Leptospirosis

M.Syamil
131829
INTRODUCTION
• Swineherd's disease, swamp fever, Weil's disease, canefield fever,
nanukayami fever, 7-day fever, Rat Catcher's Yellows, Fort Bragg fever,
and Pretibial fever
• In Malaysia: Penyakit Kencing Tikus (Rat Urine Disease)
• Animal infection by several serotypes of Leptospira (Spirocheates) and
transmitted to man.
• Disease manifestations ranging from a mild febrile illness to severe
and even fatal.

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PROBLEM STATEMENT
• The most widespread of the disease transmissible from animal to man.
• High prevalence in warm humid tropical countries.
• Outbreaks occurs as a result of heavy rainfall and consequent floodings.
• >/= 500,000 cases of leptospirosis occur worldwide each year.
• Incidence of as high as 975 cases per lac population.
• The occurrence of outbreak has highlighted the strong links between
leptospirosis and extreme weather events in Guyana, India, Philippines
and Thailand.

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EPIDEMIOLOGICAL DETERMINANTS

3. ENVIRONMENTAL
1. AGENT FACTORS 2. HOST FACTORS
FACTORS

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1) Agents
A. Agent
- Leptospira are thin and light
motile spirochaetes, highly
coiled with hooked end
- Strains of L.interrogans are
pathogenic
- Visible by dark-field
illumination and silver
staining
B. Source of infection
- Leptospira are excreted in
the urine of infected animal
- Rodents (entire life time)
C. Animal reservoirs
- Affects wild animals
worldwide (rodents)
- Wild animal domestic
livestock human
- R.Norvegicus and Mus
musculus
2) Host
A. Age
- Children > adults

B. Occupation
- Agricultural & livestock
farmers, workers in rice
fields, sugarcane fields,
underground sewers, meat
and animal handlers
- Swimming and fishing may
carry risks
3) Environment
- Through contact with an environment
contaminated by urine and faeces
- Leptospira shed in urine can survive for weeks
in soil and water
- Poor housing, limited water supply, inadequate
method of waste disposal,
 Modes of Transmission
1. Direct contact with urine or tissue of infected animal
Through skin abrasions, intact mucus membrane
2. Indirect contact INCUBATION PERIOD
USUALLY 10 DAYS (4-
Broken skin with infected soil, water or vegetation 20 DAYS)

Ingestion of contaminated food & water

3. Droplet infection
Through inhalation as when milking infected cows/goats by breathing air
polluted with droplets of urine.
CLINICAL FEATURES
INVESTIGATIONS
• BLOOD TEST:
• TC / DC / ESR / Hb / Platelet count
• LIVER TEST:
• Serum Bilirubin / SGOT/ SGPT
• Blood Urea, Creatinine & Electrolytes
• Chest X-Ray; ECG

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• Tests for diagnosis of Leptospirosis
• Culture for Leptospira: Positive
• Microscopic agglutination test (MAT) – gold standard
• ELISA – For early diagnosis, as it + as early as 2 days into illness
• PCR molecular diagnostic- sensitive, specific, positive early in disease, able to
detect leptospiral DNA in blood, urine, CSF and aqueous humor.

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DIAGNOSIS
CONFIRMED CASE:
A confirmed case of leptospirosis is a suspected OR probable case with any one of the
following laboratory tests:
• Microscopic Agglutination Test (MAT), For single serum specimen - titre ≥1:400 For
paired sera - four fold or greater rise in titre
• Positive PCR (samples should be taken within 10 days of disease onset)
• Positive culture for pathogenic leptospires (blood samples should be taken within 7 days
of onset and urine sample after the 10th day)
• Demonstration of leptospires in tissues using immunohistochemical staining (e.g. in post
mortem cases)
• In places where the laboratory capacity is not well established, a case can be considered
as confirmed if the result is positive by two (2) different rapid diagnostic tests.

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Interpretation of Tests

ELISA/SAT MAT Interpretation

Positive Single High Titre Current Infection

Positive Negative Current Infection

Negative Single High Titre Past Infection

Negative Negative R/o Leptospirosis

+/- Rising titers 4 fold Current Infection

TREATMENT
• Many case are self limiting without specific
treatment
Mild case
- Doxycycline 100mg, twice daily for 7 days
- Amoxicillin 50mg/kg, 3 divided doses daily

Severe case
- Doxycycline 100mg, every 12 hours orally or intravenously
- Penicillin 1.5 million units, every 6 hours intravenously
VACCINATION
• Immunization - done on farmers and pets
• China, Italy and USSR - certain occupations that
carry a high risk of infection
• Should incorporate strains of serotype that
predominate in that particular area
PREVENTION & CONTROL

• Effective prevention and control can be achieved by controlling

the reservoir or reducing infection in animal reservoir
populations such as dogs or livestock via treatment or
vaccination.
• Target of prevention and control:
• The infection source
• Route of transmission between infection source and the human host
• Prompt and proper treatment of infection.

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• Measures can be taken:
• Health education create awareness among public about the disease
 motivate public to take preventive actions
 Proper disposal of wastes
• Risk assessment of possible contaminated water sources
• Alert public or users regarding the hazard of possible contaminated
area
• Persons with occupational/ recreational exposure should
• Wear waterproof protective clothing (rubber boots and gloves)
• Cover skin lesions with waterproof dressings
• Wash with clean water immediately after exposure
• Seek immediate medical treatment if develop symptoms within incubation
period

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• Advice public to keep home and premise from rodents
• Advices people to vaccinates pets against leptospirosis
• Promote cleanliness at recreational area and housing area
• Promote collaboration with local authorities, Wild Department
(PERHILITAN), Department of Veterinary Service (JPV) etc, to maintain
cleanliness in respective environment setting

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• “…from 1st January 2018 to
September 2018, reported
1913 suspected cases of
leptospirosis, 1006 confirmed
cases of leptospirosis and total
42 deaths due to it…”-Times of
India, September 5, 2018
• In Malaysia, under the Prevention and Control of Infectious Diseases Act 198,
leptospirosis has been gazetted as a notifiable disease on 9 December 2010
• Based on a research conducted on 2016; Malaysia was categorized as a probable
endemic country without any available data.
• There were 3,665 and 4,457 probable and laboratory confirmed leptospirosis
cases notified in 2012 and 2013, respectively.
• In the 2-year period, the most common age group of patients was
• 19 years old or less (23.3%)
• male:female ratio of 2.61:1.
• Students  16.9% of patients
• agriculture-based or plantation workers  14.7% of patients.
• Overall age-standardized incidence rate of leptospirosis in Malaysia for 2012 and 2013
was 29.02 per 100,000.
• Overall case fatality rate was 1.47% for 2-year period
• overall age-standardized mortality rate was 0.45 per 100,000.

Leptospirosis is an emerging public health concern in Malaysia and may pose a significant
health impact and burden to the nation in the coming years if not well controlled.
• Sharp rise in incidence rate among human population in the year
2014 which attributed to flooding and heavy rainfall experienced
OUTBREAK RESPONSE

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OUTBREAK
NOTIFICATION
FLOW CHART

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EARLY
OUTBREAK
NOTIFICATION
FORM

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STANDARD
REPORT
FORM

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CASE
INVESTIGATI
ON FORM

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RISK
ASSESMENT
EVALUATION
FORM

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