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Leptospirosis

Leptospirosis

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Published by: rommel f irabagon on Jan 19, 2010
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LEPTOSPIROSISLEPTOSPIROSIS
..
LeptospirosisLeptospirosis
an infectious disease.an infectious disease.characterized by a broad spectrum of clinical manifestations (from inapparentcharacterized by a broad spectrum of clinical manifestations (from inapparent infection to fulminant, fatal disease).infection to fulminant, fatal disease).Mild form:Mild form:present as an influenza-like illness with headache and myalgias.present as an influenza-like illness with headache and myalgias.Severe leptospirosis:Weil's syndromeSevere leptospirosis:Weil's syndrome jaundice, renal dysfunction, and hemorrhagic diathesis jaundice, renal dysfunction, and hemorrhagic diathesis
ETIOLOGIC AGENTSETIOLOGIC AGENTS
LeptospiresLeptospiresSpirochetesSpirochetesorder Spirochaetalesorder Spirochaetalesfamily Leptospiraceae.family Leptospiraceae.The pathogenic leptospires are divided into serovars according to theirThe pathogenic leptospires are divided into serovars according to their antigenic composition.antigenic composition.More than 200 serovars make up the 23 serogroups.More than 200 serovars make up the 23 serogroups.
LeptospiresLeptospires
are coiled, thin, highly motile organisms with hooked ends and twoare coiled, thin, highly motile organisms with hooked ends and two periplasmic flagella that permit burrowing into tissue.periplasmic flagella that permit burrowing into tissue.6 to 20 um long and about 0.1 um wide.6 to 20 um long and about 0.1 um wide.Stain poorly but can be seen microscopically by dark-field examination andStain poorly but can be seen microscopically by dark-field examination and after silver impregnation staining.after silver impregnation staining.Require special media and conditions for growth; it may take weeks forRequire special media and conditions for growth; it may take weeks for cultures to become positivecultures to become positive
Morphology Morphology 
The Leptospira appear tighly coiled thin flexible SpritochetesThe Leptospira appear tighly coiled thin flexible SpritochetesFine spiral of 0.1 – 0.2 micronsFine spiral of 0.1 – 0.2 micronsOne end appears bent forms a hook.One end appears bent forms a hook.Actively motileActively motileSeen best with dark field Microscopy.Seen best with dark field Microscopy.
Greater Understanding with Electron Microscopy Greater Understanding with Electron Microscopy 
Electron Microscopy show thin axial filament and a delicate membraneElectron Microscopy show thin axial filament and a delicate membraneIn dark field it may appear as chain of miniature cocci.In dark field it may appear as chain of miniature cocci.
Comparative Morphology of Comparative Morphology of SpritochetesSpritochetes
 EPIDEMIOLOGYEPIDEMIOLOGY
Zoonosis with a worldwide distribution that affects at least 160 mammalianZoonosis with a worldwide distribution that affects at least 160 mammalian speciesspecies
 
Rodents, especially rats, are the most important reservoir, although otherRodents, especially rats, are the most important reservoir, although other wild mammals, dogs, fish, and birds may also harbor thesewild mammals, dogs, fish, and birds may also harbor these microorganisms.microorganisms.Establish a symbiotic relationship with their host and can persist in the renalEstablish a symbiotic relationship with their host and can persist in the renal tubules for yearstubules for years
Some serovars are associated with particular animals:Some serovars are associated with particular animals:
icterohaemorrhagiae/copenhageni : ratsicterohaemorrhagiae/copenhageni : ratsGrippotyphosa: volesGrippotyphosa: volesHardjo:cattleHardjo:cattleCanicola :dogsCanicola :dogspomona : pigs.pomona : pigs.
TransmissionTransmission
May follow direct contact with:May follow direct contact with:urineurinebloodbloodor tissue from an infected animalor tissue from an infected animalexposure to a contaminated environmentexposure to a contaminated environmenthuman-to-human transmission is rare.human-to-human transmission is rare.Excreted in the urine and can survive in water for many monthsExcreted in the urine and can survive in water for many monthsWater is an important vehicle in their transmission.Water is an important vehicle in their transmission.Epidemics may result from exposure to flood waters contaminated by urineEpidemics may result from exposure to flood waters contaminated by urine from infected animalsfrom infected animalsMost commonly in the tropics because of:Most commonly in the tropics because of:climateclimatepoor working and hygienic conditions favor the pathogen's survival.poor working and hygienic conditions favor the pathogen's survival.Certain occupational groups are at especially high risk; included are:Certain occupational groups are at especially high risk; included are:veterinariansveterinariansagricultural workersagricultural workerssewage workerssewage workersslaughterhouse employeesslaughterhouse employeesworkers in the fishing industryworkers in the fishing industry
OccupationOccupationCertain occupational groups such as agriculture workers in rice and caneCertain occupational groups such as agriculture workers in rice and cane fields, miners and sewer cleaners are potential victimsfields, miners and sewer cleaners are potential victims
Recreational exposure and domestic animal contact are also prominentRecreational exposure and domestic animal contact are also prominent sourcessourcesRecreational water activities, such as canoeing, windsurfing, swimming, andRecreational water activities, such as canoeing, windsurfing, swimming, and waterskiing, place persons at risk for leptospirosiswaterskiing, place persons at risk for leptospirosisIn a recent study in the Netherlands, 14% of patients with confirmedIn a recent study in the Netherlands, 14% of patients with confirmed leptospirosis had acquired the infection while traveling in tropicalleptospirosis had acquired the infection while traveling in tropical countries, mostly in Southeast Asia.countries, mostly in Southeast Asia.
 
