Infectious Leptospira Flashcards
Coiled thin motile organisms with hooked ends and 2 periplastic flagella with polar extrusion
Leptospira
Leptospira transmission
Direct contact with urine, blood and tissue fr infected animal
Exposure to environmental contaminant
Leptospira rf:
Veterinarians, agricultural
Direct or indirect contact with animal
Recreational freshwater activity
Fever of 3-10d
Proliferation of organism
Hematogenous dissemination
Leptospira isolated fr blood stram
Leotospiric phase
Strong inhibitor of complement response
Factor 8
Disappearance of leptospires
Appearance of antibody,
Leptospires
Leptospiruric
Immune phase
Virulencr factor encoding surface exposed protein
loa22
Gold standard for dx
Culture and isolation
High accuracy in 1st 5 days of illness
PCR
Used in PH
Seroconversion or a rise in antibody titer
1:1600 cut off for PH
Preferred 4 fold or greater RISE in titer bet acute and convalescent phase (2nd week)
MAT
Tx for mild leptospirosis
Doxycycline 100mg PO BID
Amox
Ampi
Moderate/Severe
Penicillin 1.5 m IM/IV
Ceftriaxone 2g IV
Cefotaxime
Leptospirosis other tx
Aggressive fluid and electrolyte resuscitation
Peritoneal dialysis
Mech vent
Glucocorticoids
Develops within hours after initiation of antimicrobial
Jarisch-Herxheimer rx
Common in syphilis and penicillin use
During the immune phase culture is best obtained from
urine
Hemorrhage
Severe calf pain
Wading in flood water
Leptospiremic blood
Tx for mod to severe leptospirosis
Weil’s
Penicillin
Doxycycline contraindicated in children bec
Affects bone and cartilage growth
Yellowing of teeth
Arrest of epiphyseal growth
Doxycycline chemoprophylaxis
200 mg OD x 7 days
Most common indication if penicillin in PH
Rheumatic fever 5-15 y/o
Poor morbidity in malaria
Cytoadherence
Rosetting
Agglutination
Why is there fever in malaria
lysis of rbc
Fever cytokines
IL 1
IL 6
Poor prognosis sx for malaria
Hypoglycemia <40
For ovale, vivax, malariae and falciparum sensitive
Chloroquine
Amodiaquine
Radical tx for ovale and vivax
Chloroquine or Amodiaquine
Primaquine (14d)
do not give in G6PD
P falciparum tx
Artesunate + Sulfadoxine A and amodiaquine Artemeter lumefantrine A and mefloquine DHA piperaquine
Severe falciparum tx
Artesunate IV
Artemeter IM
Quinidine IV
Quinine dihydrochloride
Quinidine SE
ECG monitoring
Sulfa se
SJS
Test to confirm presence of leptospira during the acute phase
Isolation by culture
