Leptospirosis

Question 1

What is the reservoir for leptospirosis?

Answer 1

Proximal renal tubule of mammals

Question 2

Most common locations to get lepto?

Answer 2

India, Thailand, Laos and a bit in Central America/carribean

Question 3

How is leptospirosis transmitted?

Answer 3

Contaminated soil water with urine of wild/domestic animals

Question 4

How is leptospirosis transmitted?

Answer 4

Contaminated soil water with urine of wild/domestic animals

Question 5

Where does leptospirosis transmission occur?

Answer 5

-occupational activities: farming, mining, sewer workers, butchering,
-recreational activities: immersion in water (canoeing, kayaking)
-after environmental disasters: floods, hurricanes, typhoons
-daily activities in endemic areas

Question 6

Common animal reservoirs for leptospirosis?

Answer 6

Pigs, cattle, dogs, horses, rats, sheep, mice, bats

Question 7

What is the organism for leptospirosis?

Answer 7

Gram negative motile aerobic spirochete
Leptospira interrogans, leptospirosis biflexa (non pathogenic)- 200 serovars (antigenically related subgroups)
Stains poorly - need fluorescent microscopy
Selected media needed for isolation

Question 8

Pathogenesis of leptospirosis?

Answer 8

Disseminates widely on entering body -> liver necrosis, interstitial nephritis and tubular necrosis, alveolar infiltrates and pulmonary haemorrhage, muscle oedema (rhabdo)
Other: jaundice, HSM, vasculitis, meningoencephalitis

Question 9

Incubation period for leptospirosis?

Answer 9

10 days
Mostly asymptomatic or mild illness
Fulminant presentation: known as Weils disease

Question 10

Stages of illness in lepto?

Answer 10

First stage , days 3-7: fever, myalgia, headache, abdo pain, vomiting, conjunctival haemorrage

Second stage, days 10-30 either meningitis, uveitis, rash -> progressing to jauncice, haemorrhage, myocarditis, rhabdo, liver and renal failure -WEILS disease

Question 11

Stages of illness in lepto?

Answer 11

First stage , days 3-7: fever, myalgia, headache, abdo pain, vomiting, conjunctival haemorrage

Second stage, days 10-30 either meningitis, uveitis, rash -> progressing to jauncice, haemorrhage, myocarditis, rhabdo, liver and renal failure -WEILS disease

Question 12

What is the pattern of liver disease in Weil’s disease?

Answer 12

Cholestatic jaundice with mild rise in liver enzymes

Question 13

Other disease manifestations in severe leptospirosis?

Answer 13

Cardiac: myocarditis, arrhythmias
muscle: rhabdo, high CK
Renal: AKI, tubular necrosis
Eye: anterior uveitis, optic neuritis
Aseptic meningitis - lymphocytic
Rash on legs: Fort Bragg fever
Thrombocytopenia

Question 14

Bad prognostic markers in leptospirosis?

Answer 14

Creatinine high
Lactate high
Pllts <50
Leptospires high

Question 15

Differential diagnosis of febrile illness, jaundice, thrombocytopenia, renal failure?

Answer 15

Dengue
Malaria
Rickettsia/scrub typhus
Typhoid
Gram negative sepsis
Viral hepatitis
EBV
Flu
Brucellosis
Meiliodosis
Meningococcal septicaemia

Question 16

Diagnosis of lepto?

Answer 16

• Within first week can do PCR of blood
• PCR of urine better - stays positive for longer
• serology - Elisa for IGM or agglutination test.

Question 17

What is the treatment of leptospirosis?

Answer 17

Ceftriaxone
Can also use doxy or azithro