A case history


A 25 year old man is brought to the Out Patient Department with history of fever of 3 days duration with following symptoms & signs. High grade fever of continuous nature. Generalized aches & severe myalgia. Yellowish discoloration of eyes & urine. Non-specific head ache.


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Leptospirosis is a most widespread zoonotic disease in the world caused by the pathogenic bacteria called leptospires. Human to human transmission occurs only very rarely. Generally it is transmitted by the infected urine of rodents. Case fatality may vary from 0.3 ± 8 %. Severe form of leptospirosis is called Weil¶s Syndrome Also included as water borne & milk borne disease

Worldwide disease. € Most common in tropical & subtropical areas with high rainfall. € In India with frequent outbreaks in Maharashtra ,Gujarat,Karnataka , Kerala & Andaman islands especially during the monsoon.

Mud fever € Japanese seven day fever € Leptospiral Jaundice € Spirochete Jaundice € Autumn fever € Weil's disease € Rat Catcher's Yellows

History of Leptospirosis
1883 it was recognized as an occupational disease of sewer workers € 1886 first description (by Adolf Weil) of the clinical manifestations seen in 4 men -severe jaundice, fever, and hemorrhage with renal involvement € 1916 the causal agent was identified by Inada et al in Japan

Epidemiological determinants

Causative agent-Leptospira
Corkscrew -shaped delicate flexible spirochetes. € About 6 ± 20 micrometer long & 0.1 micrometer thick. € Posses a large number of closely wound spirals & characteristic end hooks. € Actively motile.

Leptospira -Too thin to visible under ordinary microscope. € dark field micros copy is using. € Order-Spirochaetals. € Family- Leptospiraceae. € Genus- Leptospira

Natural maintenance hosts
Rats ± icterohaemorrhagiae,copenhageni & smithi, etc € Dogs ± canicola etc € Cattle ± pomona ,hardjo ,etc

resistance- leptospira
Very susceptible to heat € 10 mnts at 50 degree centigrade € 10 seconds in 60 degree centi: € Sensitive to acid € Readily destroyed by chlorine

Reservoir of infection
Rodents ±(Rattus rattus ,Rattus norvegicus, Mus musculus ) € Dogs € Wild animals € Domesticated animals € Caged game animals

Source of infection

Leptospires are excreted in the urine of infected animals ,rodents etc.

Host factor

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Age ±most affected age group is 20-40 yrs Children acquire infection from domestic dogs Sex - males are more prone to get infection Occupation ± agricultural & live stock farmers Immunity ± A solid host specific immunity follows an infection

Risk groups
Agricultural & Live stock farmers € Workers in rice fields & sugar cane fields € Underground sewer € Meat & animal handlers € Swimmers

Environmental factors
Endemic in many countries. € Has a seasonal distribution. € Associated with Poor housing Limited water supply Inadequate method of waste disposal Rodent intensity

Leptospirosis as Epidemic€

Associated with 1. Changes in human behavior 2. Contamination of water by animal / sewage 3. Changes in animal reservoir density 4. Follow natural disasters like cyclones & floods

Incubation period

Usually 10 days Range- 4-20 days

Mode of transmission
1. Direct contact with urine or tissue of infected animal a.through skin abrasions b.intact mucus membrane 2. Indirect contacta.broken skin with infected soil, water or vegetation b.through ingestion of food & water contaminated with leptospira

Pathogenesis of severe disease
Leptospira Damage to small blood vessels vasculitis

Massive migration of fluid from Intravesicular to interstitial compartment

Direct cytotoxic injury Immunological injury

Renal dysfunction,vascular injury To internal organs

Clinical variety

Septicemic Stage 

Fever lasting 4-7 days Abrupt onset of high remittent fever, chills, headache, n/v, abdominal pain,myalgia Respiratory manifestations like cough, respiratory distress, bloody sputum Fever subsides by lysis and other symptoms improve

Clinical variety
2. Immune or Toxic Stage 
With or without jaundice  Lasting 4-30 days  If severe, death may occur bet. 9-16th day
a. Anicteric Type Leptospiruria b. Icteric Type

Weil Syndrome Major organs involvement

Clinical variety
3. Convalescence relapses may occur during 4th- 5th week

€ Suspected

clinically by

Deep jaundice Sub- conjunctival haemorrhage Muscle tenderness Decreased urine output Possible exposure to rat¶s urine

€ Culture

y Blood ± 1-7 days y Cerebrospinal Fluid ± 4- 10

days y Urine- after the 10th day until period of convalescence

Agglutination tests - done after 2nd or 3rd week
€ Dark field microscopy (MAT) € Culture from blood (IgM ELISA) € Macroscopic Slide Agglutination Test € PCR

Differential diagnosis
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Influenza; Dengue and dengue haemorrhagic fever; Yellow fever and other viral haemorrhagic fevers; Malaria Pyelo nephritis Aseptic meningitis Viral hepatitis Typhoid & other enteric fevers

Renal failure € Acute hepatic failure € Acute cardio vascular failure € Haemorrhage € Meningitis € pneumonia

Cause of death
Renal failure € Cardio pulmonary failure € Widespread haemorrhage € Liver failure rare

Recovery from Leptospirosis
Most patient recover completely. € Some patients may take months/years. € Late sequlae may occur.

General measures
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Complete bed rest Light easily digestible diet Plenty of oral fluids Anti-pyretic medication as needed Patients with complication shall be admitted Sodium, potassium & phosphorus may be restricted Nephrotoxic drugs should be avoided

Penicillin is the drug of choice when given early -7 days. € If penicillin allergic tetracycline /erythromycin.
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Early recognition and treatment within 2 days of illness

Management of severe cases
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Should be treated in higher centre with facilities for organ support. Organ dysfunction may be treated on standard lines. There is nothing specific treatment to leptospirosis. Hypovolemia should be corrected with normal saline. Adequate calories (1000Kcal+100Kcal/year of age) may be given.

Prevention & control
Should be targeted at the 1.Source of infection 2.Route of transmission 3.Level of human host

Source of infection

Possible interventions a. Rodent control. b. Infected animals can be treated with antibiotics. c. Immunization of pets & farm animals. d. Excreta of domestic animals should be disposed

Interventions at the transmission route
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Wearing protective clothings (boots,gloves ,aprons mask ,etc) . Covering skin lesions with water proof dressings. Strictly maintaining hygienic measures during handling all animals. Mechanization in agricultural operations. Disinfection of water & swimming pool with chlorine.

Interventions at the level of human host
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Raising awareness about the disease. Antibiotic prophylaxis- Doxycycline give some degree of protection.It can reduce the severity of disease. Immunization in available countries.Vaccine give protection only against the specific serovar. Health education.

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