Saturday, August 3, 2019


Rats, rains, ricefields? Ring any bells? Sewer workers coming in with jaundice and fever? Still no?
Assam/Odisha/Kerala floods?
The spirochete called Leptospira is the culprit.
The most common species are L. interrogans and L. biflexa.
It is epidemiologically important as it has a high case fatality rate (CFR) between 5-20%.
It affects 1.03 million people annually.
It is endemic in the states of Kerala, Tamil Nadu, Karnataka, Gujrat, Odisha, and the Andaman Islands.
Males suffer more than females.
More common post-monsoon season, 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, buffaloes, goats, sheep, and pigs carriers of infection.
Rodents harbor leptospira in their renal tubules LIFELONG!!! They 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.

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

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, arrhythmias
CNS-meningitis, irritability and restlessness, seizures, encephalitis, focal neurological deficits macular, maculopapular erythematous 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 encephalitides syndromes, and pyelonephritis.

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, cephalosporins, tetracyclines, macrolides, fluoroquinolones.
DOC OPD pts. T. Doxycycline 100mg BD for 7 days, IPD severely ill- Crystalline penicillin 20Lakhs unit,6hrly. pregnant and lactating- ampicillin 500mg 6hrly
corticosteroids in gradual doses in severe hemorrhagic are considered.

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

That's all folks!

Stay awesome:)

Dr. ShilPill

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