CASE PRESENTATION: LEPTOSPIROSIS
Cabanilla, Jan Ezra T.
DISEASE CONDITION: Leptospirosis
Leptospirosis is a disease that is caused by
pathogenic spirochetes of the genus Leptospira
Interrogans. It is a bacterial infection passed from
animals to humans by way of contaminated urine. The
bacteria penetrate mucous membranes or breaks in the
skin, multiply in the bloodstream, and carried to all parts
of the body.
Causes of Leptospirosis
Leptospirosis is not only acquired from
absorbing contaminated floodwaters through cuts in the
skin but also by swallowing the bacteria directly from
water or through food. Although the disease is
commonly associated with rat urine, the infection can
also come from animals like cattle, pigs, horses, dogs,
and wild animals.
PATHOPHYSIOLOGY
The most consistent pathologic finding in
leptospirosis is vasculitis of capillaries, manifested by
endothelial edema, necrosis, and lymphocytic
infiltration. Capillary vasculitis is found in every
affected organ system. The resulting loss of red blood
cells and fluid through enlarged junctions and fenestrae,
which cause secondary tissue injury, probably accounts
for many of the clinical findings.
In the kidneys, leptospires migrate to the
interstitium, renal tubules, and tubular lumen, causing
interstitial nephritis and tubular necrosis. Capillary
vasculitis is readily identified.
Liver involvement is marked by centrilobular
necrosis and Kupffer cell proliferation. Jaundice may
occur as a result of hepatocellular dysfunction.
Pulmonary involvement is secondary to alveolar
and interstitial vascular damage resulting in hemorrhage
Hemorrhage, focal necrosis, and inflammatory
infiltration have been documented within the adrenal
gland.
The skin is affected by epithelial vascular insult.
Skeletal muscle involvement is secondary to edema,
myofibril vacuolization, and vessel damage.
The damage to the vascular system as a whole
can result in capillary leakage, hypovolemia, and shock.
If the host survives the acute infection,
septicemia and multiplication of the organism persist
until the development of opsonizing immunoglobulin in
the plasma, followed by rapid immune clearance.
Despite clearance from the blood, leptospires
may remain in immunologically privileged sites,
including the renal tubules, brain, and aqueous humor of
the eye, for weeks to months.
CAUSES AND SIGNS & SYMPTOMS
Leptospirosis
Causes:
The bacteria Leptospira causes leptospirosis. Bacteria
get into your body through your mouth, nose or eyes or
through breaks in your skin.
Signs and symptoms:
Acute leptospirosis
 High fever.
 Red eyes (conjunctival injection).
 Headache.
 Chills.
 Muscle aches.
 Abdominal pain.
 Nausea and vomiting.
 Diarrhea.
 Yellow skin or eyes (jaundice).
 Rash.
 CASE PRESENTATION: LEPTOSPIROSIS
Cabanilla, Jan Ezra T.

Severe leptospirosis (Weil’s syndrome)  Report all cases of leptospirosis.

 Investigation of contacts and source of infection
 Coughing up blood (hemoptysis).
 Chemoprophylaxis can be done in a group of
 Chest pain.
high-risk infected hosts
 Trouble breathing.
 Severe yellowing of your skin or eyes.
 Black, tarry poop (stool).
TREATMENT
 Blood in your pee (hematuria).
 Decrease in the amount you pee (urinate).  Penicillins and other B- lactam antibiotics(PCN
 Flat, red spots on your skin that look like a rash at 2M units q6H IM/IV)
(petechiae).  Tetracycline(Doxycycline at 100mg q12H PO)
 Erythromycin (500mg q12H PO)- if allergic to
Penicillin
DIAGNOSTIC TESTS
The most common way to diagnose leptospirosis
is through serological tests either the Microscopic
Agglutination Test (MAT) which detects serovar-
specific antibodies, or a solid-phase assay for the
detection of Immunoglobulin M (IgM) antibodies.

NURSING MANAGEMENT
Supportive care - In the setting of severe illness due to
leptospirosis, supportive care with renal replacement
therapy, ventilatory support, and blood products may
also be required. In general, such management is the
same as organ failure due to other causes of sepsis.
Health teaching

 Provide education to clients telling them to

avoid swimming or wading in potentially
contaminated water or flood water.
 Use of proper protection like boots and gloves
when work requires exposure to contaminated
water.
 Drain potentially contaminated water when
possible.
 Control rats in the household by using rat traps
or rat poison, maintaining cleanliness in the
house.
Management

 Isolate the patient and concurrent disinfection of

soiled articles.
 Stringent community-wide rat eradication
program. Remove rubbish from work and
domestic environment to reduce the rodent
population.