Common during the rainy season in the tropics.Common during the rainy season in the tropics.
How Man gets Infected How Man gets Infected 
Water the great sourceWater the great sourceDrinkingDrinkingSwimmingSwimmingBathing, as the urine of Rodents chronically infected contaminateBathing, as the urine of Rodents chronically infected contaminate water sourceswater sources 
Children get infected when in contact with infected DogsChildren get infected when in contact with infected Dogs
PATHOGENESISPATHOGENESIS
Leptospires may enter the host through:Leptospires may enter the host through:abrasions in the skin or through intact mucous membranes (conjunctivaabrasions in the skin or through intact mucous membranes (conjunctiva and the lining of the oro- and nasopharynx)and the lining of the oro- and nasopharynx)Drinking of contaminated water may introduce leptospires through theDrinking of contaminated water may introduce leptospires through the mouth, throat, or esophagus.mouth, throat, or esophagus.After entry of the organisms: leptospiremia developsAfter entry of the organisms: leptospiremia developssubsequent spread to all organs.subsequent spread to all organs.Multiplication takes place in blood and in tissues.Multiplication takes place in blood and in tissues.leptospires can be isolated from blood and cerebrospinal fluid (CSF) duringleptospires can be isolated from blood and cerebrospinal fluid (CSF) during the first 4 to 10 days of illness.the first 4 to 10 days of illness.Can damage the wall of small blood vessels leading to vasculitis with leakageCan damage the wall of small blood vessels leading to vasculitis with leakage and extravasation of cells, including hemorrhages.and extravasation of cells, including hemorrhages.The most important known pathogenic properties are adhesion to cellThe most important known pathogenic properties are adhesion to cell surfaces and cellular toxicity.surfaces and cellular toxicity.Vasculitis is responsible for the most important manifestations of the disease.Vasculitis is responsible for the most important manifestations of the disease. Mainly infect the kidneys and liver, any organ may be affected.Mainly infect the kidneys and liver, any organ may be affected.In the kidney they migrate to the interstitium, renal tubules, and tubularIn the kidney they migrate to the interstitium, renal tubules, and tubular lumen, causing interstitial nephritis and tubular necrosis.lumen, causing interstitial nephritis and tubular necrosis.Hypovolemia:Hypovolemia:due to dehydrationdue to dehydrationaltered capillary permeability may contribute to the development of renalaltered capillary permeability may contribute to the development of renal failure.failure.In the liver, centrilobular necrosis with proliferation of Kupffer cells may beIn the liver, centrilobular necrosis with proliferation of Kupffer cells may be foundfoundPulmonary involvementPulmonary involvementresult of hemorrhage inflammation.result of hemorrhage inflammation.Invasion of skeletal muscleInvasion of skeletal muscleresults in swelling, and focal necrosis.results in swelling, and focal necrosis.In severe leptospirosis, vasculitis may ultimately impair the microcirculationIn severe leptospirosis, vasculitis may ultimately impair the microcirculation and increase capillary permeability, resulting in fluid leakage andand increase capillary permeability, resulting in fluid leakage and hypovolemia.hypovolemia.

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