MCU-MEDICINE BATCH 2018

PEDIATRICS

LEPTOSPIROSIS
Dr. Masigan Natural History

Epidemiology Animal Source – Exposure -Infection

 Rainfall, contaminated environment
 Poor sanitation; inadequate drainage facilities
 Presence of rodents, cattle and stray dogs
Overt Clinical Illness Inapparent
 Walking/working bare foot poses high risk
 Difficult to pinpoint the source of infection
 Any person can get infected if exposed to No carrier
contaminated environment
Anicteric Icteric
Risk Groups Dead End
A. Occupational Exposure Recovery Fatality
o Farmers – rice, sugarcane, vegetables, cattles,
pigs
o Sewerage workers, abbatoirs, butchers
o Veterinarians, laboratory staff, miners,
soldiers Pathogenesis of Severe Disease
o Fishermen in land (not on sea)
B. Recreational Activities
o Swimming, sailing, marathon runners, Leptospira Damage to small Vasculitis
gardening blood vesels

Reservoirs of Infection
1. Rodents – Rattusrattus, Rattusnorvegicus,
Musmusculus
Massive migration of fluid
2. Dogs
from Intravascular to Direct cytotoxic injuries,
3. Wild animals
4. Domesticated animals Interstitial compartment Immunological injury
5. Caged game animals
6. Leptospira are excreted in the urine
Renal dysfunction, Vascular
Modes of Transmission Injury to Internal Injury
1. Direct contact with urine or tissue of infected animals
through skin abrasions, intact mucus membrane
2. Indirect contact
a. Broken skin with infected soil, water or
vegetation
b. Ingestion of contaminated food and water
3. Droplet infection
a. Inhalation of droplets of infected urine

***Human infection is accidental! There is no human to human

transmission***

MD AlphaPi_13
 MCU-MEDICINE BATCH 2018
PEDIATRICS

 Incubation Period: 7-12 days o Nephrotoxicity: Endotoxin (direct)

 L. interrogans – pathogenic; with >200 serovars o Bacterial migration, toxic
 L. biflexa – non-pathogenic; with >60 serovars metabolites
 Rat is the principal source of human infection o Hypoperfusion: hypotension, fluid
 Dog is the major animal reservoir in the US loss/fluid shift
o GI Bleed, Myocarditis
Clinical Illness  Hemorrhagic fever – Vascular Injury
Types: o Respiratory, alimentary, renal and
1. Anicteric (common, 95% recovery) genital tracts
2. Icteric (Weil’s Syndrome) – rare data o More common in icteric and with
3. Hepatorenal Syndrome renal failure
4. Hemorrhagic syndrome with Acute Renal Failure o Reported in Korea, Andaman’s and
5. Atypical Pneumonia syndrome Brazil
6. Aseptic Meninog-encephalitis  Hemorrhagic Pneumonitis
7. Myocarditis, Chronic Uveitis o Hemoptysis/Respiratory failure
o Chest x-ray: single/multiple ill
Clinical Presentation defined opacities
1. Anicteric o Occurs in 2nd week (as early as 24-48
 90% of cases hours)
 Common, mild o Reported in Korea, Andaman’s and
 <2% mortality Nicaragua
 Leptospiremic Phase  Cardiac Manifestation
o Initial o Hemorrhagic myocarditis
o Fever, myalgia o Cardiomyopathy/Cardiac failure
o Severe headache o Arrhythmias, hypotension, death
o Conjunctival suffusion o Atrial fibrillation/conduction defects
o Abdominal pain, epistaxis  ECG Changes
 Subsequent Phase o Non-specific ST-T changes
o Subsequent o Low voltage complxes
o Mild fever o Reported in Sri Lanka, Barbados and
o Meningism Portugal
o Uveitis  Aseptic Meningo-Encephalitis
o Incubation Period: 5-14 days (21 o It is rare, it occurs in the immune
days) phase
2. Icteric Phase o CSF: increased protein and
 10% of cases lymphocytes
 Rare, severe o Convulsions, encephalitis, myelitis
 15% mortality and Polyneuropathy
 Liver  Ocular Manifestations
o Jaundice that occurs in 4 to 6 days o Late complication: conjuctival
(2-9days) suffusion/hemorrhage
o Serum Bilirubin markedly increased o Anterior uveitis, iritis, iridocyclitis,
(20-40md/dl) chorioretinitis
o SGOT/SGPT: mild elevation o Occurs in 2 weeks to 1 year (average
o Hepatocellular necrosis/Intra- of 6 months)
Hepatic Cholestasis
o Death: not due to liver disease
 Kidney – mild to severe
o Urinalysis:
hematuria/pyuria/proteinuria
o Renal Failure: Pre-renal azotemia,
ATN/AIN
o Oliguric/Non-oliguric
 Mechanism
2

MD AlphaPi_13
 MCU-MEDICINE BATCH 2018
PEDIATRICS

Jarisch-Hexheiner Reaction
 is a reaction to endotoxins released by the death of
harmful organisms within the body

Prognosis and Mortality

 FATALITY results from complications in
o Renal
o Cardiac
o Bleeding
o Pulmonary
o Meningitis

Prevention
 Prevention is difficult due to wild animal infection
 Good sanitation, immunization of live stock
 Personal hygiene, PPE, water treatment
Differential Diagnosis
1. Fever – viral fever, malaria, typhus  No useful human vaccines – due to multiple serovars
2. Jaundice – malaria, viral hepatitis, sepsis present
3. Renal failure – malaria, hanta virus, sepsis  Doxycycline 100mg weekly for those at risk
4. Meningitis – bacterial/viral causes
5. Hemorrhagic fever –dengue, hanta virus, typhus Post Exposure Prophylaxis in Children
1. Amoxicillin
Laboratory Tests 2. Azithromycin
1. TC/DC/ESR/Hb/Platelet Count
2. Serum Bilirubin/SGPT/SGOT So stick to the fight when you’re hardest hit;
3. Blood urea, creatinine and electrolytes It’s when things seem worst that you must not quit.
4. Chest x-ray, ECG
5. Tests for Diagnosis of Leptospirosis
a. Culture of leptospira (+)
b. MAT; Seroconversion or 4-fold rise/high titer
c. ELISA/MSAT (+)
i. MAT: microscopic agglutination test
ii. MSAT: microscopic slide
agglutination test

Treatment
1. Mild
 Start early
 Oral treatment 7 to 10 days
 Doxycycline 100mg bid
 Amoxicillin 500mg qid
 Ampicillin 500mg qid
 Supportive treatment
2. Severe
 Start invasive treatment
 IV treatment 5 to 7 days
 Benzyl penicillin 20L qid
 Ampicillin IG qid
 3rd generation Ceftriaxone IG od
 Cefotaxime IG tid

MD AlphaPi_13