A Family Doctor's Tale- LEPTOSPIROSIS

DOC I HAVE LEPTOSPIROSIS

LEPTOSPIROSIS is an acute infectious illness caused by the bacteria Leptospira with a wide spectrum of illness from inapparent to fatal.

The bacteria which causes LEPTOSIROSIS is the Leptospira interrogans which is an extremely hardy bacteria occurring in domestic and wild animals.

Humans are accidental hosts.

Human infections occur through abraded skin and exposed mucous membranes from urine or tissues of infected animal or through contaminated water soil and vegetation.

The bacteria can affect the liver, kidney, skeletal muscle, heart, spleen, lungs and central nervous system.

Hemorrhagic changes and necrosis of tissues may occur together with interstitial edema and lympocytic, plasma cell and neutrophilic leucocyte infiltration.

Symptoms and Signs of LEPTOSPIROSIS are:
Incubation period is approximately 10 days.


Illness is typically biphasic.

A.Leptospiremic or First Phase
1.Organisms found in the blood and cerebrospinal fluid

2.Abrupt onset of headache, myalgia, high fever and chills

This will last 4-9 days

3.Anorexia, nausea, vomiting, cough, chest pain, hemoptysis, conjunctival suffusion, cutaneous rash and hemorrhages seen.

B.Immune or Second Phase:
1.Correlates with appearance of circulating IgM antibodies

2.Clinical manifestations in this phase varies:
Patient may be asymptomatic for 1-3 days with return of fever and other symptoms of first stage.

3.Iridocyclitis, optic neuritis, encephalitis, myelitis,
and perpheral neuropathy and meningismus may occur.

Specific Leptospirosis Disease:
Weil's Disease:
is severe leptospirosis with
1.liver involvement with jaundice, hyperbilirubinemia
2.renal involvement with proteinuria, pyuria, hematuria
2.hemorrhagic manifestations with epistaxis, hemoptysis, GIT bleeding, subarachnoid hemorrhage
3.anemia
4.changes in consciousness
5.continuous fever
6.pneumonitis
7.aseptic meningitis
8.myocarditis

Doctors generally diagnose LEPTOSPIROSIS based on:
1. blood test and cultures.

2.cerebrospinal tests

3.animal innoculation

4.liver scan and ultrasound

LEPTOSIROSIS is a disease which can kill especially through its complications:
1.Liver disease due to damage to the liver leading to cirrhosis

2.Kidney disease can occur from damage to the kidney

3.Brain damage is rare but can occur from spread to the brain and meninges

4.Severe hemorrhage uncommon but can cause death

Treatment of  LEPTOSPIROSIS is :
LEPTOSPIROSIS is an infectious disease which can spread to other people through contaminated food and water.

1.Antibiotics such as penicillin and tetracycline are started once the diagnosis is confirmed.

2.intravenous drip and blood transfusion if necessary

Symptomatic treatment includes:
1.Paracetamol for relief of fever and headache

2.antispasmodic drug to stop abdominal cramps

3.medicine to stop vomiting and itch

4.Gradually reintroduce food, starting with bland, easy-to-digest food, like porridge or soups.

5.Get plenty of rest.

Prevention of LEPTOSPIROSIS can be by:
1..Avoid eating or drinking foods or liquids that might be contaminated especially by the germ and animals

5.Good food hygiene and hand washing

Prognosis of LEPTOSPIROSIS depends on the virulence of disease and general condition of the patient.

It is excellent with prompt treatment of leptospirosis infection.

Weil's disease is more serious but will respond well to treatment.

Infection of pregnant women may be associated with increased risk of fetal loss.