Leptospirosis

Dr.T.V.Rao MD
 Leptospirosis - Zoonosis
• Leptospirosis is an acute anthropo-
zoonotic infection of worldwide
significance caused by spirochaete
Leptospira interrogans which has 23
serogroups and >200 serovars. Various
factors influencing the animal activity,
suitability of the environment for the
survival of the organism and behavioral
and occupational habits of human beings
can be the determinants of incidence and
prevalence of the disease.
 What is leptospirosis?

• Leptospirosis, also known as canicola

fever, hemorrhagic jaundice, infectious
jaundice, mud fever, spirochetal jaundice,
swamp fever, swineherd's disease, caver's
flu or sewerman's flu, is a bacterial
infection resulting from exposure to the
Leptospira interrogans bacterium. There is
an acute form of human infection known
as Weil's disease, where the patient
suffers from jaundice, though this term is
often (incorrectly) used to describe any
case of infection..
 Leptospirosis – A Major
Zoonotic Infection
• Weil's disease is comparatively rare,
though 'mild' cases of leptospirosis
happen everywhere there are
carriers, and it is believed that
leptospirosis is one of the most
common zoonotic infections in the
world. Millions of people are infected
each year, but information and
treatment can be limited, especially
in the developed world where cases
are considered 'rare' by the medical
community.
 Animals spread
Leptospirosis
Rats, Mice, Wild
Rodents, Dogs, Swine,
Cattle are principle
source of infection
The above animals
excrete Leptospira
both in active infection
and Asymptomatic
stage
The Leptospira survive
and remain viable for
several weeks in
stagnant water.
 What causes Leptospirosis
• Leptospirosis is a bacterial disease
that affects humans and animals.
Leptospira bacteria are found
worldwide and there are many
different types or serovars capable of
causing disease. Disease caused by
Leptospira bacteria is most common
in temperate or tropical climates and
appears to be rare in North America.
 Scientific Beginning
• It was first described by Adolf Weil in
1886 when he reported an "acute
infectious disease with
enlargement of spleen, jaundice and
nephritis". Leptospira was first
observed in 1907 from a
post mortem renal tissue slice.[2]
 Pathogenic strains x Non pathogenic
Leptospirosis
• There are several species of Leptospira
only few are pathogenic to Humans, rest
to some Animals and Many in Nature as
saprophytes
• Leptospira Interrogans is Pathogenic there
are 200 serovars.
• Leptospira biflexa Non Pathogenic there
are 60 serovars
• Further classifications are made on shared
antigens
 Genomic based
classification

• DNA – DNA hybridization studies

proved more specific
• The traditional serologic classification
has limitations at Molecular level, but
useful at Epidemiological studies.
 Morphology
• 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.
 Greater Understanding with
Electron Microscopy
• Electron
Microscopy show
thin axial filament
and a delicate
membrane
• In dark field it may
appear as chain of
miniature cocci.
Comparative Morphology of
Spritochetes
 Culturing of Leptospira
• Leptospira grwos best
under aerobic
conditions at 280 to
300c best
demonostrated in
Semisolid agar media
• Optimal Media
Fletchers Media
Stuarts Media
Optimal growth after 1 –
2 weeks
 Growth requirements
• Leptospira derive
energy from
oxidation of long
chain fatty acids,
and cannot use or
carbohydrates or
amino acids as
major energy
source.
 Antigenic structure
• All isolates of L.inttterogans from different
parts of the world are serologically related
and exhibit cross reactions in serologic
tests.
• Overlapping of Antigens do occur in
different species.
• Outer envelop contains large amount of
Lipopolysaccharides ( LPS )
• Antigenic structure varies from one strain
to other
• This variation forms the basis of serologic
classification
 Genome of Leptospira
• L. interrogans serogroup
Icterhaemorrhagiae consists of a 4.33
megabase large chromosome and a 359
kilobase small chromosome, totaling 4,768
predicted genes. A series of genes have
been discovered that could potentially be
related to adhesion. This genome differs
from the two other pathogenic spirochaete
(Treponema palladium and Borrelia
burgdorferi), though some similar genes
are visible (CHGC, 2004).
 Pathogenesis
• Leptospira are present in the water bodies
• Enter through breaks in the skin ( cuts and
abrasions ) and mucous membranes
• Enters through Mouth – Nose – Conjunctive
• Rarely enters though ingestion.
• Incubation period 1 – 2 weeks
• When multiples blood stream produces
fever.
• May establish organ involvement in Kidney
and Liver,
• May produce hemorrhage and necrosis in
the tissues and initiates dysfunction of
these organs
Sequence of Leptospira
Infection
 May present with

