HOW WE DIAGNOSED

LEPTOSPIROSIS??

Donnie Lumban Gaol, MD, Internist

Internal Medicine Dept.
 LEPTOSPIROSIS IN THE WORLD
Incidence of severe cases 300,000-500,000 per year
Discovery of Pathogen
in 1915

Ryoukichi Inada
（1874-1950）
 CAUSATIVE AGENT

• highly motile
•

• flexible
• helical or coiled
• aerobic bacteria
• with bent or hooked Spirochaeta icterohaemorrhagiae

ends Yasuda et al. Deoxiribonucleic acid relatedness between seogroups and

serovars in the family Leptospiraceae. Int J Sys Bacteriol 1987; 407-415
SENSITIVITY

• killed at 500C in 10 mins or 600C in 10 seconds

• susceptible to dessication, hypochlorite disinfectants and pH

outside of 6.2 to 8.0

• acid urine, non-aerated sewage and polluted water

• Leptospires can survive in untreated water for months or
years, but cannot survive desiccation or salt water.
PHENOTYPIC CLASSIFICATION OF LEPTOSPIRES
 TRANSMISSION CYCLE OF LEPTOSPIROSIS
DIRECT CONTACT

• thru tissue or urine of

infected animals
• ingestion of contam food
• droplet aerosol inhalation

• contact with moist • swimming or wading in

soil or vegetation floodwaters
contaminated with • accidental immersion
urine of infected animals INDIRECT CONTACT
• occupational abrasion
HOW THEY INFECT????
• The organisms can penetrate abraded skin or intact mucous membrane,
after which they enter the circulation and rapidly disseminate to various
tissues.
CLINICAL MANIFESTATIONS
• influenza-like illness with headache and myalgia.
• Severe leptospirosis, characterized by jaundice, renal
dysfunction, and hemorrhagic diathesis, is referred to as Weil’s
syndrome.
• Incubation Period: 2-26 days (usually 7-12 days))
• clinical manifestation can be divided into two distinct clinical
syndromes. 90% of patients present with mild anicteric febrile
illness; 10% are severely ill with jaundice and other
manifestations (Weil’s disease).
ANICTERIC LEPTOSPIROSIS (SEPTICEMIC
PHASE)
• first or septicemic phase, patients usually present
• with an abrupt onset of fever, chills, headache, myalgia, skin
rash, nausea, vomiting, conjunctival suffusion, and prostration.
• Leptospires can be isolated from blood, cerebrospinal fluid
(CSF), and tissues.
• The fever may be high and remittent reaching a peak of 40°C
before defervescence.
• Conjunctival suffusion is found in the third day
ANICTERIC LEPTOSPIROSIS (SEPTICEMIC
PHASE)
• Myalgias usually involve the muscles in the calf, abdomen, and
paraspinal region and can be severe. When present in the neck,
myalgias may cause nuchal rigidity reminiscent of meningitis.

• The first phase lasts 3-9 days followed by 2-3 days of

defervescence, after which the second or “immune” phase
develops.
ANICTERIC LEPTOSPIROSIS (THE IMMUNE
PHASE)
• Leptospiruria and correlates with the appearance of IgM
antibodies in the serum.
• Leptospira now settle in glomeruli
• Fever and earlier constitutional symptoms recur in some
patients, and signs of meningitis, such as headache,
photophobia, and nuchal rigidity may develop.
• Central nervous system (CNS) involvement in leptospirosis most
commonly occurs as aseptic
• meningitis.
ANICTERIC LEPTOSPIROSIS (THE IMMUNE
PHASE)
• Complications such as optic neuritis, uveitis, iridocyclitis,
chorioretinitis, and peripheral neuropathy occur more frequently
in the immune phase.
• The illness in anicteric leptospirosis may be self-limited, lasting
4-30 days, with complete recovery as a rule.
ICTERIC LEPTOSPIROSIS (WEIL’S SYNDROME)
• (usually caused by L. icterohaemorrhagiae)
• persistent high fever and jaundice may obscure the two phases.
• This is usually associated with hepatic dysfunction, renal
insufficiency, hemorrhage and multi-organ failure (MOF).
• Hemorrhage can occur as petechiae, purpura, conjunctival
hemorrhage and gastrointestinal hemorrhage.
 Anicteric Leptospirosis Icteric Leptospirosis
Weil's Syndrome

First stage Second stage First stage Second stage

3-7 days 0-1 month 3-7 days 10-30 days

Septicemic Immune Septicemic Immune

fever

Myalgia/ Meningitis Jaundice

Clinical findings

Myositis Uveitis Hemorrhage

Important

Abdominal Rash Renal failure

pain Fever Myocarditis
Conjunctival Meningitis
Pulmonary
suffusion
hemorrhage
Respiratory
failure
present

Blood Blood
Lepto

CSF CSF
urine urine
Signs and Symptoms of Leptospirosis

Icterus and hemorrhage

Acute renal failure

DIAGNOSIS OF LEPTOSPIRA
DIFFERENT STAGES OF LEPTOSPIROSIS
LEVEL AND DURATION OF IGM ANTIBODIES AT
DIFFERENT TIME INTERVALS
 LEVEL AND DURATION OF MICROSCOPIC
AGGLUTINATING ANTIBODIES AT DIFFERENT TIME
INTERVALS
IMMUNOFLOURESCENCE
TREATMENT

• Early anti-microbial therapy is importantshorten the course and prevent carrier state
• Choice : Penicillin G, Ampicillin
• May cause “ Jarish-Huxheimer type reaction”
• Mild cases oral Doxycycline or Amoxicillin
• Penicillin (e.g. 6 million units daily intravenously) is the drug of choice in severe
leptospirosis and is especially effective if started within first four days of illness. Jarisch-
Herxheimer reactions may occur.
TREATMENT

Ceftriaxone and sodium penicillin G were equally effective for the

treatment of severe
leptospirosis.

Once-daily administration and the extended spectrum of ceftriaxone

against bacteria provide additional benefits over intravenous penicillin
PREVENTION

• Vaccination of domestic animals

• Rodent control
• Protective gloves and boots
• Avoid swimming in contaminated waters
• Vaccination in endemic region
TARGETS FOR CONTROL STRATEGIES