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LEPTO-HEPA

LEPTO-HEPA

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Published by: Patrick Paterno on Jan 06, 2011
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What is leptospirosis?

Leptospirosis is an infectious disease caused by a particular type of bacteria called a spirochete. Leptospirosis can be transmitted by many animals such as rats, skunks, opossums, raccoons, foxes, and other vermin. It is transmitted though contact with infected soil or water. The soil or water is contaminated with the waste products of an infected animal. People contract the disease by either ingesting contaminated food or water or by broken skin and mucous membrane (eyes, nose, sinuses, mouth) contact with the contaminated water or soil. Leptospirosis occurs worldwide, but it is most commonly acquired in the tropics. The U.S. Centers for Disease Control and Prevention states 100-200 cases of leptospirosis are reported each year in the United States, with about 50% of cases occurring in Hawaii.

What are symptoms of leptospirosis?
Leptospirosis symptoms begin from two to 25 days after initial direct exposure to the urine or tissue of an infected animal. This can even occur via contaminated soil or water. Veterinarians, pet shop owners, sewage workers, and farm employees are at particularly high risk. People participating in outdoor sporting activities like canoeing, rafting, hiking, and camping can also come into contact with contaminated water or soil. The illness typically progresses through two phases: y The first phase of nonspecific flulike symptoms includes headaches, muscle aches, eye pain with bright lights, followed by chills and fever. Watering and redness of the eyes occurs and symptoms seem to improve by the fifth to ninth day. The second phase begins after a few days of feeling well. The initial symptoms recur with fever and aching with stiffness of the neck. Some patients develop serious inflammation of the nerves to the eyes, brain, spinal column (meningitis), or other nerves. Right upper area abdominal pain may occur. Less common symptoms relate to disease of the liver, lungs, kidneys, and heart. Leptospirosis associated with liver and kidney disease is called Weil's syndrome and is characterized by yellowing of the eyes (jaundice). Patients with Weil's syndrome can also develop kidney disease and have more serious involvement of the organs affected.

y

How is leptospirosis diagnosed?
The diagnosis of leptospirosis is made by culture of the bacterial organism Leptospirafrom infected blood, spinal fluid, or urine. However, many doctors must rely upon risingLeptospira antibody levels in the blood in order to make the diagnosis, as the technique required to perform the culturing is delicate and difficult.

How is leptospirosis treated?

Many illnesses and conditions can cause inflammation of the liver. Leptospirosis was a reportable disease in the United States. do not primarily attack the liver. they usually are referring to hepatitis caused by a few specific viruses that primarily attack the liver. It is not currently available in the United States. chemicals. Remember to wash your hands frequently with soap and water after cleaning up waste from your pet. Most viruses. Your pet can contract it in the same ways you can (ingesting contaminated soil. E. Most previously healthy patients will make a full recovery. D. depending on the severity of organ dysfunction and the patient's general health prior to infection. If you suspect your pet is ill. even in severe cases. However. use latex or rubber gloves to do the job of clean up. F (not . however. can take 200 mg of doxycyline per week by mouth starting before and during the time period of potential exposure. C. When doctors speak of viral hepatitis. B. Early antibiotic treatment often can limit or prevent organ damage. Can my pets get leptospirosis? According to the CDC. weight loss. It is. Your pet may exhibit vomiting. If your pet is diagnosed with leptospirosis. and autoimmune diseases. Use a diluted (1:10 parts) bleach solution to clean surfaces where pet wastes may have contaminated. but it was removed from the national CDC list of reportable diseases. take them to a veterinarian for testing and treatment. alcohol. they have been named types A. Antibiotic treatment (doxycycline. still reportable in some states. Discuss other petcare issues directly with your vet should you have any other questions regarding the disease What is viral hepatitis? Hepatitis means inflammation of theliver. refusal to eat. muscle pains. Many viruses. water or through skin wounds). your pets (especially dogs. for example. less commonly cats) can contract leptospirosis. the liver is just one of several organs that the viruses affect. decreased activity. Severe liver and kidney manifestations of the infection may require intensive medical care and sometimesdialysis treatment. the virus of mononucleosis and thecytomegalovirus can inflame the liver. most notably Hawaii.The treatment of leptospirosis involves high doses of antibiotics. you must be careful to try to prevent exposure to yourself or other household members. liver and kidney function often does return after recovery from the illness. A vaccine for leptospirosis is available and used in Europe and Asia. And make sure your pet receives the full course of antibiotic treatment that is prescribed by your vet. Severely ill patients may need hospitalization for IV fluid and antibiotic treatment. for example. however. If possible. It must be given every year like a flu shot. penicillin) is most effective when initiated early in the course of the illness. Mortality rates for severe illness with leptospirosis can range from 5%-40%. Travelers who are going to an area where leptospirosis is common and who will be engaged in activities that increase likelihood of exposure. There are several hepatitis viruses. or stiffness. drugs.

