LEPTOSPIROSIS

No2 hospital CMU department of infectious disease Huang Fen

DEFINITION
1. Leptospirosis is a kind of zoonotic infectious disease caused by pathogenic leptospires; 2. rats and swine are cardinal source of infection; 3. the disease often occurs in summer and fall;

DEFINITION
4. clinical features: three symptoms, three signs, internal organ damage, seguelae of eyes and nerve system 5. treatment: penicillin.

ETIOLOGY
1.pathogen : pathogenic leptospira 2.features of leptospia: helicoid with hook, length 6~ 20 um,G darkfield microscope; in korthofs media;

ETIOLOGY
several months in water and moist soil (PH7.0~7.5)

3.Classification:
23 serogroups and more then 200 serotypes in the world; 19 serogroup and 74 serotypes in china.

icterohemorrhagic group, pomona group

EPIDEMIOLOGY 1.Source of infection: rat: apodemus agrarius, rice field type; pigs: flood or rain type;
patient

EPIDEMIOLOGY
2.Routes of transmission: (1) water borne (indirect contact transmission): by skin,mucosa,when skin is injured. (2) direct contact transmission: (3) food borne 3.Susceptibility of population:

EPIDEMIOLOGY
4.Epidemiologic features: (1)season: summer and fall; (2) nosogenic age: young and middle age,children (3)occupation: farmer,slaughter, fisher,veterinarian.

EPIDEMIOLOGY
4.Epidemiologic features: (4)epidemic type : rice field type flood type rain type

PATHOGENESIS
leptospira skin,mucosa leptospiremia toxic symptoms
three symptoms: fever,myalgia,fatigue; three signs: conjunctival suffussion; muscle tenderness; enlargement of lymphonodes;

Initial stage
(1~3days)

PATHOGENESIS
severe toxic symptoms lesion of organs: influenza form pneumorrhagic form middle stage icterohemorrhagic form (3~10d) meningoencephalitis renal failure form.

PATHOGENESIS
immunopathological reaction after fever; sequelae of eyes; reactive meningitis; cerebro arteritis obliterans.

convalescent stage

PATHOLOGY
1. basic pathological change is infective,toxic injured of systemic capillaries; 2. severe:lung,liver,kidneys,brain. exudation,hemorrhage, edema or necrosis.

CLINICAL MANIFESTATIONS Incubation period: 2~28 days usually 7~13days; 1. Influenza-typhoid type:5~10days three symptoms: fever,myalgia and fatigue. three signs: conjunctival suffusion,

CLINICAL MANIFESTATIONS three signs: conjunctival suffusion, tenderness of gastrocnemius muscle; enlargement and tenderness of superficial lymphnodes. Inguinal and axillary lymphodes.

CLINICAL MANIFESTATIONS 2. pneumorrhagia form:

1). three symptoms and three signs 2). pneumorrhagia symptoms(3~4d) (1). mild pneumorrhagia type cough,expectoration with blood. a few moist rales. X-ray of chest: scattering spotty and small fasciola shadow

CLINICAL MANIFESTATIONS 2. pneumorrhagia form:

(2) diffuse pneumorrhagia type short breathing, palpitation, dysphoria, massive hemoptysis, asphyxia, cyanosis, a lot of moist rales. X-ray: extensive fasciola shadow

CLINICAL MANIFESTATIONS 3.Icterohemorrhagic type:(Weil ,s disease)

1). three symptoms and three signs 2). jaundice, hemorrage, renal injury (4~5d)
liver injury:

anorexia,vomiting, jaundice, abnormal liver function.

CLINICAL MANIFESTATIONS 3.Icterohemorrhagic type:(Weil ,s disease)

hemorrhage: petechiae,ecchymoses,hemoptysis, hematemesis etc. renal injury: proteinuria, RBC, WBC, cast, oliguria,azotemia,uremia.

CLINICAL MANIFESTATIONS 4.renal failure type:

oliguria, azoteinia, uremia.

5.meningoencephalitis type:
1). three symptoms and three signs 2). 3~4days later, meningitis, encephalitis.
headache,vomiting,meningeal irritation, lethargy,coma,paralysis or convulsion.

CLINICAL MANIFESTATIONS
CSF is abnormal.
 pressure increase  pleocytosis<500 106/L  protein is normal or elevated slightly.  glucose and chloride is normal.  leptospira isolation: positive.

CLINICAL MANIFESTATIONS SEQUELAE 1. after fever :1~5days after defervascence 2. sequelae of eyes: 1week~1month
iridocycyclitis, choroiditis , uveitis

3.reactive meningitis 4.cerebroarteritis obliterans:2w~2m

hemiplegia aphasia

LABORATORY FINDINGS: 1. routine examination:

1). blood routine examination: WBC is increased slightly; 2).urine routine examination: protein (2/3)

2. serological examination:
1).microscopic agglutination test (MAT) detect antibody >1:400

LABORATORY FINDINGS:
2). ELISA: serum and CSF IgM antibody

3. pathogenic test
1).blood culture: 2).PCR: DNA

DIAGNOSIS
1.epidemiologic data:
1).epidemic area; 2).epidemic season; 3).a history of contact with contaminated water;

2.clinical manifestations: 3.Lab findings:

DIFFERENTIAL DIAGNOSIS 1.Influenza; Typhoid fever, 2.Lobar pneumonia; 3.Viral hepatitis; 4.Viral meningitis; 5.Epidemic hemorrhagic fever;

TREATMENT
1.Pathogenic therapy 1). first choice: penicillin
40 u q6h or q8h im 7days note: Herxheimer reaction
first time - small amount 5 im u

2). Gentamycin 8

u q8h im

TREATMENT
2.Symptomatic therapy
1). Herxheimer reaction physical cooling, sedative, hydrocortisone. 2). pneumorrhagia type sedative, hydrocortisone, cardiotonics

3.treatment of sequlea

PREVENTION
1.control of pigs:
1). stable breeding 2).immunized by vaccine

2.killing of rats, 3.cutting route of transmission, 4.vaccination: multivalent vaccine