Leptospirosis Flashcards
Leptospirosis
Main MO
Leptospira interrogans icterohemorrhagiae
Leptospirosis
Main primary host
rats
Leptospirosis
colonizing site of the spirochete
Proximal conv tubule of the carrier
Leptospirosis
Carriers
domestic farm animals- rodents, cattle, dogs, pigs
Leptospirosis
Surviving environmental conditions
areas with stagnant waters- paddy fields, ditches, streams, rivers
Leptospirosis
How does the MO enter the hosts
enter via intact mucous membranes and through abraded skin
Leptospirosis
How does Leptospirosis transmit to humans
- Direct- vet workers
- Indirect- occupational, recreational exposure to water contaminated w infected water
- RARELY human to human- sexual transmission during convalescence ( recovery) phase
- Occupational exposure in labs
Leptospirosis
Incubation period
5- 14 days
Leptospirosis
Main two clinical phases
- Bacteremic phase
- Immune mediated phase
Leptospirosis
Bacteremic phase pathophysio
Direct tissue damage
Leptospirosis
Bacteremic phase Sx
- Acute fever
- Headache
- Conjunctival suffusion
- Severe myalgia > arthralgia
- 1/3 pts icteric
Leptospirosis
myalgia is characteristic in
calves tenderness
Leptospirosis
Lepto pts w icterus is aka
Weil’s disease
icterus + Hemorrhage in eye. Dx?
Lepto until proven otherwise
Leptospirosis
Immune- mediated phase. Ig…?
IgM
Leptospirosis
Immune- mediated phase Sx
- Hepatic failure
- Renal failure ( Interstitial nephritis, ATN) - HYPOKALEMIA
- Hemolytic anemia
- Circulatory failure ( due to myocarditis)
- Aseptic meningitis
- Cardiac failure
- Pulmonary failure ( Hemoptysis, BL infiltrates, ARDS, RS failure)
Leptospirosis
life- threatening complication
Pulmonary failure
Leptospirosis
complications
- Acute renal failure
- Acute myocarditis w acute LHF
- Acute aseptic meningitis
- Pulm Hemorrhage
Leptospirosis
How does it cause AKI and then CKI
- MO»> Direct Kidney Injury»> Acute interstitial nephritis»> AKI»» CKI
- Hypovolemia»> K hypoperfusion»> AKI»> CKI
- Vasculitis»> K hypoperfusion»> AKI»> CKI
- Rhabdomyolysis»_space;> Kidney tubular injury»> AKI»> CKI
Leptospirosis
Ix ( Isolate the MO)
- Culture ( clinically useless. takes time to get the report) - Blood, CSF, urine
- Dark ground microscopy
- PCR
Leptospirosis
How long does it take to get the MO in urine sample
2nd week
Leptospirosis
How long does it take for the CSF sample to detect spirochete
within the first week
Leptospirosis
Dark ground microscopy
low sensitivity and specificity. So its not done generally
Leptospirosis
PCR
can detect the disease very early but expensive
Leptospirosis
the Ix done usually detects…
detect the Ab- IgM ( detected by Day 6- Day 10)
Leptospirosis
The test done
Lepto MAT ( microscopic agglutination test)
Leptospirosis
Lepto MAT
- detect Ab after a week
- > 1:320 (four fold rise) is significant
- Lasts 3-4 weeks
Leptospirosis
Lepto Ab detecting tests
- Lepto MAT
- ELISA
Leptospirosis
Other supportive tests done
- FBC - Increased WBC, ( Neut) Reduced plts
- LFT - ALP» AST/ALT
- UFR- +ve for protein, bile, red cell casts
- RFT- SE, S,Cr
- Creatine kinase - increased
- ECG - non- specific ST, T changes
- CXR- pulm edema, hemorrhage
Leptospirosis
Why is creatine kinase elevated
coz of muscle damage
Leptospirosis
Mx
- Admit
- Ix- CBS, FBC, LFT, RFT, UFR,ESR, CRP
- Observe for complucations
- Monitor- IP/OP chart, QHT
- Careful Fluid Mx
- Definitive Mx- IV Benzyl penicillin/ IV ceftriaxone/ IV cefotaxime
- Mild disease definitive Mx- doxycycline 100mg bd
- Mx of complications- HyperK, HD, ARF Mx
Leptospirosis
Preventive measures
- Immunise domestic, farm animals
- Risk occupations- protective clothing and simple hygienic practice
- Chemoprophylaxis in high risk- doxy 200mg bd continued until the exposure is over
AST> ALT seen in
- Dengue
- Lepto
- alcoholic steatohepatitis
- cirrhosis
Leptospirosis
1: 80 titre in a blood sample means?
After diluting the sample 80 times, the bacteria is +ve
