Sunday, August 4, 2019

Leptospirosis

Rats, rains, ricefields?
Ringing any bells?
Sewer workers coming in with jaundice and fever?
Still no?
Assam/Odisha/Kerala floods?
This spirochete called Leptospira is the culprit.
Most common species is L. interrogans and L. biflexa.
It is epidemologically important as high case fatality rate (CFR) between 5-20%
It affects 1.03 million people anually.
Endemic in states of Kerala, Tamil Nadu, Karnataka, Gujrat, Odisha and Andaman Islands.
Males suffer more than females.
More common post monsoon, natural disasters like floods and cyclones.
Transmission- water or soil contaminated by the urine of infected animals or by direct contact with infected animals such as cattle, buffalo, goat, sheep and pigs carriers of infection.
Rodents harbour leptospira in their renal tubules LIFELONG!!! and are considered reservoir hosts.
Leptospira forms biofilms for survival in renal tubules of reservoir and carrier animals.

Vascular endothelial damage is the primary lesion in leptospirosis ,after entry in the host.

CLINICAL  PRESENTATION
1. Anicteric phase- symptoms unnoticed. Sudden onset of remittent fever, chills, severe myalgia, intense headache and B/L conjunctival suffusion.
Mild proteinuria with few casts and cells in urine, cough and chest pain.
2. Icteric phase-  severe form of disease, where lepto from blood vessels trasfered to organs.
C/F- fever, myalgia, headache, conjunctival suffusion, acute renal failure-oliguria, anuria, nausea, vomiting, diarrhoea, abdominal pain, hypotension.
Elevated transaminases, leucocytes, erythrocytes in  urine, albuminuria, increases in blood urea and creatinine.

LIVER+ KIDNEY= WEIL'S DISEASE
HEPATIC- mild to severe jaundice, tender hepatomegaly, hepatic encephalopathy
RENAL-  acute tubular necrosis(ATN) , interstitial necrosis, renal failure.
RBC casts are common in urine microscopy.
PULMONARY- cough, respiratory distress, basal and mid zone opacities, hemorrhagic pneumonitis, interstitial and intra alveolar hemorrhages
CVS- shock, arrythmias
CNS-meningitis, irritability and restlessness, seizures, encephlitis, focal neurological deficits macular, maculopapular erythmatous skin irruptions
Pregnancy with leptospirosis BAD PROGNOSIS.
LAB- elevated WBC, Neutophilia, high ESR, thrombocytopenia, increased BUN and increased creatinine phosphokinase
D/D- falciparum malaria, dengue, scrub typhus, typhoid, viral hepatitis, acute encephlitis syndromes and pyelonephritis.

Diagnosis-
Dark ground microscopy, immunofluorescence, culture, histopathological staining assay.PCR
microscopic agglutination test (MAT) ELISA, IHA

Treatment and prevention:start treatment clinically
susceptible to penicillin, doxycycline, cephalosporine, tertracycline, macrolides, fluroquinolones.
DOC OPD pts. T. Doxycycline 100mg BD for 7 days, IPD severely ill- Crystalline penicilline 20Lakhs unit,6hrly. pregnant and lactating- ampicilin 500mg 6hrly
corticosteroids in gradual doses in severe hemorrhagic is considered.

prevention- rodent control, health education,personal protection, animal vaccination

Thats all folks!

Stay awesome:)

Dr. ShilPill

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