Leptospirosis PDF - A Guide to the Disease

Leptospirosis (Weil's disease; Canicola fever; Hemorrhagic jaundice; Mud fever; Swine herd disease) Leptospirosis Leptospirosis is a zoonotic infectious disease that originates from both domestic and wild animals. The bacterium Leptospira interrogans enters the human body through ingestion...

Leptospirosis (Weil's disease; Canicola fever; Hemorrhagic jaundice; Mud fever; Swine herd disease) Leptospirosis Leptospirosis is a zoonotic infectious disease that originates from both domestic and wild animals. The bacterium Leptospira interrogans enters the human body through ingestion and inoculation through abraded skin or mucous membranes. It can also be contracted through ingestion of flood water or liquids that were contaminated by an infected animal's urine. Leptospirosis Etiologic Agent Leptospira interrogans is a spirochete of genus Leptospira with the following characteristics: It is chiefly a saprophytic aquatic organism found in river, lake, and sea water, but is also found in sewage. Leptospirosis Etiologic Agent There are 150 serotypes divided among 18 serogroups; some species are pathogenic to humans and animals. The organism can survive in water for weeks to months. Leptospirosis Incubation Period Varies from 6-15 days Leptospirosis Mode of Transmission Ingestion or contact of the skin and mucous membranes with the urine of infected animals or carcasses of wild and domestic mammals. The pathogens enter through the mucous membrane of the eyes, nose, and mouth, and through a break on the skin. Leptospirosis Mode of Transmission Leptospira enters the blood and causes damage to the kidneys, liver, meninges, and conjunctivae. Person-to-person transmission is rare. Leptospirosis  Lestospira can be found in the urine between 10-20 days after onset. Leptospirosis Source of Infection Contaminated food and water Urine of infected wildlife and domestic animals, especially rodents Leptospirosis Serogroup Leptospira icterohaemorrhagiae (rats) causes Weil's disease, which is frequently observed among miners, abattoir staff, and sewer workers. Rats that thrive in farmlands transmits L. bataviae to rice field workers. Leptospirosis Serogroup Leptospira canicola (dogs) is observed in veterinarians, breeders, and dog owners. Leptospira grippotyphosa (mice) attacks farmers and flax workers. Leptospirosis Period of Communicability Lestospira can be found in the urine between 10-20 days after onset. Leptospirosis Risk Factors Leptospirosis is an occupational hazard to people who engage in outdoor activities, especially in tropical climates. The disease has also been associated with swimming, wading, and rafting in contaminated lakes and rivers. Leptospirosis Risk Factors The following groups are at higher risk of acquiring the disease: rice or crop farmers working on flooded rice fields, dairy farmers, mine and sewer workers, veterinarians and animal caretakers, Leptospirosis Risk Factors military personnel, and people in large cities (with extensive rat populations) that are prone to flooding during the rainy season. Leptospirosis  Clinical Manifestations 1. The degree of illness in leptospirosis varies from asymptomatic to severe or fatal. The clinical course is generally biphasic. B. In the initial phase, the patient manifests an abrupt headache (usually frontal), fever, Leptospirosis Clinical Manifestations Cutaneous hyperesthesia, chills, and rapid rising temperature. Leptospirosis Clinical Manifestations Anorexia, nausea, and vomiting may also occur. These symptoms may last for four to nine days. Leptospirosis Clinical Manifestations On physical examination, the patient is bradycardic but with normal blood pressure. On the third or fourth day, conjunctival effusion, cutaneous hemorrhages, and skin rashes can be observed. Leptospirosis Clinical Manifestations After the first phase, the patient may recover for a time but may become ill again. Leptospirosis  Clinical Manifestations A. The second phase symptoms are more varied and the hallmark of this phase is aseptic meningitis. This phase usually lasts for several days. Fever tends to be milder, GIT symptoms and myalgia are less intense. Leptospirosis Clinical Manifestations However, the icteric type of leptospirosis is the more severe form. The patient develops persistent high-grade fever with subsequent deterioration and development of jaundice, hepatic dysfunction, Leptospirosis Clinical Manifestations myocarditis, decreased renal function, pulmonary complications, and hemorrhage. Leptospirosis Clinical Manifestations Renal failure is due to acute tubular necrosis, but usually does not require dialysis. Early recognition of renal failure is critical to the patient's survival, and complete anuria is a sign of poor prognosis. Leptospirosis Clinical Manifestations Pulmonary involvement is characterized by cough, dyspnea, hemoptysis, and chest pain. Leptospirosis Clinical Manifestations Decreased hepatic function and jaundice are common, but hepatic failure is seldom the cause of death. On the other hand, jaundice is a sign of poor prognosis. The case fatality rate of patients with jaundice and kidney damage may reach 20% if not treated with renal dialysis (DOH, 2016). Leptospirosis  Clinical Manifestations 1. Three septic stages can be recognized: B. The septic stage exhibits a febrile state lasting for four to seven days. There is an abrupt onset of remittent fever, chills, headache, Leptospirosis Clinical Manifestations anorexia, abdominal pain, and severe prostration. There is also respiratory distress and fever subsides by lysis. Leptospirosis  Clinical Manifestations A. The immune or toxic stage occurs with or without jaundice, and lasts for 4-30 days. The patient exhibits iritis, headache, Leptospirosis Clinical Manifestations meningeal manifestations like disorientation, convulsions, with CSF findings of aseptic meningitis. Oliguria and anuria with progressive renal failure Leptospirosis Clinical Manifestations Shock, coma, and congestive heart failure are also seen in severe cases. Death may occur between the ninth to the 16th day. Leptospirosis  Management A. Penicillin G Na 1.5 million QID usually given intravenously B. Tetracycline 10-20 mg/kgbw/24 divided QID C. Peritoneal dialysis D. Administration of fluid and electrolyte and blood as indicated Leptospirosis  Management A. Without treatment, leptospirosis can lead to kidney damage, meningitis (inflammation of the membrane around the brain and spinal cord), liver failure, respiratory distress, and even death. Leptospirosis  Prevention and Control a. Prophylaxis with doxycycline 200 mg/week for those who are at risk b. Sanitation in homes, workplaces, and farms c. Proper drainage system and control of rodents (40%-60% infected) d. Vaccination of animals (cattle, dogs, cats, and pigs) e. Treatment of infected people and pets Leptospirosis  Prevention and Control a. Effective information dissemination campaign Avoid swimming or wading in flood waters. Use rubber boots in flooded areas, specially if wounds and other skin problems on the foot or legs are present. Leptospirosis  Prevention and Control Wash feet thoroughly with soap and water after wading through flooded areas. Instruct the patient and significant others to watch for signs and symptoms of leptospirosis such as: a. fever, pain at the muscles of the legs, and headache, Leptospirosis  Prevention and Control a. periorbital and intraocular pain, b. yellowish discoloration; first of the sclera, then the skin, c. tea-colored urine, and d. cough, vomiting, sometimes associated with diarrhea. Consult a health practitioner immediately once the symptoms aboveLeptospirosis occur.  Nursing Management A. Isolate the patient, and his/her urine must be disposed of properly. B. Keep the patient under close surveillance. C. Investigate contacts and source of infection. D. For home care, clean dirty places and pools. Remove stagnant water if possible E. Eradicate rats and other disease-carrying Leptospirosis