such as medications or alcohol. and problems associated with hepatitis. As our knowledge of hepatitis viruses grows." because it was thought that the only way hepatitis B virus (HBV) could spread was through blood or serum (the liquid portion of blood) containing the virus. Hepatitis A typically is spread among household members and close contacts through the passage of oral secretions (intimate kissing) or stool (poor hand washing). the transfer of blood or serum through shared needles in drug abusers. more complicated chemicals that are needed elsewhere in the body. The liver stores many sugars. the protein building block of the body.000 new cases of viral hepatitis that occur each year in the United States. it is likely that this alphabetical list will become longer. especially where unsanitary conditions allow water or food to become contaminated by human waste containing hepatitis A (the fecal-oral mode of transmission).confirmed). The most common hepatitis viruses are types A. body piercing. mostly behind the rib cage. 2. hemodialysis. Typically. as well as the proteins that cause blood to clot properly. It is now known that hepatitis B can spread by sexual contact. signs. and by infected mothers to their newborns. At one time. or internal. these harmful chemicals are broken down into smaller chemicals or attached to other chemicals that then are eliminated from the body in the urine or stool. Infection with hepatitis A virus can be spread through the ingestion of food or water. The liver builds smaller chemicals into larger. The liver produces many important substances. it does not perform these functions well. For example.000-600. Hepatitis B There are 200.000 of the 500. When the liver is inflamed. The liver helps purify the blood by changing harmful chemicals into harmless ones. blood transfusions. The infection also can be spread by tattooing. and G. 4. hepatitis A was referred to as "infectious hepatitis" because it could be spread from person to person like other viral infections. Type B hepatitis was at one time referred to as "serum hepatitis. The liver is located in the upper right hand side of the abdomen. and C. B. and sharing razors and toothbrushes (if there is . accidental needle sticks with needles contaminated with infected blood.000-300. such as ammonia orbilirubin.000 new cases of viral hepatitis B (HBV) infection each year in the United States. it produces albumin. especially proteins that are necessary for good health. What are the common types of viral hepatitis? Hepatitis A Viral hepatitis A (HAV) accounts for about 150. The liver performs the following vital functions: 1. which brings about many of the symptoms. It also is common to have infection spread to customers in restaurants and among children and workers in day care centers if hand washing and sanitary precautions are not observed.fats and vitamins until they are needed elsewhere in the body. The source of these chemicals can be external. The hepatitis caused by HAV is an acute illness (acute viral hepatitis) that never becomes chronic. 3. The liver of an adult normally weighs close to three pounds. An example of this type of function is the manufacture ofcholesterol.

