LEPTOSPIROSIS

GROUP 4 -
DDM 4B

BUENVENIDA, AIRA BURLA, LEANNE DELOS REYES, DEMAULO, STACEY

JANASEA RICHELLE MARIE

JAMELA, ERICCA JISON, FRANCES RIVERA, UZIEL SAMONTE, MORIENE

PAULINE JIANNE
 ESENTATION OUTLIN
PR E
ETIOLOGY DIAGNOSTICS/LABS

CLINICAL TREATMENT
PRESENTATION
 ESENTATION OUTLIN
PR E
PROGNOSIS DENTAL
CORRELATIONS

PREVENTIVE
MEASURES
LEPTOSPIROSIS
"WEIL DISEASE"
ETIOLOGY
Spirochete bacterium Leptospira
(Leptospira interrogans)

Most common Zoonotic Infection, or

Zoonotic disease.

Leptospirosis is a disease of rural areas,

but now even severe cases have
reported in urban areas
 ETIOLOGY
Leptospires belong to phylum spirochetes.
They are of two types: Saprophytes (non-
pathogenic) and Pathogenic leptospires.

The natural host for leptospires are

mammals, and they live in the proximal
renal tubes of the host’s kidney . When
these hosts urinate, then they are excreted
out along with urine and can survive up to
several months depending upon the
environmental condition
 ETIOLOGY
More than 160 species of
animals found to carry the
disease show no
signs/symptoms if infected.
They can be vectors of disease
for several months after
inoculation, sometimes never
showing any signs/symptoms
of infection.
 ETIOLOGY
Humans, acquire leptospirosis from other animals like
rats, pigs, dogs, and cattle. It is most often spread
through exposure to the urine of infected animals.
In humans, this can happen due to direct contact or
from contact with soil or water contaminated by the
urine.
The bacteria can enter the body through open wounds
or mucous membranes, like the eyes or mouth. It then
enters the bloodstream and spreads throughout the
body. Sometimes, leptospirosis causes mild flu-like
symptoms or no symptoms at all. But it can also lead to
serious complications, such as meningitis, and it can be
fatal.
 ETIOLOGY
IT DEVELOPS WHEN YOU COME
INTO CONTACT WITH:
Infected Animals
Direct or indirect contact
with contaminated animal
tissues, organs, or urine
Contaminated water getting
in your eyes, nose, mouth, or
broken skin
 CLINICAL
PRESENTATION
CLINICAL PRESENTATION
Incubation period: 2 to 30 days
Symptoms of leptospirosis began within
5 to 14 days
There are cases where symptoms do not
appear.
Clinical manifestations: leptospirosis
range from mild to severe, and may cause
potentially fatal conditions such as Weil’s
syndrome and the emerging Severe
Pulmonary Haemorrhagic Syndrome
(SPHS).
CLINICAL PRESENTATION
Generally, leptospirosis is an acute biphasic illness:

First phase (Acute stage)

It is also called as Septicemia
4- 9 days duration
Symptoms associated with this stage are:
- High fever - Headache
- Myalgia - Nausea and Vomiting
- Diarrhea - Chills
- Cough - Skin rashes
- Abdominal pain - Redness of eye
CLINICAL PRESENTATION
Second phase ( Immune Stage)
Fatal if not treated, recovery may take several months
Major Symptoms associated with this stage are:
- Kidney failure
- Liver failure
- Meningitis
- Respiratory distress

Many of the symptoms can be mistaken for other

diseases therefore it is better to consult a doctor.
DIAGNOSTIC/
LABS
 DIAGNOSTICS/LABS
When leptospirosis is suspected, they notify the microbiology
laboratory prior to sending samples, so specialized techniques can be
used. The following lab tests:

Blood samples for polymerase chain reaction (PCR) and

serology (immunoglobulin [IgM and IgG]). Leptospire culture
was also used. Then follow-up serology 7 to 14 days after the
initial serologic test.
Urine samples for PCR (and leptospire culture if available). These
are particularly valuable beyond one week after the onset of
symptoms.
Cerebrospinal fluid (CSF) for PCR (for patients with meningitis).
 DIAGNOSTICS/LABS
PCR tests can be performed on multiple types of samples:

Blood – During the first four to six days of symptoms,

leptospires are often detected by PCR in the blood.
Erythrocyte Sedimentation Rate is elevated,
WBC counts range from below normal to moderately
elevated.
Urine – The organism may be intermittently identified by
PCR in the urine during the first week of illness but is more
reliably present after one week of illness.
Urine Analysis demonstrates proteinuria, pyuria,
microscopic haematuria, hyaline and granular casts.
 DIAGNOSTICS/LABS
PCR tests can be performed on multiple types of samples:

