CASE STUDY OF LEPTOSPIROSIS Synonym:
Weil’s Dse, Mud fever, Canicola fever , Flood fever, Swineherd’s Swineherd’s Dse, Japanese Seven Days fever
Definition & Background: •
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a bacterial zoonotic disease caused by spirochaetes of the genus Leptospira that affects humans and a wide range of animals, including mammals, birds, amphibians, and reptiles first described by Adolf Weil Weil in 1886 when he reported an “acute infectious disease with enlargement of spleen, jaundice and nephritis” n ephritis”
Causative Agent: •
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Leptospira-genus bacteria was isolated in 1907 from po st mortem renal tissue slice commonly found: Leptospira pyrogenes, Leptospira manilae, & other species like L. icterohemorrhagiae, L. canicola, L. batavia, L. Pomona, L. javinica in animals often is subclinical; an infected animal may appe ar healthy even as it sheds leptospires in its urine; humans are dead-end h osts for the leptospire
Predisposing Factors:
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age: < 15 years of age sex: male season: rainy months geographic: prevalent in slum areas
Source of Infection
Infection comes form contaminated food and water, and infected wild life and domestic animals especially rodents. 1. Rats ( L. leterohemorag leterohemoragiae) iae) are the source source of Weil’ Weil’ss disease disease frequently frequently observed observed among miners, sewer, and abattoir workers. wo rkers. 2. Dogs (L. (L. canicola) canicola) can can also be be the source source of infection infection among among veterinari veterinarians, ans, breeders, and owners of dogs. 3. Mice (L. (L. grippotypho grippotyphosa) sa) may alos alos be a source source of infection infection that that attacks attacks farmers farmers and flax workers. 4. Rats (L. (L. bataviae) bataviae) are the the source of infection infection that attacks attacks ricefi ricefield eld workers. workers. Modes of Transmission Incubation Period: •
6 – 15 days/ 2 – 8 weeks
Clinical Manifestations: 1st stage: Septicemic/ Leptospiremic Phase (4 – 7 days) - onset of high remittent remittent fever, fever, chills, headache, anorexia, nausea & vomiting, abdominal pain, joint pains, muscle pains, myalgia, severe prostration, cough, respiratory distress, bloody sputum. 2nd stage: Immune/ Toxic Phase (4 – 30 days) - if severe, death may occur between the 9th & 16th day
2 types: •
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Anicteric (without jaundice) – return of fever of a lower degree with rash, conjunctival injection, headache, meningeal manifestations like disorientation, convulsions & signs of meningeal irritations (with CSF finding of aseptic meningitis) Icteric (with jaundice) – Weil syndrome; hepatic & renal manifestations: hemorrhage, hepatomegaly, hyperbilirubinemia, oliguria, anuria with progressive renal failure; shock, coma & congestive heart failure in severe cases
3rd stage: Convalescence Phase - Relapses may occur during 4th or 5th week
Diagnosis: •
culture:
blood (1st week)
CSF (5th to 12th day) Urine (after 1st wk til pd of convalescence) •
agglutination tests ( 2nd or 3rd week)
PATHOPHYSIOLOGY Complications: • • •
pneumonia iridocyclitis, optic neuritis peripheral neuritis
Prognosis: • •
cause of death: renal & hepatic failure dse usually last 1 – 3 weeks but bu t may be more prolonged; relapse may ma y occur
Treatment: •
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specific measures: beneficial if done < 4 days da ys of dse Aqueous penicillin G (50,000 units/kg/day in 4-6 d ivided doses intravenously for 7-10 days Tetracycline (20-40 mg/kg/day in 4 doses); may not be given to children < 8 years old general measures symptomatic & supportice care administration of fluid, electrolytes & blood as indicated peritoneal dialysis (for renal failure)
Nursing Interventions: • •
isolation of patient: urine must be properly disposed health teachings: keep a clean environment
Leptospirosis is a bacterial disease that affects humans and animals. It is caused by bacteria of the genus Leptospira. In humans it causes a wide range of symptoms, and some infected persons may have no symptoms at all. Symptoms of leptospirosis include
high fever, severe headache, chills, muscle aches, and vomiting, and may include jaundice (yellow skin and eyes), red eyes, abdominal pain, diarrhea, or a rash. If the disease is not n ot treated, the patient could develop kidney damage, meningitis (inflammation of the membrane around the brain and spinal cord ), liver failure, and respiratory distress.
