CASE STUDY OF LEPTOSPIROSIS Synonym: Weils Dse, Mud fever, Canicola fever, Flood fever, Swineherds Dse, Japanese

Seven Days fever

Definition & Background:

a bacterial zoonotic disease caused by spirochaetes of the genus Leptospira that affects humans and a wide range of animals, including mammals, birds, amphibians, and reptiles first described by Adolf Weil in 1886 when he reported an acute infectious disease with enlargement of spleen, jaundice and nephritis

Causative Agent:

Leptospira-genus bacteria was isolated in 1907 from post mortem renal tissue slice commonly found: Leptospira pyrogenes, Leptospira manilae, & other species like L. icterohemorrhagiae, L. canicola, L. batavia, L. Pomona, L. javinica in animals often is subclinical; an infected animal may appear healthy even as it sheds leptospires in its urine; humans are dead-end hosts for the leptospire

Predisposing Factors:

age: < 15 years of age sex: male season: rainy months geographic: prevalent in slum areas

Source of Infection Infection comes form contaminated food and water, and infected wild life and domestic animals especially rodents. 1. Rats ( L. leterohemoragiae) are the source of Weils disease frequently observed among miners, sewer, and abattoir workers. 2. Dogs (L. canicola) can also be the source of infection among veterinarians, breeders, and owners of dogs. 3. Mice (L. grippotyphosa) may alos be a source of infection that attacks farmers and flax workers. 4. Rats (L. bataviae) are the source of infection that attacks ricefield workers. Modes of Transmission Incubation Period:

6 15 days/ 2 8 weeks

Clinical Manifestations: 1st stage: Septicemic/ Leptospiremic Phase (4 7 days) - onset of high remittent fever, chills, headache, anorexia, nausea & vomiting, abdominal pain, joint pains, muscle pains, myalgia, severe prostration, cough, respiratory distress, bloody sputum. 2nd stage: Immune/ Toxic Phase (4 30 days) - if severe, death may occur between the 9th & 16th day 2 types:

Anicteric (without jaundice) return of fever of a lower degree with rash, conjunctival injection, headache, meningeal manifestations like disorientation, convulsions & signs of meningeal irritations (with CSF finding of aseptic meningitis) Icteric (with jaundice) Weil syndrome; hepatic & renal manifestations: hemorrhage, hepatomegaly, hyperbilirubinemia, oliguria, anuria with progressive renal failure; shock, coma & congestive heart failure in severe cases

3rd stage: Convalescence Phase - Relapses may occur during 4th or 5th week

Diagnosis:

culture:

blood (1st week)

CSF (5th to 12th day) Urine (after 1st wk til pd of convalescence)

agglutination tests ( 2nd or 3rd week)

PATHOPHYSIOLOGY Complications:

pneumonia iridocyclitis, optic neuritis peripheral neuritis

Prognosis:

cause of death: renal & hepatic failure dse usually last 1 3 weeks but may be more prolonged; relapse may occur

Treatment:

specific measures: beneficial if done < 4 days of dse Aqueous penicillin G (50,000 units/kg/day in 4-6 divided doses intravenously for 7-10 days Tetracycline (20-40 mg/kg/day in 4 doses); may not be given to children < 8 years old general measures symptomatic & supportice care administration of fluid, electrolytes & blood as indicated peritoneal dialysis (for renal failure)

Nursing Interventions:

isolation of patient: urine must be properly disposed health teachings: keep a clean environment

Leptospirosis is a bacterial disease that affects humans and animals. It is caused by bacteria of the genus Leptospira. In humans it causes a wide range of symptoms, and some infected persons may have no symptoms at all. Symptoms of leptospirosis include

high fever, severe headache, chills, muscle aches, and vomiting, and may include jaundice (yellow skin and eyes), red eyes, abdominal pain, diarrhea, or a rash. If the disease is not treated, the patient could develop kidney damage, meningitis (inflammation of the membrane around the brain and spinal cord), liver failure, and respiratory distress.