HOW WE DIAGNOSED

LEPTOSPIROSIS??
Donnie Lumban Gaol, MD, Internist
Internal Medicine Dept.

LEPTOSPIROSIS IN THE WORLD

Incidence of severe cases 300,000-500,000

per year

Discovery of Pathogen
in 1915

Ryoukichi Inada
1874-1950

CAUSATIVE AGENT

highly motile

flexible
helical or coiled
aerobic bacteria
with bent or hooked ends

Spirochaeta icterohaemorrhagiae
Yasuda et al. Deoxiribonucleic acid relatedness between seogroups and
serovars in the family Leptospiraceae. Int J Sys Bacteriol 1987; 407-415

SENSITIVITY
killed at 500C in 10 mins or 600C in 10 seconds
susceptible to dessication, hypochlorite disinfectants and pH
outside of 6.2 to 8.0
acid urine, non-aerated sewage and polluted water
Leptospires can survive in untreated water for months or years,
but cannot survive desiccation or salt water.

PHENOTYPIC CLASSIFICATION OF LEPTOSPIRES

TRANSMISSION CYCLE OF LEPTOSPIROSIS

DIRECT CONTACT
thru tissue or urine of
infected animals
ingestion of contam food
droplet aerosol inhalation

contact with moist

soil or vegetation
contaminated with
urine of infected animals

INDIRECT CONTACT

swimming or wading in
floodwaters
accidental immersion
occupational abrasion

HOW THEY INFECT????

The organisms can penetrate abraded skin or intact mucous membrane, after
which they enter the circulation and rapidly disseminate to various tissues.

CLINICAL MANIFESTATIONS
influenza-like illness with headache and myalgia.
Severe leptospirosis, characterized by jaundice, renal dysfunction,
and hemorrhagic diathesis, is referred to as Weils syndrome.
Incubation Period: 2-26 days (usually 7-12 days))
clinical manifestation can be divided into two distinct clinical
syndromes. 90% of patients present with mild anicteric febrile
illness; 10% are severely ill with jaundice and other manifestations
(Weils disease).

ANICTERIC LEPTOSPIROSIS (SEPTICEMIC PHASE)

first or septicemic phase, patients usually present
with an abrupt onset of fever, chills, headache, myalgia, skin rash,
nausea, vomiting, conjunctival suffusion, and prostration .
Leptospires can be isolated from blood, cerebrospinal fluid (CSF),
and tissues.
The fever may be high and remittent reaching a peak of 40C
before defervescence.
Conjunctival suffusion is found in the third day

ANICTERIC LEPTOSPIROSIS (SEPTICEMIC PHASE)

Myalgias usually involve the muscles in the calf, abdomen, and
paraspinal region and can be severe. When present in the neck,
myalgias may cause nuchal rigidity reminiscent of meningitis.
The first phase lasts 3-9 days followed by 2-3 days of
defervescence, after which the second or immune phase
develops.

ANICTERIC LEPTOSPIROSIS (THE IMMUNE PHASE)

Leptospiruria and correlates with the appearance of IgM antibodies
in the serum.
Leptospira now settle in glomeruli
Fever and earlier constitutional symptoms recur in some patients,
and signs of meningitis, such as headache, photophobia, and
nuchal rigidity may develop.
Central nervous system (CNS) involvement in leptospirosis most
commonly occurs as aseptic
meningitis.

ANICTERIC LEPTOSPIROSIS (THE IMMUNE PHASE)

Complications such as optic neuritis, uveitis, iridocyclitis,
chorioretinitis, and peripheral neuropathy occur more frequently in
the immune phase.
The illness in anicteric leptospirosis may be self-limited, lasting 430 days, with complete recovery as a rule.

ICTERIC LEPTOSPIROSIS (WEILS SYNDROME)

(usually caused by L. icterohaemorrhagiae)
persistent high fever and jaundice may obscure the two phases.
This is usually associated with hepatic dysfunction, renal
insufficiency, hemorrhage and multi-organ failure (MOF).
Hemorrhage can occur as petechiae, purpura, conjunctival
hemorrhage and gastrointestinal hemorrhage.

Icteric Leptospirosis
Weil's Syndrome

Anicteric Leptospirosis
Second stage
0-1 month

First stage
3-7 days

Second stage
10-30 days

Septicemic

Immune

Septicemic

Immune

Myalgia/
Myositis
Abdominal
pain
Conjunctival
suffusion

Meningitis
Uveitis
Rash
Fever

Lepto
present

Important
Clinical findings

fever

First stage
3-7 days

Blood

Jaundice
Hemorrhage
Renal failure
Myocarditis
Meningitis
Pulmonary
hemorrhage
Respiratory
failure

Blood
CSF

CSF
urine

urine

Signs and Symptoms of Leptospirosis

Icterus and hemorrhage

Acute renal failure

DIAGNOSIS OF LEPTOSPIRA

DIFFERENT STAGES OF LEPTOSPIROSIS

LEVEL AND DURATION OF IGM ANTIBODIES AT

DIFFERENT TIME INTERVALS

LEVEL AND DURATION OF MICROSCOPIC

AGGLUTINATING ANTIBODIES AT DIFFERENT TIME
INTERVALS

IMMUNOFLOURESCENCE

TREATMENT

Early anti-microbial therapy is importantshorten the course and prevent carrier state

Choice : Penicillin G, Ampicillin

May cause Jarish-Huxheimer type reaction

Mild cases oral Doxycycline or Amoxicillin

Penicillin (e.g. 6 million units daily intravenously) is the drug of choice in severe leptospirosis
and is especially effective if started within first four days of illness. Jarisch- Herxheimer
reactions may occur.

TREATMENT

Ceftriaxone and sodium penicillin G were equally effective for the

treatment of severe
leptospirosis.
Once-daily administration and the extended spectrum of ceftriaxone
against bacteria provide additional benets over intravenous penicillin

PREVENTION

Vaccination of domestic animals

Rodent control
Protective gloves and boots
Avoid swimming in contaminated waters
Vaccination in endemic region

TARGETS FOR CONTROL STRATEGIES