Patients who already have chronic hepatitis B infection can acquire delta virus infection at the same time as they acquire the hepatitis B infection or. The ways in which hepatitis D is spread are by shared needles among drug abusers. the combination of delta and B virus infection is very difficult to treat. please see the Hepatitis C article. Hepatitis A has an incubation period of about 15-45 days. Patients with chronic hepatitis B infection also are at risk of developing cirrhosis. hepatitis B from 45-160 days. What are the symptoms and signs of viral hepatitis? The period of time between exposure to hepatitis and the onset of the illness is called the incubation period. also known as the delta virus or agent. Hepatitis C There are about 150. blood transfusion. hemodialysis. The hepatitis C virus (HCV) usually is spread by shared needles among drug abusers. The most important of these at present is the hepatitis D virus (HDV). but is considered rare. Approximately 90% of transfusion-associated hepatitis is caused by hepatitis C. Many patients infected with hepatitis A. contaminated blood. An estimated 50-70% of patients with acute hepatitis C infection develop chronic HCV infection. Patients with chronic hepatitis due to hepatitis B and hepatitis D viruses develop cirrhosis (severe liver scarring) rapidly." because the causative virus had not been identified. B. Transmission of the virus by sexual contact has been reported. About 6-10% of patients with hepatitis B develop chronic HBV infection (infection lasting at least six months and often years to decades) and can infect others as long as they remain infected. Type C hepatitis was previously referred to as "non-A. and liver cancer. F. Patients with chronic hepatitis C infection are at risk for developing cirrhosis. liver failure.like symptoms including: y y y loss of appetite nausea vomiting . Patients with chronic hepatitis C infection can continue to infect others.contamination with infected blood).2 million people in the United States and 200300 million people world-wide who suffer with chronic hepatitis B infection. HDV cannot survive on its own because it requires a protein that the hepatitis B virus makes (the envelope protein. For those who do develop symptoms of viral hepatitis. on top of a chronic hepatitis B infection. F (not confirmed yet). and G. It is estimated that there are about 3. liver failure and liver cancer.5 million people with chronic hepatitis C infection in the United States. and G Hepatitis There also are viral hepatitis types D. E. E. Types D. Moreover. the most common are flu. also called surface antigen) to enable it to infect liver cells. For more. essentially the same ways as for hepatitis B. and hepatitis C from 2 weeks to 6 months. It is estimated that there are 1. and by sexual contact. but it was known to be neither hepatitis A nor hepatitis B. alternatively. non-B hepatitis.000 new cases of hepatitis C each year. article. It is a small virus that requires concomitant infection with hepatitis B to survive. The incubation period varies depending on the specific hepatitis virus. and C have few or no symptoms of illness. and needle sticks.

viral antibodies. and jaundice usually subside in several weeks to months. virtually all patients with acute infection with hepatitis A and most adults (greater than 95%) with acute hepatitis B recover completely. On the other hand. Patients who develop chronic infection have chronic viral hepatitis and often need treatment to prevent further liver damage. not all patients with viral hepatitis infections recover completely. the hepatitis virus has been completely eliminated from the liver by the body's immune system. Five percent of patients with acute hepatitis B infection and 80% of patients with acute hepatitis C infection develop chronic hepatitis. these patients can remain undiagnosed for years to decades. these patients do not have jaundice until the liver damage is far advanced. without any specific treatment. When a patient reports symptoms of fatigue. Unfortunately. and viral genetic materials. nausea. 3. nausea. and then develops jaundice. and 4. Symptoms and physical findings Diagnosis of acute viral hepatitis often is easy. the inflammation in the liver subsides. How is viral hepatitis diagnosed? Diagnosis of viral hepatitis is based on symptoms. In fact. Therefore. the patient develops immunity to future infection with the same virus. the patient cannot transmit the infection to others. Complete recovery from viral hepatitis means 1. darkening of urine. abdominal pain. patients with chronic hepatitis due to hepatitis B and hepatitis C often have no symptoms or only mild nonspecific symptoms such as chronic fatigue. Symptoms of viral hepatitis such as fatigue. but diagnosis of chronic hepatitis can be difficult. poor appetite. the diagnosis of acute viral hepatitis is likely and can be confirmed by blood tests.y y y y fever weakness tiredness aching in the abdomen Less common symptoms include: y y y y dark urine light-colored stools fever jaundice (a yellow appearance to the skin and white portion of the eyes) What is the prognosis of viral hepatitis? The prognosis of viral hepatitis for most patients is good. . Typically. Acute viral hepatitis needs no specific treatment. physical findings as well as blood tests for liver enzymes. 2.

