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Leptospirosis

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Leptospirosis
Classification and external resources

Leptospirose magnified 200 times with dark-field microscope ICD-10 DiseasesDB MedlinePlus eMedicine MeSH A27. 7403 001376 med/1283 emerg/856 ped/1298 C01.252.400.511

Leptospirosis (also known as Weil's disease, Weil's syndrome, canicola fever, canefield fever, nanukayami fever, 7-day fever, "Fort Bragg fever," and "Pretibial fever"[1]:290) is 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. It was first described by Adolf Weil in 1886 when he reported an "acute infectious disease with enlargement of spleen, jaundice and nephritis". Leptospira was first observed in 1907 from a post mortem renal tissue slice.[2] Though being recognised among the world's most common zoonoses, leptospirosis is a relatively rare bacterial infection in humans. The infection is commonly transmitted to humans by allowing water that has been contaminated by animal urine to come in contact with unhealed breaks in the skin, eyes or with the mucous membranes. Outside of tropical areas, leptospirosis cases have a relatively distinct seasonality with most of them occurring August–September/February–March.

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1 Causes

mice and voles are important primary hosts. Leptospirosis is transmitted by the urine of an infected animal and is contagious as long as it is still moist. There have been reports of "house dogs" contracting leptospirosis apparently from licking the urine of infected mice that entered the house. ditches. The type of habitats most likely to carry infective bacteria are muddy riverbanks. that has at least 5 serovars of importance in the United States and Canada causing disease in dogs (Icterohaemorrhagiae. There is a direct correlation between the amount . an argument exists on the basis of strain identification. It should however be noted that genetically different leptospira organisms may be identical serologically and vice versa. Canicola. and even certain marine mammals are also able to carry and transmit the disease as secondary hosts. a wide range of other mammals including dogs. Pomona. raccoons. hedgehogs. gulleys and muddy livestock rearing areas where there is regular passage of either wild or farm mammals. Hence. cows. and Bratislava)[3] There are other (less common) infectious strains. The traditional serologic system is seemingly more useful from a diagnostic and epidemiologic standpoint at the moment (which may change with further development and spread of technologies like PCR). skunks. rabbits.1 µm polycarbonate filter Leptospirosis is caused by a spirochaete bacterium called Leptospira spp. sheep.• • • • • • • 2 Symptoms 3 Complications 4 Diagnostics 5 Treatment 6 References 7 External links 8 Further reading [edit] Causes Scanning electron microscope of a number of Leptospira sp. or drink from an infected puddle. Grippotyphosa. Although rats. Dogs may lick the urine of an infected animal off the grass or soil. deer. bacteria atop a 0. possums.

sewer workers.[5] Occupations at risk include veterinarians. and vomiting. fever. causing edema and potentially disseminated intravascular coagulation (DIC). and uveitis are also possible sequelae. the liver and kidney are most commonly damaged by leptospirosis. Leptospirosis is a biphasic disease that begins with flu-like symptoms (fever. failure to eat. Myocarditis. abdominal pain. liver damage (causing jaundice). slaughter house workers. Leptospirosis is also transmitted by the semen of infected animals.of rainfall and the incidence of leptospirosis.[4] Abattoir workers can contract the disease through contact with infected blood or body fluids. severe headache. Vomiting. making it seasonal in temperate climates and year-round in tropical climates. and/or a rash. intense headache). Humans become infected through contact with water. myalgias. meningitis. though the absence of jaundice does not eliminate the possibility of leptospirosis. [3] One should strongly suspect leptospirosis and include it as part of a differential diagnosis if the sclerae of the dog's eyes appear jaundiced (even slightly yellow). and lethargy are also indications of the disease. The first phase resolves. reduced urine output. Leptospirosis is common among watersport enthusiasts in specific areas as prolonged immersion in water is known to promote the entry of the bacteria. chills. because of the wide range of symptoms the infection is often wrongly diagnosed. The symptoms in humans appear after a 4–14 day incubation period. This leads to a lower registered number of cases than there really are. Vasculitis can occur. and some infected persons may have no symptoms at all. farmers. leptospiral infection causes a wide range of symptoms. and renal failure. splashing contaminated water into their eyes or nose. muscle aches. red eyes. and its presence could indicate hepatitis or other liver pathology rather than leptospirosis. diarrhea. and persons working on derelict buildings. or exposing open wounds to infected water. [edit] Complications . This is characterized by meningitis. In animals. chills. Symptoms of leptospirosis include high fever. unusually dark or brown urine.[3] [edit] Symptoms In humans. This may happen by swallowing contaminated food or water or through skin contact. The disease is not known to be spread from person to person and cases of bacterial dissemination in convalescence are extremely rare in humans. and the patient is briefly asymptomatic until the second phase begins. food. In dogs. pericarditis. and may include jaundice. the incubation period (time of exposure to first symptoms) is anywhere from 2 to 20 days. or soil containing urine from these infected animals. Surfers are especially at high risk in areas that have been shown to contain the bacteria and can contract the disease by swallowing contaminated water.

