Introduction to

Leptospirosis
Managing
infectious hazards

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 Learning objectives

▪ describe the signs, symptoms and

treatment of the disease
▪ identify key preventive actions
▪ describe the main challenges in
prevention and control.

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 The disease

▪ cause by bacteria belonging to the

genus Leptospira. The bactaeria can be
hosted in animal’s kidneys for
months/years
▪ environment contaminated by urine
(weeks/months)
▪ transmission to humans by contact with
infected animals or contaminated water
▪ entry point: skin abrasions, mucous
membranes, inhalation of droplets of
urine, drinking water.

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 Risk factors

▪ close and repeated contacts with rodents and

domestic animals
▪ contact with contaminated waters
▪ poor living conditions
▪ climate (humidity, heat)

▪ occupational disease
▪ recreational disease
▪ disease of poverty, humanitarian crisis & natural
disasters: Endemic / Epidemic.

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 Signs and symptoms

Incubation: 5-14 days

Asymptomatic forms
4 Categories:
▪ mild, influenza-like illness
▪ Weil’s syndrome (jaundice, renal
failure, hemorrhage, myocarditis)
▪ meningitis Global Morbidity and Mortality of Leptospirosis: A Systematic Review
Costa F. et al. PLoS Negl Trop Dis. 2015 Sep 17;9(9)

▪ pulmonary hemorrhage ±
respiratory failure. Note: Varied and non specific
presentations (dengue,
Case fatality rate: 5 to 30% yellow fever, malaria….)

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 Differential diagnosis

In Africa, especially in epidemic context:

▪ mild forms: malaria, dengue, and flu

▪ icteric fever: yellow fever

▪ febrile hemorrhagic forms: viral hemorrhagic fevers

▪ severe pneumonia: plague

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 Diagnosis

▪ complexity of the pathogen

▪ 300 species, saprophyte or pathogenic
▪ 25 serogroups divided into 250 serovars
▪ gold standards
▪ isolation by culturing but is too slow
▪ microscopic agglutination test (MAT)
▪ ELISA IgM:
▪ interpretation in endemic areas ?
▪ IgM can persist several months
▪ rapid diagnostic test (detecting antibodies):
▪ relatively low and variable diagnostic
accuracy
Current recommendation: ▪ to be locally evaluated
Serology + PCR ▪ PCR: 4-7 days after onset of disease
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 Treatment

As early as possible

▪ with common antibiotics but efficacy

dependent on early treatment
(within the first 5 days)
▪ amoxycillin, ampicillin, doxycycline..
▪ severe forms: penicillin IV &
aggressive supportive care.

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 Prevention and control

Improving living conditions

▪ Control of infection sources:

▪ rodents
▪ used waters
▪ immunization of livestock.

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 Prevention and control

Individual protection

▪ no human vaccine
▪ chemoprophylaxis (doxycycline) for
limited but high risk of exposure
▪ protect water supply from
contamination
▪ limit direct contacts with animal urine
and potentially infected environment.

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 Prevention and control

Epidemic situation
▪ provide empiric treatment of all probable cases
▪ provide population with treated water
▪ targeted chemoprophylaxis and protective
equipment to very high risk population (disaster
relief workers, sewage and sanitation workers…)
▪ rodent control and animal immunization are
useless at this stage
▪ no evidence that a mass chemoprophylaxis
impacts the course of an outbreak.

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 Key concerns

▪ complex pathogen agent and natural

history
▪ challenging clinical diagnosis and
difficult to make laboratory diagnosis

▪ Can mimic several epidemic

diseases of international importance
▪ high proportion of severe cases in
epidemic situation

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 Public Health

A global emerging public

health problem
1 million cases / 60,000 deaths
Misdiagnosed and under reported
Expected incidence rise, especially in Africa
▪ improvement of diagnosis and surveillance
capacity
▪ rapid urbanization
▪ mining activities
▪ impact of climate change

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 Global Leptospirosis Environmental Action Network
(GLEAN) project
To reduce the impact that leptospirosis outbreaks have on communities
through providing cost-effective, implementable and sustainable solutions

Reducing the impact Increasing the

Early warning
of leptospirosis systems and knowledge of the
outbreaks through Improved prevention relationship between
cost-effective, and control environmental, biological,
implementable and strategies ecological, economic,
sustainable solutions demographic factors

GLEAN: An international Community of Practice

Medical Clinicians, Public health specialists, Veterinarians, Climatologists, Statisticians,
Rodent specialists, Biologists, Anthropologists, Ecologists, Water and Sanitation
Specialists, Economists...
https://sites.google.com/site/gleanlepto/

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 Key contact

▪ Dr. Eric Bertherat

Emerging and re-emerging pathogens
Infectious Hazard management
Health Emergency programme
WHO Geneva
bertherate@who.int

Photo credits: WHO/TDR /A. Craggs; WHO/A. Bhatiasevi; WHO/T. Pietrasik; WHO/F. Thompson; WHO/A. Kari

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