Therefore.How is viral hepatitis treated? Treatment of acute viral hepatitis and chronic viral hepatitis are different. Medications for chronic hepatitis C infection include: y y injectable interferon oral ribavirin Medications for chronic hepatitis B infection include: y y y y injectable interferon oral lamivudine (Epivir) oral adefovir (Hepsera) oral entecavir (Baraclude) Decisions regarding treatment of chronic hepatitis can be complex. Chronic hepatitis Treatment of chronic infection with hepatitis B and hepatitis C usually involves medication or combinations of medications to eradicate the virus. Treatment of acute viral hepatitis involves relieving symptoms and maintaining adequate intake of fluids. The patient must abstain from drinking alcohol since alcohol is toxic to the liver. Only those medications that are considered necessary should be administered since the impaired liver is not able to eliminate drugs normally. and can cause more rapid progression to cirrhosis. Careful attention should be given to medications which can have adverse effects in patients with abnormal liver function. Alcohol aggravates liver damage in chronic hepatitis. Smoking cigarettes also can aggravate liver disease and should be stopped. It occasionally is necessary to provide intravenous fluids to prevent dehydration caused by vomiting. and should be directed by gastroenterologists or hepatologists (doctors specially trained in treating diseases of the liver) for several reasons including: . In addition. sedatives and "tranquilizers" are avoided because they may accentuate the effects of liver failure on the brain and cause lethargy and coma. and liver cancer. successful eradication of the viruses can stop progressive damage to the liver and prevent the development of cirrhosis. Acute hepatitis In patients with acute viral hepatitis. Treatment of chronic viral hepatitis involves medications to eradicate the virus and taking measures to prevent further liver damage. and drugs may accumulate in the blood and reach toxic levels. liver failure. patients with chronic hepatitis should stop drinking alcohol. the initial treatment consists of relieving the symptoms of nausea. Patients with severe nausea and/or vomiting may need to be hospitalized for treatment and intravenous fluids. vomiting. Doctors believe that in properly selected patients. and abdominal pain.

intravenous drug abusers. Blood transfusion is a rare cause of viral hepatitis. Even with prolonged treatment. 4. injectable immunoglobulins or vaccines. y y y y y y y . Viruses that primarily attack the liver are called hepatitis viruses. and the diagnosis of chronic hepatitis often is delayed. There are several different strains of hepatitis C viruses with differing susceptibilities to medications. The symptoms of chronic viral hepatitis often are mild and nonspecific. Sometimes aliver biopsy may have to be performed for confirmation of liver damage. and C are the most common. Doctors experienced in managing chronic liver diseases must weigh the risk of liver biopsy against the potential benefits of the biopsy. and doses may have to be reduced. acute viral hepatitis causes fulminant hepatic failure. hepatitis C type 3 is more likely to respond to interferon injections and ribavirin than type 1. Symptoms of acute viral hepatitis include fatigue. B. 2. B. cirrhosis. All hepatitis viruses can cause acute hepatitis. Some patients need no treatment (since some patients with chronic hepatitis B and C do not develop progressive liver damage or liver cancer). E. fever. flu-like symptoms. and liver cancer Hepatitis infections can be prevented by avoiding exposure to viruses. Prolonged treatment (6 months to years) often is necessary. rates of successful treatment (defined as complete and lasting eradication of the virus) often are low (usually less than 80% and often around 50%). dark urine. light-colored stools. The diagnosis of chronic viral hepatitis may not be straightforward. Some of the medications such as interferon and ribavirin can have serious side effects. liver failure. Viral hepatitis types B and C can cause chronic hepatitis. 5. F (not yet confirmed). 3.1. Types A. For example. Not all patients with chronic viral hepatitis are candidates for treatment. Viral Hepatitis At A Glance y y Many illnesses and conditions can cause inflammation of the liver (hepatitis). D. Those at risk for viral hepatitis include workers in the health care profession. There are several types of hepatitis viruses including types A. Certain hepatitis B strains are resistant to lamivudine but respond to adefovir or entecavir. Chronic viral hepatitis often requires treatment in order to prevent progressive liver damage. and G. people with multiple sexual partners. C. and hemophiliacs. Rarely. and jaundice. Medications for chronic infection with hepatitis B and hepatitis C are not always effective.

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