Leptospirosis

Introduction Weils Syndrome Dangerous

Pretibial (Forg Bragg) Fever
Myocarditis
Aseptic Meningitis
Clinical Incubation period: 2-20 (7-113) days
Manifestations A. Leptospiremic Phase B. Immune Phase C. Convalescent Phase
Lasts 4-9 days ~ appearance of igm antibodies ~ between the second & fourth weeks
Leptospires are present in the: ~ c3 in serum is normal range ~ fever and aching recur
blood and cerebrospinal fluid ~ cerebrospinal fluid: pleocytosis
Symptoms: ~ lepto dalam darah/ dalam csf
Abrupt fever to 37-40c Symptoms
Recurrent chills - asymptomatic 1-2 days
Abdominal pain - fever 1-3 days duration
Anorexia, nausea, vomiting - anoreksia
Diarrhea - mual/muntah
Photophobia - diare
Severe headache: - sefalgia
- frontal - mialgia betis, paha, pinggang
- <retro-orbital DHF - batuk / sakit dada
- bitemporal Signs
- occipital ~ meningismus
pulmonary manifestations: ~ irdocyclitis
cough ~ optic neuritis
chest pain ~ encephalitis
hemoptysis is rare ~ myelitis
adult respiratory distress ~ peripheral neuropathy
syndrome (ards) ~ conjunctival suffusion (conjunctival
severe muscle aching: tights, lumbar injection)
area, cutaneous hyperesthesia
(causalgia), and myalgia calf
muscle/gastrocnemius !!!

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 Signs
~ relative bradycardia
~ normal blood pressure/hypotension
~ disturbances in the sensorium
~ conjunctival suffusion !!!
~ purulent conjunctivitis
~ pharyngeal injection
~ cutaneous hemorrhages
~ skin rashes > on the trunk
~ splenomegaly <
~ hepatomegaly <
~ lymphadenopathy
~ jaundice

Kriteria Beratnya
Leptospira
Perlapangan
Penglihatan
Pembesaran 10 X
40
Specific Features Weils Syndrome Aseptic Meningitis Pretibial ( fort bragg) fever Myocarditis
Severe Leptospirosis ~ pleocytosis is present after the Development of a rash: - cardiac arrhytmias
~ Clinical Manifestations: immune phase - on about the fourth day - atrial fibrilation
- jaundice ~ leukocytes tens - slightly raised - atrial flutter
- azotemia hundreds/mm3 - erythematous lesions usually - ventricular contactions
- hemorrhages >>neutrophils or mononuclear symmetrically distributed over - acute left ventricular failure
- anemia cells the pretibial areas - jaundice
- disturbances in consciousness ~ CSF glucose normal - splenomegaly 95% - pulmonary infiltrates
- continued fever several ~ CSF protein > 100 mg% - arthritis
weeks ~ xanthochromic CSF - skin rashes
- renal or hepatic manifestations
- hepatic tenderness &
enlargement

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 - SGOT <4x
hyperbilirubinemia >> direct
serum bilirubin of 40 mg/dl
with SGOT of 170 IU
Renal manifestation:
- proteinuria
- pyuria
- hematuria
- azotemia
- dysuria is rare
- acute tubular necrosis
oliguria
- blood urea nitrogen (BUN)
- hemorrhagic manifestation
- hypoprothrombinemia
- thrombocytopenia
Treatment Antimicrobial Drugs Supportive Therapy
~ Penicillin G/ Pp ~ early bed rest
~ Streptomycin
~ Tetracycline ~ fluid & electrolyte
~ Chloramphenicol
~ peritoneal dialysis/hemodialysis azotemia
~ Erythromycin
~ Ceftriaxon 2-3 Grms Daily
~ exchange transfusion hyperbilirubunemia
~ Must Be Administered Within 2-4 Days, of The Onset Of Illness

Prognosis ~ the virulence of the organism the jaundice: anicteric patients death << and jaundice mortality 15-40%
~ the general condition of the patient
~ mortality rate: * 10% in <50 yrs
* 56% in > 51 yrs
Reference:

Bahan Kuliah. Mubin, R. Leptospirosis. 2011

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