I.

Introduction to leptospirosis with Etiologic Agent

Leptospirosis is a disease caused by Leptospira interrogans, a corkscrew-
shaped spirochete that possesses a diverse array of pathogenic strain of
motile spirochetes. Spirochetes are described as gram-negative, aerobic
bacteria that use their flagella for moving around the environment.
II. Epidemiology:
Leptospirosis is considered as a widespread zoonotic disease that is
prevalent in the world, and is considered as an endemic disease in india,
central america, and the pacific rim. With the incidence of the disease being
higher in temperate and tropical regions. It is an under reported disease and
the current statistics are considered unreliable. A recent modeling exercise
done by the world health organization’s leptospirosis burden epidemiology
group estimates that there is an estimated 873,000 cases worldwide annually
accompanied by 48,600 deaths.
III. Pathogenesis
Leptospires may enter their target host via miniscule abrasions, integument
breaches, the conjunctiva, mucous membrane, and genital track. And
requires chemotaxis mechanisms for adhesion and transmembrane
passages. The bacteria then requires a vascular compartment, and may
settle in the convoluted tubules in the kidneys and can be released in the
urine for a period. Consequent symptoms appear when the number of
leptospires within the blood and tissues reaches a critical level. In several
serovars of leptospires, endotoxin activity has been observed. Leptospiral
lipopolysaccharide preparations exhibit activity within biological assays for
endotoxin which is similar to that of other gram-negative bacteria. Hemolysins
have been observed to be phospholopases that initiates cytolysis in cells that
possess substrate phospholipids in their cell membrane such as erythrocytes.
The doubling time for leptospires under optimal conditions range from 6-8
hours and their density is 109 cell/ml with the maintenance of virulence
requiring a regular passage of a susceptible animal. The endothelium of
small blood vessels are damaged leading to localized ischemia in organs, that
may result in renal tubular necrosis, pulmonary damage, meningitis, myositis,
and placentitis. The incubation period of leptospirosis depends on infective
dose, growth rate of organisms, their toxicity, and immunity. In possible hosts
such as humans, systemic infection can produce severe multi-organ
manifestations.
IV. Clinical manifestations:
Clinical manifestions of Leptospirosis may include but is not limited to : High
fever,Headaches, Chills, Myalgia,Vomiting, Jaundice, Conjunctivitis,
Abdominal pain,Diarrhea, and Rashes. Clinical manifestations of leptospirosis
may manifest in 2 days to 4 weeks of exposure to contaminated source with
the illness usually beginning with fever, Leptospirosis may occur in two
phases: The first phase can be accompanied by fever,chills,headache,muscle
aches, vomiting, and or diarrhea, the patient may recover but can become ill
again, If ever a second phase occurs, it is more severe with the person being
susceptible to kidney or liver failure or even meningitis. Leptospirosis may last
for a few days to 3 weeks or longer, if treatment is not applied, recovery may
take several months.
V. Diagnosis
For confirmation and discovery of the condition, laboratory findings remain a
reliable means as with most diseases encountered in the modern day. These
methods are as follows:

Microscopy methods such as Dark Field Microscopy (DFM), Light

Microscopy, Immunoflorescence and various Staining procedures have been
used in confirming the Leptospirosis. The advantage lies mainly in being able
to visualize leptospires in infected body fluids such as blood, urine and, rarely,
CSF. However, methods like DFM lack specificity and sensitivity, and they
may even lead to errors or false positives in some findings.

Raising Cultures remain a reliable and accurate means of obtaining absolute

confirmation on whether or not there is truly an infection, provided it is done
properly. Naturally, the method is cumbersome and more time-consuming
and is dependent on proper execution of the procedure.

A method known for its specificity and accuracy is through Serology.

Through antibody and antigen detection, methods such as Genus and
Serogroup Specific tests remain the gold standard in leptospirosis diagnosis;
able to be completed usually within 30 seconds to 4 hours, depending on
conditions and methods. However the method is complex, requiring
maintenance of strains for preparing live antigens.

Molecular Diagnosis through Dot-Blotting and In Situ Hybridization provide

an alternative means, specifically a method to successfully detect Leptospira
DNA in serum and urine in the first week of infection. It can also be used to
detect the DNA in tissues for postmortem analysis, as a last resort. Specificity
remains low, however; rendering it largely unsuitable for diagnosis in general.
 VI. Treatment :
Treatment of Leptospirosis patients may vary to a certain extent, depending
on their conditions. For example, a patient suffering the first phase may be
given treatment for fever, while others suffering from the second phase may
have their care focused on symptoms such as kidney failure or meningitis. In
general, however, it is treated with antibiotics such as doxycycline or
penicillin, to be given early in the course of the disease.

VII. Prognosis
Prognosis for the disease varies, depending on multiple factors. How early
the disease is discovered, diagnosed, and treated may end up deciding the
fate of the patient. As mentioned, prompt and correct antimicrobial therapy
can prevent the infection from worsening the condition of the patient.
Additionally, appropriate treatment and care of the patient and known
symptoms would further improve the patient’s survivability. For drugs, the
treatment is continued until the immune system is able to adapt to the disease
and is able to mount an effective means of combating the infection. In
conclusion, the disease can range from nonfatal to deadly, depending on how
it is managed.

VIII. Prevention
Infection can be possible when coming in contact with fresh water, vegetation,
or mud that has been contaminated by infected animals such as rodents.
Therefore, wearing protective equipment such as waterproof boots or legwear
should be done when engaging in activities or work in the aforementioned
environments. Additional measures such as rodent or pest control would go a
long way to improving conditions in the local environment. Furthermore,
vaccination of livestock like dairy cows would also go towards prevention.
Lastly, health education concerning Leptospirosis and other diseases is
crucial in minimizing, and eliminating, the presence of these illnesses in the
future.

Document by: Patricia Monique Brazil, Marco Cañeja, Bea Cedro, Elyjha Gabriel,
Duffnie Manalili, Kristen Danielle Manalo, Jino Rebosa, Vizzel Ayrah Saludo,
Duane Dominic Santiago and Augustine Martin Tan
References:

Centre for Health Protection, Department of Health - Leptospirosis. (n.d.). Retrieved

from https://www.chp.gov.hk/en/healthtopics/content/24/3056.html
Gordis, L. (2014). Epidemiology. Philadelphia, PA: Elsevier Saunders.
Leptospirosis. (2017, October 27). Retrieved from
https://www.cdc.gov/leptospirosis/symptoms/index.html
Mohammed, H., Nozha, C., Hakim, K., & Abdelaziz, F. (2011). LEPTOSPIRA:
Morphology, Classification and Pathogenesis. Journal of Bacteriology &
Parasitology,02(06). doi:10.4172/2155-9597.1000120