Infectious disease caused by spirochete bacteria (Leptospira interrogans)

Acquired when coming in contact with flood

water contaminated by urine of animals such as rats, dogs, goats, and swine.

Common in tropical countries with heavy rainfall

“Leptospirosis is a bacterial disease that affects both humans and animals. The early stages of the disease

may include high fever, severe headache, muscle pain, chills, redness in the eyes, abdominal pain,

jaundice, haemorrhages in skin and mucous membranes (including pulmonary bleeding),

vomiting, diarrhea and a rash.”

Infection usually occurs in adolescents or young adults more common in men (male-to-female ratio of

4:1) ▪ peak incidence is in men aged 30 to 39 years

Leptospirosis is seen worldwide, except in the

polar regions human infection is endemic in most temperate and tropical

climates

(annual rates of infection )

In TEMPERATE CLIMATES:

0.1 -1 per 100,000 (WHO)

In TROPICAL CLIMATES (humid): 10-100 per 100,000

300,000 – 500,000 severe cases per year

As of September 2013 - 78% lower than 2012 cases

Most cases reported during rainy / typhoon season.

Median age affected: 30 y/o, but age

most affected > 40 y/o. 86% of cases were male * Top 5 areas most affected (from most

to least): NCR, Regions VI, III, XI, II. In NCR itself, Manila is most affected, followed by QC, Caloocan, Parañaque.

-DOH

I HEALTHY

INDIVIDUALS

III SYMPTOMATIC INDIVIDUALS

II ASYMPTOMATIC

INDIVIDUALS

IV OUTCOME

4 STAGES

Susceptible

Asymptomatic infection

Acute febrile illness

No sequelae

Uveitis

Other potential sequelae

Well’s Syndrome

Pulmonary Hemorrhage

Aseptic Meningitis

Other potential sequelae

Includes depression & other mental health problems

Death

HOST VECTOR AGENT

People who work outdoors or with animals and people in contact with infected water:

Veterinarians Farm and agricultural

workers Meat workers Sewage system

personnel Military personnel

Rodents

Dogs

Wild animals

Domesticated animals

Leptospira interrogans

ENVIRONMENT INFECTIVITY PATHOGENICITY

TROPICAL AND SUBTROPICAL

REGIONS

LEPTOSPIREMIA develops after Leptospires gain entry LEPTOSPIRES multiply in the blood and tissues and can be isolated from blood and CSF during first 4-10 days of illness damage walls of small blood vessels and cause vasculitis

Incubation period: average 5–14 days (range: 2-4 weeks)

Asymptomatic infection

Acute febrile illness

Uveltis

Other potential sequelae

Weil’s Syndrome

Pulmonary Hemorrhage

Aseptic Meningitis

Other potential sequelae

Death

Susceptible

Includes depression & other mental health problems

No sequelae

LEPTOSPIREMIC PHASE

Nonspecific flu-like symptoms includes

( headaches, muscle aches, eye pain with bright lights, followed by chills and fever, watering and redness of the eyes ) Lasts for 3-10 days Leptospires in the blood

IMMUNE PHASE

Fever not responsive to antibiotics and aching with stiffness of the neck Inflammation of the nerves of the eyes, brain and spinal column, RUQ abdominal pain Leptospires in the urine

WEIL’S SYNDROME • Fulminant type Jaundice, acute kidney

injury, hypotension, pulmonary hemorrhage, acute abdomen, myocarditis, hepatic injury

Complications:

Acute Kidney Injury

Respiratory problems

Chronic fatigue and other neuropsychiatric symptoms (headache, paralysis, depression, etc)

DEATH

I PRIMARY

III TERTIARY

II SECONDARY

Health education/awareness

Good sanitary practice Drinking of safe/potable

water (distilled/purified/boiled)

Proper drainage of water Avoiding contact with

flood waters Use of protective

covering (boots/gloves) when in contact with flood water

Pest/rodent control (rats/mice)

Doxycycline prophylaxis Vaccination (animals)

Mild leptospirosis

Moderate – severe

leptospirosis

Antibiotic therapy

- Doxycycline - Aamoxicillin

- Azithromycin dihydrate

- Penicillin G - Cefotaxime - Ceftriaxone - Parenteral Azithromycin

dihydrate

- 7 days - 3 days

(azithromycin dihydrate)

Philippine Society Of Microbiology and Infectious Diseases. Leptospirosis Clinical Practice Guidelines 2010

EARLY DIAGNOSIS

DIRECT METHODS INDIRECT METHODS Immunofluorescence

staining Immunoperoxidase staining Silver staining Various methods of

POLYMERASE CHAIN REACTION

various types of ELISA tests Spot agglutination test MICROSCOPIC

AGGLUTINATION TEST

Symptomatic rehabilitation

Rest kidneys –avoid lifting heavy weights, avoid contact sports, complete bed rest, if necessary

Maintain fluid and electrolyte homeostasis

Provide ample time for recovery

Environmental sanitation must be given importance Recognition of the signs and

symptoms is the key to prompt treatment necessary to prevent dreaded outcomes Leptospirosis is treated with

antibiotics and is rarely fatal Prevention is better than cure

ACCORDING TO WHO:

If Leptospirosis is detected early, antibiotics can be administered that can successfully treat the disease.

The plan: Establish accurate estimates of disease burden to better direct adequate intervention, control and prevention efforts.

If risk factors are identified, then interventions can be appropriately targeted at the individual and community level that can successfully prevent the disease.