LEPTOSPIROSIS

No2 hospital CMU

department
of infectious disease
Huang Fen

DEFINITION

1. Leptospirosis is a kind of zoonotic

infectious disease caused by pathogenic
leptospires;

2. rats and swine are cardinal source

of infection;

3. the disease often occurs in summer

and fall;

DEFINITION
4. clinical features:
three symptoms,
three signs,
internal organ damage,
seguelae of eyes and nerve system
5. treatment: penicillin.

ETIOLOGY
1.pathogen : pathogenic leptospira
2.features of leptospia:

helicoid with hook,

length 6~ 20 um,G -

darkfield microscope;

in korthofs media;

ETIOLOGY

several months in water and

moist soil (PH7.0~7.5)

3.Classification:

23 serogroups

and more then

200

serotypes in the world;

19 serogroup and 74 serotypes in china.

icterohemorrhagic group,
pomona group

EPIDEMIOLOGY
1.Source of infection:

rat: apodemus agrarius,

rice field type;

pigs: flood or rain type;

patient

 EPIDEMIOLOGY
2.Routes of transmission:
(1) water borne (indirect contact

transmission):
by skin,mucosa,when skin is injured.
(2) direct contact transmission:
(3) food borne
3.Susceptibility of population:

 EPIDEMIOLOGY
4.Epidemiologic features:

(1)season: summer and fall;

(2) nosogenic age:

young and middle age,children

(3)occupation:

farmer,slaughter,

fisher,veterinarian.

 4.Epidemiologic features:

(4)epidemic type :

rice field type

flood type

rain type

PATHOGENESIS

leptospira

Initial stage

skin,mucosa
leptospiremia toxic symptoms

(1~3days)

three symptoms:
fever,myalgia,fatigue;
three signs:
conjunctival suffussion;
muscle tenderness;

 PATHOGENESIS

severe toxic symptoms

lesion of organs:

influenza form

pneumorrhagic form
middle stage
icterohemorrhagic form
(3~10d)

meningoencephalitis

renal failure form.

 PATHOGENESIS

immunopathological reaction
after fever;
sequelae of eyes;
reactive
meningitis;
cerebro arteritis
obliterans.

convalescent stage

PATHOLOGY
1. basic pathological change is
infective,toxic injured of systemic
capillaries;
2. severe:lung,liver,kidneys,brain.

exudation,hemorrhage,

edema or necrosis.

CLINICAL MANIFESTATIONS

Incubation period: 2~28 days

usually 7~13days;
1. Influenza-typhoid type:5~10days
three symptoms:

fever,myalgia and fatigue.

three signs:

conjunctival suffusion,

CLINICAL MANIFESTATIONS

three signs:
conjunctival suffusion,
tenderness of
gastrocnemius muscle;
enlargement and tenderness
of superficial lymphnodes.
Inguinal and axillary
lymphodes.

CLINICAL MANIFESTATIONS

2. pneumorrhagia form:
1). three symptoms and three signs

2). pneumorrhagia symptoms(3~4d)

(1). mild pneumorrhagia type
cough,expectoration with blood.
a few moist rales.
X-ray of chest: scattering spotty
shadow

dyspnea,
palpitaton,aspharyxia,rales.

and small fasciola

CLINICAL MANIFESTATIONS

2. pneumorrhagia form:

(2) diffuse pneumorrhagia type

short breathing, palpitation,
dysphoria,
massive hemoptysis, asphyxia,
cyanosis,

a lot of moist rales.

X-ray: extensive fasciola shadow

 CLINICAL MANIFESTATIONS
3.Icterohemorrhagic type:(Weil ,s disease)
1). three symptoms and three signs

2). jaundice, hemorrage, renal injury

(4~5d)
liver injury:

anorexia,vomiting, jaundice,
abnormal liver function.

 CLINICAL MANIFESTATIONS
3.Icterohemorrhagic type:(Weil ,s disease)
hemorrhage:
petechiae,ecchymoses,hemoptysis,
hematemesis etc.
renal injury: proteinuria,

RBC, WBC, cast,

oliguria,azotemia,uremia.

 CLINICAL MANIFESTATIONS
4.renal failure type:
oliguria, azoteinia, uremia.
5.meningoencephalitis type:
1). three symptoms and three signs

2). 3~4days later, meningitis, encephalitis.

headache,vomiting,meningeal irritation,

lethargy,coma,paralysis or convulsion.

 CLINICAL MANIFESTATIONS

CSF is abnormal.
pressure increase
pleocytosis<500 106/L
protein is normal or elevated slightly.
glucose and chloride is normal.
leptospira isolation: positive.

CLINICAL MANIFESTATIONS
SEQUELAE
1. after fever :1~5days after defervascence
2. sequelae of eyes: 1week~1month

iridocycyclitis, choroiditis , uveitis

3.reactive meningitis
4.cerebroarteritis obliterans:2w~2m

hemiplegia aphasia

LABORATORY FINDINGS:
1. routine examination:
1). blood routine examination:

WBC is increased slightly;

2).urine routine examination:
protein (2/3)

2. serological examination:
1).microscopic agglutination test (MAT)

detect antibody

>1:400

LABORATORY FINDINGS:
2). ELISA: serum and CSF IgM antibody
3. pathogenic test
1).blood culture:

2).PCR:

DNA

DIAGNOSIS
1.epidemiologic data:
1).epidemic area;
2).epidemic season;
3).a history of contact with contaminated
water;

2.clinical manifestations:
3.Lab findings:

DIFFERENTIAL DIAGNOSIS

1.Influenza; Typhoid fever,

2.Lobar pneumonia;
3.Viral hepatitis;
4.Viral meningitis;
5.Epidemic hemorrhagic fever;

TREATMENT
1.Pathogenic therapy
1). first choice: penicillin

40 u q6h or q8h im 7days

note: Herxheimer reaction
first time - small amount 5 u
im

2). Gentamycin 8 u q8h im

TREATMENT
2.Symptomatic therapy

1). Herxheimer reaction

physical cooling, sedative,

hydrocortisone.
2). pneumorrhagia type
sedative, hydrocortisone, cardiotonics

3.treatment of sequlea

PREVENTION
1.control of pigs:
1). stable breeding

2).immunized by vaccine

2.killing of rats,
3.cutting route of transmission,
4.vaccination: multivalent vaccine