Formerly, when religion was strong and science weak, men mistook magic for medicine'', Now, when sci

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Formerly, when religion was strong and science
weak, men mistook magic for medicine.., Now,
when science is strong and religion weak, men
mistake medicine for magic...!
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Leptospirosis

• Dr. Venkatesh M. Shashidhar
• Senior Lecturer in Pathology
• Fiji School of Medicine

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Introduction

• Zoonotic Bacterial Disease.
• Spirochetes.
• Rodent / domestic animal reservoir.
• Animals - asymptomatic disease
• Humans are accidental hosts.
• Mild to severe form of febrile illness.

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Microbiology

• Leptospira sp - Spirochetes
• L interrogans L biflexa (free living)
• Tightly coiled spiral bacteria
• Periplasmic flagella (2)
• Serotypes of L interrogans - pathologic

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Microbiology

• Over 200 Serovars of L interrogans.
• Not species ? L interrogans sv - Hardjo
• L. hardjo - Cattle
• L. canicola - Dogs Pigs
• L. icterohemorrhagiae - Rats

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Spirochetes - (Dark-ground Microscopy)
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People at risk

• Farmers
• Sewage workers
• Vets
• Water sport enthusiasts
• River fishermen

Route of Spread

• Wet / damaged skin

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Pathogenesis

• Animal urine - water contamination.
• Penetrate through wet/damaged skin
• Proliferate in liver, kidney muscle.
• Concentration in Blood, CSF Urine.
• Rapid clearing by second phase - Ab
• Healing without complications.

Morphology
Liver cell necrosis, Hemorrhagic pneumonitis,
Interstitial inflammation in kidney, lymphocytic
meningitis.
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Clinical course

• Incubation period - 1-3 weeks
• Biphasic disease
• Leptospiremic phase - 7 days
• Leptospiremia, Fever, headache, myalgia.
• Leptospiruric phase -
• immune phase, Ab, meningitis, urine ve.

Weils Disease(1886)
Leptospira icterohemorrhagica - Severe form.
High fever, jaundice, Hemorrhagic diathesis,
shock high mortality.
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Clinical Presentation

• gt90 mild non-icteric form
• lt10 severe icteric form
• Jaundice, myalgia with conjunctivitis suggest
  severe form of leptospirosis.

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Clinical Features

• Early myalgia
• Conjunctivitis
• Lymphocytic meningitis
• Hepatitis with fever
• Renal impairment- Blood, Pr/Bil in urine
• Nodular pneumonitis
• Rash, some times haemorrhagic
• Thrombocytopenia

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Conjunctivitis Icterus
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Nodular Pneumonitis
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Hepatocyte necrosis
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Nodular Pneumonitis - CT-Scan
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Diagnosis

• Epidemiologic history
• Occupation / exposure
• Outbreak / other cases
• Clinical manifestations
• Fever, myalgia, conjunctivitis, meningitis.
• Laboratory findings
• Direct demonstration, Culture
• Macro-agglutination tests ELISA

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Laboratory Methods

• Dark-ground microscopy of urine/blood
• Culture of blood/urine
• Serum leptospira agglutination tests
• Serum ELISA for IgM antibody.

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Management

• Spontaneous recovery in 10-14 days
• Antibiotics - 10 days.
• Benzylpenicillin
• Tetracycline
• Sulphonamides
• erythromycin
• Supportive

Complications

• DIC, Hemorrhagic pneumonitis.
• Rare - Uveitis

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Conclusions

• Spirochete - Leptospira species.
• L interrogans L biflexa - free living, np
• hardjo, canicola, icterohemorrhagiae
• Mild and Severe forms
• Mild - non icteric - canicola hardjo
• Fever, conjunctivitis meningitis.

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Conclusions

• Severe icteric form - Weil disease.
• Leptospira Icterohemorrhagiae
• Rat reservoire
• Hepatitis hemorrhagic - Jaundice,
• nephritis - Renal tubular necrosis
• nodular pneumonitis DIC.
• Antibiotics Supportive therapy.

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Thank you...