LEPTOSPIROSIS

dr. Wahyu Djatmiko, SpPD

PENDAHULUAN
Leptospirosis adalah penyakit zoonosis yg disebabkan oleh
genus Leprospira
Adolf Heil (1886), untuk pertama kali meneliti ttg leprospirosis
klinis : demam, hepatomegali, splenomegali, ikterus, ggn ginjal
Goldsmith (1887), memberi istilah WEILS DISEASE
Inada (1915), membuktikan Weils Disease disebabkan oleh bakteri :
Leptospira icterohemorrhagiae
Sejak itu beberapa jenis leptospira lain dapat diisolasi

ISTILAH LAIN LEPTOSPIROSIS

Weils Disease

Mud fever
Canicola fever
Hemorrhagic jaundice

Trench fever
Swineherds disease

EPIDEMIOLOGI
Bakteri leptospirosis berbentuk spiral, aerob
Ordo : Spirochaetales, Famili : Trepanometaceae
Tersebar luas : tropik dan sub tropik, sering tidak terdiagnosis
Terdapat lebih dari 170 serotipe patogen
Hampir setengahnya terdapat di Indonesia
(L bataviae, L icterohemorrhagiae, L javanica, L semaranga, L canicola, L sarmini, L benyamin, L bovis, L hardjo, dll)

hanya dapat dilihat dengan mikroskop medan gelap atau fase kontras
Leptospira peka terhadap asam

Dapat hidup di air tawar sekitar 1 bulan

Vektor : tikus, babi, sapi, kambing, domba, kuda, anjing, kucing,dll
Inkubasi : 4-19 hari, rata-rata : 10 hari

LEPTOSPIRA

The Leptospira appear

tighly coiled thin flexible
Spritochetes 5 15
microns long.
Fine spiral of 0.1 0.2
microns
One end appears bent
forms a hook.
Actively motile
Seen best with dark field
Microscopy.

CARA PENULARAN
Kontak dg air, lumpur yg tercemar air kencing vektor
Pintu masuk : mukosa mata, hidung, kulit lecet, sal cerna

Kualitatif : sama untuk semua serovar leptospira

Kuantitatif : tergantung agen, host, dan lingkungan

PENULARAN

Incompletely understood.
Leptospires enter the host through abrasions
in skin or intact mucous membranes
(conjunctiva or oro- & nasopharynx)
After entry of organisms , leptospiremia
develops, with subsequent spread to all
organs.
Multiplication takes place in blood & tissues,
leptospires can be isolated from blood & CSF
during first 4 10 days of illness.

Damage the wall of small blood vessels

leading to vasculitis with leakage &
extravasation of cells, including Hemorrhage.
Mainly affect kidneys & liver.

They migrate to interstitium, renal tubules

causing interstitial nephritis & tubular
necrosis.
Hypovolemia due to
dehydration or altered
capillary permeability leads to
renal failure.

Centrilobular necrosis with proliferation of

kupffer cells

Pulmonary involvement is as a result of

hemorrhage but not of inflammation.
Invasion of skeletal muscles results in
swelling, vacuolation of myofibrils & focal
necrosis.
In severe infection, vasculitis impairs the
microcirculation & increased capillary
permeability results in fluid leakage &
hypovolemia.

When antibodies are formed, leptospires are

eliminated from all sites except eye, proximal
renal tubules & brain where they persist from
weeks to months.
Persistence in aqueous humour leads to
recurrent uveitis.

GEJALA KLINIK
Fase Leptospiremia

Demam tinggi mendadak, sakit kepala, nyeri otot, hiperaestesia

mual, muntah, diare, bradikardi relatif, ikterus, injeksi silier
Berlangsung 4 9 hari dan klinis menghilang
Fase Imun
Terbentuk IgM, gambaran klinik bervariasi, demam tidak terlalu tinggi
Dapat sisertai ggn fungsi ginjal, hati dan hemostasis
Fase Konvalesens

Terjadi pada mgg-2 sd mgg-4

Patogenesis belum jelas
Gejala klinis : demam, muntah, nyeri otot, ikterus, sakit kepala, batuk,
hepatomegali, splenomegali, perdarahan

PENDEKATAN DIAGNOSTIK KLINIK

Leptospirosis anikterik
90% kasus, sering tidak terdiagnosis

Leptospirosis ikterik
Indikator leptospirosis berat GGA, Ikterus, perdarahan

DIAGNOSIS
Anamnesis : gejala klinik
Dx Fisik

: tanda klinik

Penunjang : mikroskop medan gelap, fase kontras

Isolat kuman dari darah atau urine

Serologi : titer Ab, Tes aglutinasi, ELISA

Serovar Specific tests : Microscopic

Agglutination Test
Genus Specific tests : ELISA
MSAT
Latex Agglutination
Dipstik Tests
Lepto Tek Dri Dot Test

Silier Injeksi

TERAPI
Support cairan dan nutrisi
Antipiretik
AB : penisilin, streptomisin, tetrasiklin, eritromisin, sefalosporin
Penanganan komplikasi :
Gagal ginjal diuretik, agen dopaminergik, dialisis
Gagal jantung : batasi cairan, digitalis, diuretik

Hiperkalemia : gluconas calcii, Insulin-glukosa

Hipertensi : anti hipertensi
Kejang : sesuai kausa
Perdarahan

KOMPLIKASI
Ginjal

: gagal ginjal akut

Mata

: silier injeksi ( hemorhagic conjungtivitis )

Hati

: ikterus

Jantung

: aritmia, miokarditis, gagal jantung

Paru

: Hemorhagic pneumonitis, distres respirasi, sianosis

Kehamilan

: abortus, lahir mati, prematuritas, cacat

Perdarahan