Leptospira

Question 1

Organism of lepto?

Answer 1

Leptospira interrogans

An aerobic spiral bacteria

Question 2

Clinical features of lepto?

Answer 2

Incubation 5-14 days
Most infections are asymptomatic

Bacteremia phase- proliferation and dissemination throughout body causing direct tissue damage
Acute febrile, conjunctival suffision, headache, severe myalgia>athralgia,1/3 icteric

2nd phase(immune mediated) 
Tissue damage due to IgM Ab

Hep F 
Acute RF 
Acute LHF 
Acute myocarditis
Acute aseptic meningitis 
Pulmonary hemorrhage

Question 3

Ix for lepto?

Answer 3

1. isolation of org.
   - culture-blood,csf In 1st week, urine in 2nd week
   - dark ground microscopy
   - PCR- diagnose early in the 1st w before appearing ab
2. indirect evidence (ab IgM can be detectable by d6-d10.peak within 3-4w)
   - microscopic agglutination test (MAT)
   - ELISA
3. other Ix
   - FBC-WBC^, NEU^,plt reduces
   - LFT- ALP>AST>ALT
   - UFR - +protein,bile,red cell cast
   - RFT- SE,S.Cr, K+ usually ^ but here decreases due to tubular necrosis
   - creatinine kinase ^
   - ECG
   - CXR- pulmonary edema,hemorrhage

Question 4

Mx of lepto ?

Answer 4

1. Observe complications (Mx by heperkalemia Mx, hemodialysis, ARF Mx)
2. monitor IP/OP,QHT
3. careful fluid Mx
4. def Mx- IV benzyl penicillin, IV ceftriaxone,IV cefotaxime
5. mild disease- doxycycline 100mg/bd

Prophylaxis- doxy 200mg/bd