139 Cruz, John Jobert (12-M) High Fever with N&V; with the dx of Leptospirosis

02-06-12/ 2-10 Pediatrics Department

Case Study of Leptospirosis Also called: Weils Dse, Mud fever, Canicola fever, Flood fever, Swineherds Dse, Japanese Seven Days fever Definition & Background: a bacterial zoonotic disease caused by spirochaetes of the genus Leptospira that affects humans and a wide range of animals, including mammals, birds, amphibians, and reptiles first described by Adolf Weil in 1886 when he reported an acute infectious disease with enlargement of spleen, jaundice and nephritis Causative Agent: Leptospira-genus bacteria was isolated in 1907 from post mortem renal tissue slice commonly found: Leptospira pyrogenes, Leptospira manilae, & other species like L. icterohemorrhagiae, L. canicola, L. batavia, L. Pomona, L. javinica in animals often is subclinical; an infected animal may appear healthy even as it sheds leptospires in its urine; humans are dead-end hosts for the leptospire

Predisposing Factors: age: < 15 years of age sex: male season: rainy months geographic: prevalent in slum areas Source of Infection Infection comes form contaminated food and water, and infected wild life and domestic animals especially rodents. 1. Rats ( L. leterohemoragiae) are the source of Weils disease frequently observed among miners, sewer, and abattoir workers. 2. Dogs (L. canicola) can also be the source of infection among veterinarians, breeders, and owners of dogs. 3. Mice (L. grippotyphosa) may alos be a source of infection that attacks farmers and flax workers. 4. Rats (L. bataviae) are the source of infection that attacks ricefield workers. Modes of Transmission Incubation Period: 6 15 days/ 2 8 weeks

Clinical Manifestations:

1st stage:

Septicemic/ Leptospiremic Phase (4 7 days)

- onset of high remittent fever, chills, headache, anorexia, nausea & vomiting, abdominal pain,joint pains, muscle pains, myalgia, severe prostration, cough, respiratory distress, bloody sputum. 2nd stage: Immune/ Toxic Phase (4 30 days) - if severe, death may occur between the 9th & 16th day 2 types: Anicteric (without jaundice) return of fever of a lower degree with rash, conjunctivalinjection, headache, meningeal manifestations like disorientation, convulsions & signs of meningeal irritations (with CSF finding of aseptic meningitis) Icteric (with jaundice) Weil syndrome; hepatic & renal manifestations: hemorrhage, hepatomegaly, hyperbilirubinemia, oliguria, anuria with progressive renal failure; shock, coma & congestive heart failure in severe cases

3rd stage:

Convalescence Phase

- Relapses may occur during 4th or 5th week Diagnosis: culture: blood (1st week) CSF (5th to 12th day) Urine (after 1st wk til pd of convalescence) agglutination tests ( 2nd or 3rd week)

PATHOPHYSIOLOGY Complications: pneumonia iridocyclitis, optic neuritis peripheral neuritis Prognosis: cause of death: renal & hepatic failure dse usually last 1 3 weeks but may be more prolonged; relapse may occur Treatment: specific measures: beneficial if done < 4 days of dse Aqueous penicillin G (50,000 units/kg/day in 4-6 divided doses intravenously for 7-10 days Tetracycline (20-40 mg/kg/day in 4 doses); may not be given to children < 8 years old

general measures

symptomatic & supportice care administration of fluid, electrolytes & blood as indicated peritoneal dialysis (for renal failure)

Nursing Interventions: isolation of patient: urine must be properly disposed health teachings: keep a clean environment.

Marie Jennifer Paril BSN II-C English