LEPTOSPIROSIS

Alcalde, Ma. Kathrina Teresa T.

Eke, Jozen A.
Siazon, Rigil Mariquieta Fe P.

3A
LEPTOSPIROSIS

Alcalde, Ma. Kathrina Teresa T.

Eke, Jozen A.
Siazon, Rigil Mariquieta Fe P.

3A
WHAT IS LEPTOSPIROSIS?

WHO

CDC

HARRISON’S
DEFINITION:

“ Leptospirosis is an infection in rodents and

other wild and domesticated species… is a
zoonosis of worldwide distribution, endemic
mainly in countries with humid subtropical or
tropical climates and has epidemic potential. It
often peaks seasonally….and is often linked to
climate changes, to poor urban slum
communities, to occupation or to recreational
activities. “ (WHO)
DEFINITION:

“Leptospirosis is a bacterial disease that

affects humans and animals…caused by
bacteria of the genus Leptospira…causes a
wide range of symptoms… Some infected
persons may have no symptoms at all. ” (CDC)
DEFINITION:

“ Leptospirosis is an emerging infectious

disease of global importance, as illustrated by
recent large outbreaks in Asia, Central and
South America, and the United States….
Caused by pathogenic leptospires and is
characterized by a broad spectrum of clinical
manifestations” (Fauci, et.al, 2008)
 ETIOLOGIC AGENT
Leptospires
•L. interrogans
•L. biflexa
o obligate, aerobic
o coiled, thin, highly
motile
o w/ hooked ends and 2
periplasmic flagella →
permit burrowing into
tissue
o 6–20 µm long and
~0.1µm wide
o dark-field examination

Source: Fauci AS, Kasper DL, Braunwald E, Hauser SL, Longo, DL, Jameson JL, Loascalzo J.
Harrison’s Principles of Internal Medicine, 17th Edition. USA: Mc Graw Hill.
 ETIOLOGIC AGENT

Serological Classification &

Groupings
Hosts Serogroups
RATS L. Icterohaemorrhagiae
MICE L. Ballum
DAIRY CATTLES L. Hardjo, Pomona
DOGS L. Canicola
SHEEP L. Hardjo
PIGS L. Pomona, Tarassovi

HUMANS L. Icterohaemorrhagiae
 EPIDEMIOLOGY

• 1932:
• Leptospirosis was first isolated in the Philippines
from one of the human cases of Weil's Disease
• 1971 to 1973:
• total of 390 cases were studied out of which 82
(21.02%) were found positive by isolation and
serological examination
• 1976 to 1983:
• outbreak of leptospirosis in Sablayan, Mindoro

Source: Sevilla, B.V. et. al. 1986. Leptospirosis in the Philippines. Southeast Asian J Trop Med Public
Health.  17(1). pp. 71-74.
 EPIDEMIOLOGY

• late 1960s and 1970s:

– antibodies against serovars Pyrogenes, Bataviae,
Pomona, Grippotyphosa, Manilae and Javanica were
detected among high-risk workers
– outbreaks due to flooding were reported in prisons,
penal farms and in many parts of the country

Source: Victoriano, A.F. et.al. 2009. Leptospirosis in Asia Pacific Region. BMC Infectious Diseases.
9:147. pp. 1471-2334.
 EPIDEMIOLOGY

• 1998-2001:
– seroepidemiological survey: 70% of suspected
leptospirosis patients were seropositive
– also isolated leptospires from humans and rats (both
house and field)

• 1999:
– Department of Health listed leptospirosis as a
notifiable disease in the country.

Source: Victoriano, A.F. et.al. 2009. Leptospirosis in Asia Pacific Region. BMC Infectious Diseases.
9:147. pp. 1471-2334.
 EPIDEMIOLOGY
• 2009:
• outbreak of leptospirosis in
three barangays in Marikina
and an upsurge of cases in
Metro Manila and the regions
of Rizal and the Calabarzon
following the flooding brought
by tropical storm “Ondoy.”
• there were 2,158 confirmed
cases of Leptospirosis
infections
• with 167 deaths reported by
the National Epidemiology
Centre.
Source: Department of Health. 28 October 2009
EPIDEMIOLOGY
 PATHOPHYSIOLOGY

Cause:  Leptospira bacteria

Incubation Period:  7-10 days

Mode of Transmission:
Entry of the leptospira bacteria through
wounds when in contact with flood waters,
vegetation, moist soil contaminated with the
urine of infected animals, especially rats.

Source: Department of Health.

 PATHOPHYSIOLOGY

Two Phases:
1.Leptospiremic Phase
2.Immune leptospiruric Phase

Two forms:
1.Anicteric Leptospirosis
2.Icteric Leptospirosis (Weil’s Disease)

Source: Fauci AS, Kasper DL, Braunwald E, Hauser SL, Longo, DL, Jameson JL, Loascalzo J.
Harrison’s Principles of Internal Medicine, 17th Edition. USA: Mc Graw Hill.
 Leptospirosis
Leptospiremic Phase

Skin/Mucosa/Conjunctiva/Oropharynx

Leptospiremia

Damage of walls of
small blood vessels

Vasculitis

Kidney Liver Lungs Skeletal Muscle

Interstitial Centrilobular Focal necrosis

Renal Failure* nephritis and necrosis
Tubular
necrosis
Source: Fauci AS, Kasper DL, Braunwald E, Hauser SL, Longo, DL, Jameson JL, Loascalzo J.
Harrison’s Principles of Internal Medicine, 17th Edition. USA: Mc Graw Hill.
 Host Reaction Immune leptospiruric Phase

Production of Antibodies

Elimination of Leptospirosis in the

organs except eye, proximal tubules
and brain.

