BIOETHICS
MEDICINE3 2
P.04 LEPTOSPIROSIS
Dr. Fajardo | January 14, 2020
OUTLINE
I. Blah
II. Blah Blah
III. Blah Blah Blah
IV. Blah Blah Blah Blah
I. CLINICAL SCENARIO
30 year old male who has fever for 7 days. Tricycle driver
from Manila. History of wading in flood water 1 week prior to the
onset of fever. The patient is weak looking with severe muscle
pain most notably on the back and calf. The patient has ictericia
and complains of increased urine output.
II. LEPTOSPIROSIS
 Genus Leptospira
o 2 species:
 L. interrogans: pathogenic
 L. biflexa: free living, non-pathogenic
 Leptospires are thin, long, slender, spiral or curved, tightly
coiled, highly motile gram negative aerobic organisms
A. EPIDEMIOLOGY
 Leptospirosis is an important zoonosis with a worldwide
distribution
 Rodents (rats): most important reservoirs
o Wild animals, domestic farm animals
 Infections occur most commonly in the tropics
o Climate and poor hygienic conditions favor the
pathogen’s survival and distribution
 Transmission to humans: direct contact with urine, blood or
tissue from an infected animal or exposure to a
contaminated environment
 Human to human transmission: rare
 Leptospires survive in water for many months
 Occupational and recreational exposures
B. PATHOGENESIS
 Transmission: cuts, abraded skin, mucous membranes
(conjunctiva and oral mucosa)
 Disseminate hematogenously in all organs (leptospiremic
phase)
 Leptospires survive in non-immune host
1. Evade complement-mediated killing
2. Resist ingestion and killing by neutrophils, monocytes,
macrophages
 Immune phase: appearance of antibodies, loss of
leptospires in the blood
 Bacteria persist in various organs: liver, lungs, kidneys,
heart and brain
 Petechiae and hemorrhages in the heart, lungs, kidneys,
pancreas, liver, gastrointestinal tract, muscles, prostate,
testis and brain (subarachnoid bleeding
C. CLINICAL MANIFESTATIONS
 Majority of cases: relatively mild
 Incubation period: 1-2 weeks (1-30 days)
 Leptospirosis is classically described as biphasic
MEDICINE 2 | 1 of 2
o Acute leptospiremic phase: fever of 3-10 days
duration; organism can be cultured from the blood
o Immune phase: resolution of symptoms, appearance
of antibodies; leptospires can be cultured from the
urine
1. MILD LEPTOSPIROSIS
 Asymptomatic, mildly ill: do not seek medical attention
 Flu-like illness, sudden onset of fever and chills, headache,
nausea, vomiting and abdominal pain
 Conjunctival suffusion (diffuse erythema without exudates)
 Intense muscle pain: calves, back and abdomen
 May present with aseptic meningitis: benign course
 Natural course: spontaneous resolution within 7-10 days
o Absence of antibiotics: mortality rate is low
2. SEVERE LEPTOSPIROSIS
 Classic presentation: Weil’s Syndrome
o Hemorrhage
o Jaundice
o Acute kidney injury
 Death due to septic shock with multiple organ failure and
severe bleeding
o Pulmonary hemorrhage, melena, hemoptysis,
hematuria, petechiae, ecchymosis and bleeding from
venipuncture sites
 Severe disease: associated with case fatality rate ranging
from 1-50%
 Higher mortality rates are associated with
o Age >40
o Altered mental status
o Acute renal failure
o Respiratory insufficiency
o Hypotension
o Arrythmias
D. DIAGNOSIS
 Clinical diagnosis: based on an appropriate exposure history
combined with any of the protean manifestation of the
disease
 Returning travelers from endemic areas
o History of recreational freshwater activities or other
mucosal or percutaneous contact with contaminated
surface waters or soil
 Non-travelers
o Recreational water contact and occupational hazards
that involve direct or indirect animal contact
E. LABORATORY AND RADIOLOGIC FINDINGS
 Urinary sediment changes, mild proteinuria
 Renal failure and azotemia
 Marked leukocytosis, thrombocytosis
 Bilirubins (high); ALP, LFTs (moderately elevated)
 Prolonged prothrombin time
 CSF: polymorphonuclear leukocytosis, elevated protein,
normal glucose
 CXR: patchy alveolar patterns (alveolar hemorrhage)
 A definitive diagnosis of leptospirosis is based on
1. Isolation of the organism from the patient
2. Positive result in the PCR
3. Seroconversion or a rise in antibody titer
LAFUENTE, ALDABA, GATCHALLAN
 BIOETHICS
MEDICINE3 2

 In cases with a strong clinical evidence of infection plus a

single antibody titer of 1:200 to 1:800 in the microscopic  Post exposure measures
agglutination test (MAT)
 Fourfold or greater rise in titer is detected between acute
and convalescent phase serum specimens

F. TREATMENT

CHECKPOINT
Identify what is being asked:
1. Who am I?
2. Do you mean… what I am?
3. What I do?
4. What I did?
5. Who are we?
G. PREVENTION
 Pre-exposure measures ANSWERS: (1) Hippocrates, (2) Herophilus, (3) Modern Human Anatomy, (4)
o The most effective preventive measure is the Microscopic Anatomy, (5) Surface Anatomy

avoidance of high risk exposure (ie. wading in floods

and contaminated water, contact with animal body
END
fluids)
o If high risk exposure is unavoidable, appropriate
protective measures include wearing boots, goggles,
overalls and rubber gloves
o Pre-exposure antibiotic prophylaxis is not routinely
recommended
 Individuals who intend to visit highly endemic
areas and get exposed, pre-exposure prophylaxis
may be considered
o Pre-exposure prophylaxis regimen for non-pregnant,
non-lactating adult
 Doxycycline 2 capsules of 100mg/capsule once
weekly, to begin 1 to 2 days before exposure and
continuing through the period of exposure
o Currently, there is no recommended pre-exposure
prophylaxis that is safe for pregnant and lactating
women

MEDICINE 2 | 2 of 2 LAFUENTE, ALDABA, GATCHALLAN