogans can be divided into more than 200 recognized serovars.

Free-living saprophytic strains (L. bifl exa) do not cause disease in humans but their presence
in the environment indicates that conditions exist under which strains pathogenic to humans
can survive. L. bifl exa strains are not pathogenic to hamsters and grow at 13C and in the
presence of 8-azaguanine, both of which are inhibitory to L. interrogans.
EPIDEMIOLOGY
Rural seroprevalence surveys in some developing countries indicate 1520% of the
population has been exposed. There are wide differences in seroprevalence, mainly according
to climatic factors (ranging from 0.7% in a desert shantytown to 28% in a similar area which
tended to flood). The annual incidence of leptospirosis in an endemic area of leptospirosis in
Sao Paulo, Brazil was 0.53 per 100 000 of the population calculated over almost 30 years and
predominantly involved male adults in the working age group 2039 years. In Vietnam, by
the age of 7 years, the prevalence is 11% (M : F 1.5 : 1.0) with a calculated acquisition rate of
1.5% p.a. The mortality ranges from 514% in diagnosed cases and is commoner in the older
population.
Occupations associated with leptospirosis include mining, farming, animal slaughter,
veterinary medicine, fish farming and processing, sewage and canal work, sugar cane
harvesting and trench warfare. Leptospirosis is known by many different local names
describing the likely source, location, season or occupational associations (e.g. mud, swamp,
Fort Bragg, Japanese autumnal fevers, cattle-associated leptospirosis). More recently, the
disease has been described in those taking part in recreational water sports, such as canoeing,
white-water rafting, swimming in canals or windsurfing. Military recruits involved in jungle
training and those taking safari holidays in tropical areas are at risk of infection. Major
sports events may be involved and disease may be more severe in those who take exercise
during the prodrome.
The sources of leptospirosis in Denmark (118 cases between 1970 and 1996) were
occupational (63%), travel (8%), exposure to sewers (7%) and recreational activities (4%).
Domestic animals such as dogs may be infected. Although human infection with L. canicola
is most often contracted from dogs, the latter are more likely to develop overt disease from
infection caused by L. icterohaemorrhagiae.
The incidence of leptospirosis in Indonesia is very high. Indonesia ranks third in the world for
mortality due to leptospirosis according to International Leptospirosis Society (ILS).
The infection is spread in many areas of Sumatra, Java, Sulawesi, Kalimantan, Nusa
Tenggara Barat with incidence increases with flooding. The person prone to infection are
farmers, ranchers, miners, abattoir workers, loggers, and veterinarians.
The number of human cases worldwide is not known precisely. According to
currently available reports, incidences range from approximately 0.11 per 100
000 per year in temperate climates to 10100 per 100 000 in the humid tropics.
During outbreaks and in high-exposure risk groups, disease incidence may reach
over 100 per 100000. (WHO,2003)

Reference:
- Manson`s Tropical Diseases
- Kapita Selekta Kedokteran edisi 4 vol 2

WHO. 2003. HUMAN LEPTOSPIROSIS:

SURVEILLANCE AND CONTROL.

GUIDANCE

FOR

DIAGNOSIS,