For forms with middle to high severity. Hence. extreme fatigue. even in children with jaundice. azotemia. and gamma-glutamyltransferase (GGT) levels are relatively mild. malaria and typhoid fever. and renal interstitial tubular necrosis. which is incubated at 28 to 30 °C.. hearing loss. the list includes dengue fever and other hemorrhagic fevers. Differential diagnosis list for leptospirosis is very large due to diverse symptomatics. [edit] Diagnostics Kidney tissue. developing countries) to specific diagnostic means. The latter reveal a moderate elevation of transaminases. Light forms should be distinguished from influenza and other related viral diseases. viral meningitis. respiratory distress. fresh urine and possibly fresh kidney biopsy. Diagnosis of leptospirosis is confirmed with tests such as Enzyme-Linked Immunosorbent Assay (ELISA) and PCR. Serological testing. Brief elevations of aspartate aminotransferase (AST). etc) and/or rodents in the medical history support the leptospirosis hypothesis and serve as indications for specific tests (if available). mainly in developing countries. using a silver staining technique. contact with stagnant contaminated water (Bathing swimming.[7] The median time to positivity is three weeks with a . alanine aminotransferase (ALT). which results in renal failure and often liver failure (the severe form of this disease is known as Weil's disease. Cardiovascular problems are also possible. the MAT (microscopic agglutination test). which is both laborious and expensive. Leptospira can be cultured in Ellinghausen-McCullough-Johnson-Harris medium. seasonality. These levels may be normal.g. Kidney function tests (Blood Urea Nitrogen and creatinine) as well as blood tests for liver functions are performed. Specific tests are a must for proper diagnosis of leptospirosis. revealing the presence of Leptospira bacteria On infection the microorganism can be found in blood for the first 7 to 10 days (invoking serologically identifiable reactions) and then moving to the kidneys. though it is sometimes named Weil Syndrome[6]). hepatitis of various etiologies. It is also possible to culture the microorganism from blood. working on flooded meadows.Complications include meningitis. Factors like certain dwelling areas. is considered the gold standard in diagnosing leptospirosis. it is underused. close attention must be paid to anamnesis of the patient. Under circumstances of limited access (e. serum. early diagnostic efforts include testing a serum or blood sample serologically with a panel of different strains. After 7 to 10 days the microorganism can be found in fresh urine. As a large panel of different leptospira need to be subcultured frequently.

Serum phosphorus levels may likewise increase to unacceptable levels due to renal failure. or oral administration of calcium carbonate. 4. Aetiotropic drugs are antibiotics. such as cefotaxime. Elevations of serum potassium are common and if the potassium level gets too high special measures must be taken. liver or heart involvement.nlm. William D. [edit] References 1. PMID 12910744. 2. (2006).g. Organ specific care and treatment are essential in cases of renal. Heuter KJ (July 2003). but not without first checking the serum calcium levels (these two levels are related). doi:10.. ^ James.fcgi? cmd=Retrieve&db=PubMed&list_uids=987112&dopt=Abstract." Public Health Reports 22:541. and are only effective for a few months. [edit] Treatment Leptospirosis treatment is a relatively complicated process comprising two main components: suppressing the causative agent and fighting possible complications. ampicillin. but is commonly used in research. ISBN 0-7216-2921-0.gov/entrez/query. in severe cases) include detoxication and normalization of the hydro-electrolytic balance. Saunders Elsevier. et al.Medical Dictionary definitions of popular medical terms easily defined on MedTerms . Doxycycline 200–250 mg once a week is administered as a prophylaxis. There are no human vaccines. penicillin is most commonly used to end the leptospiremic phase (infection of the blood). ^ Stimson AM (1907).[citation needed] In dogs. J Hyg Epidemiol Microbiol Immunol. doxycycline. Corticosteroids administration in gradually reduced doses (e.nih. Andrews' Diseases of the Skin: clinical Dermatology. 5. http://www. animal vaccines are only for a few strains. Berger. 21 (2): 207–213. "Note on an organism found in yellow-fever tissue. dialysis where appropriate. 3. Timothy G. ^ Kiktenko VS (1976). dialysis is used in serious cases. and amoxicillin (doxycycline can also be used as a prophylaxis). penicillin. A re-emerging zoonotic disease". and doxycycline is used to eliminate the carrier state... ^ Seven Surfing Sicknesses. Treatment for hyperphosphatemia consists of treating the underlying disease. Supportive therapy measures (esp.1016/S0195-5616(03)00026-3.ncbi. "Leptospirosis. This makes culture techniques useless for diagnostic purposes. Small animal practice 33 (4): 791–807. prednisolone starting from 30–60 mg) during 7–10 days is recommended by some specialists in cases of severe haemorrhagic effects.maximum of 3 months. ^ a b c Langston CE. 6. Human therapeutic dosage of drugs is as follows: doxycycline 100 mg orally every 12 hours for 1 week or penicillin 1–1. The Veterinary clinics of North America.5 MU every 4 hours for 1 week. ^ Weil syndrome definition . . Glucose and salt solution infusions may be administered. "Leptospirosis infection through insemination of animals".

7. J Clin Microbiol (3): 500–504. Alexander AD (1986). "Gellan gum as a substitute for agar in leptospiral media". ^ Rule PL. PMID 3754265 .

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