Bacteria 11: Leptospirosis

Question 1

What is the reservoir for leptospirosis?

Answer 1

Question 2

What is the life cycle of leptospirosis and how is it transmitted?

Answer 2

• Transmitted through ingestion of contaminated water, crack in skin/mucous memebranes while being contaminated water
• At risk:
  
  • In the UK: water workers, electricians, triathletes
  • Tropical regions: slum dwellers, rice farmers, associated with poverty
  • Large outbreaks have been associated with floods, droughts and other disasters

Question 3

What kind of bacteria causes leptospirosis?

Answer 3

Question 4

What are the clinical features of leptospirosis?

Answer 4

• Initial bacteraemic phase followed by an immune mediated phase
• 75 - 100% will have fever, rigors, headache and myalgia
• Conjunctival suffusion or haemorrhage is an important diagnostic feature: up to 55% of patients
• Weil’s disease and leptospirosis sometimes used interchangeably, however refers to a specific triad of symptoms:
  
  • Jaundice
  • Thrombocytopaenia
  • Renal Failure
• Renal failure can be quite severe, often requires RRT, but tends to resolve
• Pulmonary disease -> causes haemorrhage, mortality at 71%. 12% of people with leptospirosis develop pulmonary haemorrhage

Question 5

How do we diagnose leptospirosis?

Answer 5

• In UK: Serology - IgM elisa or microscopic agglutination test (gold stnadard but takes longer)

Question 6

How do we treat leptospirosis?

Answer 6

Question 7

What is the Jarisch-herzheimer reaction?

Answer 7

• Important in spirochaete disease as particularly common here
• Spectrum of severity
• This reaction occurs within 24 hours after antibiotic treatment of spirochaetal infections