Source: Fauci AS, Kasper DL, Braunwald E, Hauser SL, Longo, DL, Jameson JL, Loascalzo J.
Harrison’s Principles of Internal Medicine, 17th Edition. USA: Mc Graw Hill.
 CLINICAL DESCRIPTION
•Usual presentation is an acute febrile illness with
headache, myalgia (particularly calf muscle) and
prostration associated with any of the following
symptoms/signs:
Conjunctival suffusion
Anuria or oliguria
Jaundice
Cough, hemoptysis and breathlessness
Hemorrhages (from the intestines; lung bleeding is
notorious in some areas)
Meningeal irritation
Cardiac arrhythmia or failure
Skin rash

Source: WHO, 2004

 CLINICAL MANIFESTATIONS

ANICTERIC ICTERIC

Flu- like symptoms Initially- same as anicteric

Myalgias (predominantly-back, Profound Jaundice (orange color of

calves and abdomen)
Intense headache (frontal and retro-
orbital)
Cough, chest pain, hemoptysis
(pulmonary involvement)
Fever + conjunctival suffusion (most
common finding on PE).
Aseptic meningitis (children> adult)
skin)
Renal dysfunction
Hemorrhagic diathesis (epistaxis,
petechiae, purpura and ecchymosis)
Pulmonary involvement (cough,
dyspnea, chest pain, and blood-
stained sputum)
Hemorrhagic manifestations

Source: Fauci AS, Kasper DL, Braunwald E, Hauser SL, Longo, DL, Jameson JL, Loascalzo J.
Harrison’s Principles of Internal Medicine, 17th Edition. USA: Mc Graw Hill.
 LABORATORY CRITERIA

Presumptive diagnosis:

A positive result of a rapid screening test such as IgM

ELISA, latex agglutination test, lateral flow, dipstick etc.

Source: WHO, 2004

 LABORATORY CRITERIA
Confirmatory diagnosis:

Isolation from blood or other clinical materials through

culture of pathogenic leptospires.

A positive PCR result using a validated method (primarily

for blood and serum in the early stages of infection).

Fourfold or greater rise in titre or seroconversion in

microscopic agglutination test (MAT) on paired samples
obtained at least 2 weeks apart. A battery of Leptospira
reference strains representative of local strains to be used
as antigens in MAT.
Source: WHO, 2004
 DIAGNOSIS
• Isolation of the organism
blood/CSF= 1st 10 days
urine= 1 wk onwards
• Microscopic agglutination test( MAT)
= 4 fold rise in Ab titer
• Indirect Hemagglutination
Assay(IHA)-IgM and IGg
• IgM-ELISA
• Culture
Source: Fauci AS, Kasper DL, Braunwald E, Hauser SL, Longo, DL, Jameson JL, Loascalzo J.
Harrison’s Principles of Internal Medicine, 17th Edition. USA: Mc Graw Hill.
 CASE CLASSIFICATION (HUMANS)

Suspected:

A case that is compatible with the clinical

description and a presumptive laboratory diagnosis.

Confirmed:

A suspect case with a confirmatory laboratory

diagnosis.

Source: WHO, 2004

 LABORATORY and RADIOLOGIC FINDINGS
Anicteric Icteric (Weil’s)
Urinalysis urinary sediment Same
changes (leukocytes,
erythrocytes, and
hyaline or granular
casts)
azotemia
mild proteinuria to
renal failure
ESR ↑
WBC count 3000 to 26,000/L, with marked leukocytosis
a left shift
Liver enzymes
(bilirubin, ↑
phosphatase,
aminotransferases)

Source: Fauci AS, Kasper DL, Braunwald E, Hauser SL, Longo, DL, Jameson JL, Loascalzo J.
Harrison’s Principles of Internal Medicine, 17th Edition. USA: Mc Graw Hill.
 LABORATORY and RADIOLOGIC FINDINGS
Anicteric Icteric (Weil’s)
Prothrombin time prolonged (corrected
with vitamin K)
Creatine ↑ (up to 50% during the first week of illness;
phosphokinase may help to differentiate from viral hepatitis)
CSF slightly elevated protein; normal glucose level;
increased PMN followed by mononuclear cells
Radiographic findings affected lower lobes
shows patchy alveolar
pattern

that corresponds to
alveolar hemorrhages

Source: Fauci AS, Kasper DL, Braunwald E, Hauser SL, Longo, DL, Jameson JL, Loascalzo J.
Harrison’s Principles of Internal Medicine, 17th Edition. USA: Mc Graw Hill.
 PREVENTION

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.

Source: Department of Health

 TREATMENT

Regimen
Doxycycline, 100 mg orally bid or
Mild leptospirosis Ampicillin, 500–750 mg orally qid
or
Amoxicillin, 500 mg orally qid
Penicillin G, 1.5 million units IV qid
or
Ampicillin, 1 g IV qid or
Moderate/severe leptospirosis Amoxicillin, 1 g IV qid or
Ceftriaxone, 1 g IV once daily or
Cefotaxime, 1 g IV qid or
Erythromycin, 500 mg IV qid

Chemoprophylaxis Doxycycline, 200 mg orally once a

week

Source: Fauci AS, Kasper DL, Braunwald E, Hauser SL, Longo, DL, Jameson JL, Loascalzo J.
Harrison’s Principles of Internal Medicine, 17th Edition. USA: Mc Graw Hill.
 PREVENTION

LEPTOSPIROSIS NAKAMAMATAY!

Buhay ay mahalaga, huwag lumusong sa

baha.

-- DOH

Source: Fauci AS, Kasper DL, Braunwald E, Hauser SL, Longo, DL, Jameson JL, Loascalzo J.
Harrison’s Principles of Internal Medicine, 17th Edition. USA: Mc Graw Hill.
Thank you!