CSF – In patients with meningitis, PCR is often negative in

the CSF, presumably because most cases of meningitis are
due to immune-mediated mechanisms as opposed to
ongoing active infection.
Lumbar Puncture reveals an elevated CSF pressure,
predominance of lymphocytes and polymorphs.
Tissue – Although biopsy is rarely performed, PCR can be
performed on tissue. From deceased patients, CDC suggests
PCR testing of fresh frozen kidney (preferred) or liver
samples.
 DIAGNOSTICS/LABS
Different methodologies to perform serologic tests:

Microscopic agglutination test (MAT) – The MAT is the historical

reference standard for leptospirosis. The test requires live organisms,
considerable expertise, and is performed only by reference
laboratories.
Culture – Although leptospirosis can be confirmed by culture of
blood, urine, or CSF, the sensitivity of culture is suboptimal. Isolation
of the organism is successful in 5 to 50 percent of cases and may take
several weeks.
Liver Functions Tests - show an elevation in aminotransferases,
bilirubin and alkaline phosphatase, hyperbilirubinaemia is out of
proportion to jaundice in cases of icteric leptospirosis.
 DIAGNOSTICS/LABS
Other tests that are used less frequently that can be used to make a
diagnosis:
Antigen detection – Antigen detection in blood using a monoclonal
anti-LipL32 antibody-based antigen capture ELISA has been
developed and validated against PCR. This test is not widely available
but may provide a cost-effective alternative to PCR for diagnosis of
early infection.
Blood smears – Darkfield microscopic examination of a peripheral
blood smear may sometimes reveal spirochetes during the first few
days of infection. It also shows peripheral leukocytosis with shift to left
and thrombocytopenia.
Renal Function Tests - are usually impaired as indicated by raised
plasma creatinine.
TREATMENT


MILD MILD
LEPTOSPIROSIS LEPTOSPIROSIS
(ADULT) (CHILDREN)

DOXYCYCLINE
DOXYCYCLINE
2 mg/kg per day in two equally
100 mg orally twice daily
divided doses not to exceed
for 7 days
200 mg daily] for 7 days

AZITHROMYCIN
AZITHROMYCIN
500 mg orally once
10 mg/kg orally on day 1
daily for three days [maximum dose 500
mg/day]followed by 5 mg/kg/day
orally once daily on subsequent
days [maximum dose 250
mg/day]
TREATMENT

MILD LEPTOSPIROSIS (PREGNANT WOMEN)

AMOXICILLIN 25 to 50 mg/kg in three equally divided doses [maximum

500 mg/dose] for 7 days

AZITHROMYCIN
500 mg orally once daily for three days
TREATMENT
SEVERE LEPTOSPIROSIS (ADULT)

PENICILLIN 1.5 million units IV every 6 hours

100 mg IV twice daily

DOXYCYCLINE

CEFTRIAXONE 1 to 2 g IV once daily

CEFOTAXIME 1 g IV every six hours

*The duration of treatment in severe disease is usually 7 days

TREATMENT
SEVERE LEPTOSPIROSIS (CHILDREN)

250,000 to 400,000 units/kg IV per

day in four to six divided doses

PENICILLIN
[maximum dose 6 to 12 million units
daily]

4 mg/kg IV per day in two equally

DOXYCYCLINE
divided doses [maximum dose 200
mg/day]
TREATMENT
SEVERE LEPTOSPIROSIS (CHILDREN)

80 to 100 mg/kg IV once daily

CEFTRIAXONE
[maximum dose 2 g daily]

100 to 150 mg/kg IV per day in three to

CEFOTAXIME
four equallydivided doses

10 mg/kg IV on day 1 [maximum dose 500
AZITHROMYCIN mg/day], followed by 5 mg/kg/day IV once daily
on subsequent days [maximum dose 250mg/day]

*The duration of treatment in severe disease is usually 7 days

TREATMENT

SEVERE LEPTOSPIROSIS (PREGNANT WOMEN)

PENICILLIN CEFOTAXIME DOXYCYCLINE

CEFTRIAXONE AZITHROMYCIN  
 TREATMENT AND CHEMOPROPHYLAXIS OF LEPTOSPIROSIS IN ADULTS

INDICATION REGIMEN

TREATMENT

Doxycycline (100 mg PO bid) or

MILD LEPSTOSPIROSIS Amoxicillin (500 mg PO tid) or
Ampicillin (500 mg PO tid)

Penicillin (1.5 million units IV or IM q6h) or

Ceftriaxone (2 g/d IV) or
MODERATE/SEVERE LEPTOSPIROSIS Cefotaxime (1 g IV q6h) or
Doxycycline (loading dose of 200 mg IV, then 100 mg
IV q12h)

CHEMOPROPHYLAXIS

 
Doxycycline (200 mg PO once a week) or
Azithromycin (250 mg PO once or twice a week)
TREATMENT
All regimens are given for 7 days.