• Jaundice
• Hemorrhage
• Nitrogen retention
• The Illness is Biphasic with initial
temperature when the second phase
comes with raise of IgM titers raise
• Aseptic meingitis – initial headache,
stiffness of neck, pleocytosis of Cerebro
spinal fluid
Presenting with Jaundice is
significant and Important,
Serious Manifestation
 May present with Major
Complications

• Nephritis
• Hepatitis.
• Manifestations in
eye
• Muscular lesions
• Many infections are
mild and
subclinical
 Weil’s Syndrome
• Weil's syndrome is a severe form of
leptospirosis that causes a continuous
fever, stupor, and a reduction in the
blood's ability to clot, which leads to
bleeding within tissues. Blood tests reveal
anemia. By the third to sixth day, signs of
kidney damage and liver injury appear.
Kidney abnormalities may cause blood in
the urine and painful urination. Liver injury
tends to be mild and usually heals
completely.
 Hepatitis - Leptospirosis
• Hepatitis is the
frequent
complication
• Elevation of serum
creatine
phosphilipae
enzyme raise
differentiates from
Viral hepatitis
where the enxyme
is not raised
 Nephritis - Leptospirosis
• Kidney involvement in
animals produce
chronic disease of the
kidney and the
infected animal starts
shedding large
number of leptospira
and main source of
environmental
contamination of
bacteria and results I
human infections
• Human urine also
contain Spirochetes in
the second and third
week of infection
 Early and Prompt Diagnosis is
Highly Essential
• The development of simpler, rapid
assays for diagnosis has been based
largely on the recognition that early
initiation of antibiotic therapy is
important in acute disease but also
on the need for assays which can be
used more widely.
 Laboratory Diagnosis
Specimens

1 Blood to be collected
in a heparin tube
2 CSF, Tissues
Microscopic
examination
3 Urine to be collected
with great care to
avoid contamination
4 Serum for
agglutination tests
 Culturing Leptospira
Blood and Urine be
cultured in Fletcher’s
semisolid agar or
other media
chemically defined
protein-free media for
the growth of
leptospires have been
proposed. In order to
obtain the desired
rapid and abundant
growth of organisms
necessary for the
efficient production of
vaccines, it has been
necessary to
supplement such
media with a source of
 Serology
• Agglutinating
antibodies raise to
very high titers
1 : 10,000 or
higher
occurs 5 – 10
weeks after onset
of infection
 Serology - ELISA
• Several
Immunoassays are
available as
commercial kits
• Detection of IgM
and razing titers of
IgG will guide in
association with
clinical history will
help in Diagnosis
 Treatment

• Antibiotic of choice is Benzyl Pencillin

given by injection in doses of 5 mega
units in a day, for 5 days.
• If the patients are genuinely
hypertensive to Pencillin opted with
Erythromycin 250mgs four times a
day for a period of 5 days.
Treatment - Other alternatives
• The leptospirosis can be effectively
treated with
Doxycycline
Ampicillin
Amoxicillin
Severe patients need
administration Intravenous
Pencillin or Amoxcillin
 Epidemiology

• Leptospirosis causes several animal

infections
• Most wide spread zoonotic infection in
Nature
• Human infections are accidental
associated with contamination of water,
other materials contaminated with excreta
and animal flesh.
• Animal carriers often excrete upto
100million leptospirosis per ml of urine
 Epidemiology -
Occupation
Certain
occupational
groups such as
agriculture workers
in rice and cane
fields, miners and
sever cleaners are
potential victims
 How Man gets Infected
• Water the great
source
Drinking
Swimming
Bathing, as the urine
of Rodents
chronically infected
contaminate water
sources

Children get infected

when in contact
with infected Dogs
 Control of Leptospirosis

• Rodent control is
most important.
• Human’s should
avoid contact with
water
contaminated with
animal contact.
 Chemoprophylaxis

Doxycycline 200
mg orally once a
week is simple
effective measure.
When heavy
exposure is
anticipated
 Vaccination in humans

• Vaccination for humans is justified where

they cannot be separated from animal
sources or where the animals cannot be
immunized successfully
• Necessity of human vaccinated will arise
where people live and work in proximity to
rodents in wet, tropical conditions, in wet
rice planting and harvesting, in military
operations, or working in sewers.
• Yet no universally accepted vaccine is
available for humans
Vaccination of Animals
Vaccinating animals have a dual purpose
1 Protecting animals
2 Protecting humans who may contract
leptospirosis from them
It is probably true as that immunization of
animals will prevent leptospirosis in people
in contact with them.
It proved true in 1980 when extensive
vaccination of dairy cows in New Zealand
lead to marked decreased incidence in
Humans.
Animals immunized experimentally with
polysaccharide derived from Leptospira LPS
linked to diphtheria Toxoid were protected
against challenges
New Vaccine trails - Leptospira
Created for Health
awareness on
Leptospirosis
Dr.T.V.Rao MD
Email
doctortvrao@gmail.com