Doxycycline should not be given to pregnant women or children.

The efficacy of doxycycline prophylaxis in endemic or epidemic

settings remains unclear.

Experiments in animal models and a cost-effectiveness model

indicate that azithromycin has a number of characteristics that

may make it efficacious in treatment and prophylaxis.

PROGNOSIS
PROGNOSIS
The prognosis of leptospirosis depends on the
severity of the disease and the associated
complications.
Anicteric leptospirosis usually has a good
prognosis.
Without jaundice the disease is almost never fatal;
however, fatal pulmonary hemorrhage and
myocarditis have been reported occasionally in
anicteric cases.
The case fatality rate for Weil's disease is 15-40%,
and is higher for patients over 60 years of age.
PROGNOSIS
Recovery from Leptospirosis

Most patient recover completely.

Some patients may take months/years.
Late sequlae may occur
PREVENTIVE
MEASURES
PROGNOSIS
Many human vaccinations have been produced for
certain epidemiologic situations. None, however,
are readily available.

Since leptospirosis is hard to eliminate, risk

reduction is the best solution. The risk exists, but
exposure is reduced by suitable measures such as a
robust and well-known immunization program,
awareness, cleanliness, PPE, and monitoring
methods.
 METHODS OF
PREVENTING
LEPTOSPIROSIS
Methods of preventing leptospirosis

ELIMINATE ISOLATE
Elimination implies eliminating a hazard
from the workplace. In some closed-herd
Isolation comprises directly
housed conditions with all pests managed it separating the hazard or
may be able to eliminate leptospirosis by hazardous activity from the
vaccination of animals, rodent control,
management, and disinfection of living
individuals. Isolation will not
quarters, accompanied by testing be effective for leptospirosis,
(particularly on pig farms). but it may be part of a risk
A strong vaccination program is necessary;
nevertheless, because leptospirosis is
management strategy, along
difficult to eradicate in the open with rodent/wildlife control
environment, alternative management and vaccination.
approaches should be implemented.
Methods of preventing leptospirosis

MINIMIZE PERSONAL PROTECTIVE

Minimization is most likely the EQUIPMENT (PPE)
key to controlling the risk of
PPE is designed to prevent
leptospirosis. The risk remains,
urine, contaminated water,
but exposure is reduced with and fluids from entering the
proper measures such as body through incisions in the
education, cleanliness, personal skin or the mucous
protective equipment (PPE), membranes of the eyes, nose,
monitoring protocols, and and mouth.
immunization.
Methods of preventing leptospirosis
FURTHER CONTROLS
Overall animal health can help
to mitigate the impact of
infection or reinfection. There
are still leptospirosis outbreaks
in healthy flocks/herds, but
unhealthy animals are more
seriously afflicted and take
longer to recover.
 SUMMARY
➔The use of open water or water from a swamp, canals, or
lakes should be avoided since the agent that causes
Leptospirosis can be present in such polluted water.

➔Any wounds or punctures in the skin must be treated as

soon as possible since they might serve as an entry point for a
variety of pathogens.

➔To avoid contact with the agent, anyone who works with
animals must wear protective equipment.
 SUMMARY
➔This agent is also spread by rodents. As a result, appropriate
rodent control methods should be implemented in homes.

➔Animal waste must be disposed of correctly so that it has the

least amount of interaction with the human environment
possible.

➔Pet owners must get their pets checked by a veterinarian on a

regular basis.
DENTAL CORRELATION
PATHOGENESIS:
Potential portals of entry include the skin via a cut or
abrasion and the mucous membranes, especially the
conjunctivae or oral cavity.

The importance of the oral mucosa as a portal of entry is

indicated by a number of studies that found that
swallowing while swimming in contaminated water is a
risk factor for infection.
Recreational freshwater activities, especially ones that put you in
contact with contaminated water for long periods of time, put you
at increased risk. This includes activities that put your head
underwater or cause you to swallow water (for instance, white
water rafting, swimming and boating). Your risk is even greater
after heavy rainfall or flooding.