Leptospirosis: Symptoms and Treatment
Leptospirosis is a zoonotic infectious disease caused by bacteria of the genus Leptospira.These microorganisms are found everywhere except in Antarctica.The most common in countries with tropical climate.Leptospira are resistant to the environment.So, in reservoirs, bacteria can exist for about thirty days, and in moist soil and at all to nine months.Table of contents:
The source of infection is primarily rodents, hedgehogs, as well as farm animals( pigs, cattle), dogs.Leptospira are excreted with the products of animal life, polluting water, soil, vegetables, plants.It is impossible to get infected with leptospirosis from a sick person.
The disease has many transmission mechanisms:
- Alimentary - infection occurs when drinking water from open water bodies, as well as food contaminated with the urine of a sick animal;
- Contact - infection occurs when contact with damaged skin, mucous membranes with contaminated water, soil.
A person risks getting leptospirosis when swimming in stagnant water bodies.Water can be contaminated with urine, feces of sick animals.Thus, listeria can penetrate not only through the damaged skin, but also the mucous membrane of the mouth, nose, and also through the conjunctiva of the eyes.You can get sick with leptospirosis even when walking barefoot on infected soil.
People who work on livestock farms, meat processing plants and also work in wetlands are at high risk of being infected.Do not discount the veterinarians, animal shelter workers, communal services that can get infected from sick dogs.
The human susceptibility to infection is very high.So, when swimming in a pond, a person can get sick even with a small area of damaged skin and a small amount of bacteria in the water.
Symptoms of leptospirosis
The incubation period ranges from three to thirty days, but on average six to fourteen days.The spectrum of clinical manifestations is very wide.The disease can occur in icteric and jaundiced forms, with a bright clinical picture or worn out.For leptospirosis is characterized by polymorphism of clinical symptoms observed in other diseases.Therefore, the disease requires careful differential diagnosis. During the course of the illness, the periods are as follows:
- Midsummer period;
The disease develops sharply, the temperature rises to 39-40 degrees, a person suffers from chills, weakness, nausea, vomiting, and pain in the lumbar region may occur.Fever can last for a week, be permanent or recurrent.Pathognomonic signs of the disease are muscle pains, in particular in calves.The pain increases with palpation of the muscles.Thus, the emergence of pain during palpation of the anterior abdominal wall may be mistaken for a doctor as a symptom of an acute abdomen.
The appearance of a person is striking: the skin of the face and upper body becomes red, puffy( a hood symptom), the sclera are injected.The tongue is dry, covered with gray, and then brownish.In the area of the lips, the wings of the nose may appear herpetic eruptions.
On the third or sixth day of the disease, a rash appears on the skin: dots, rose-osseous, urticaria.This symptom is observed in approximately 30-40% of patients.Leptospira produce endotoxin, which destroys erythrocytes.This leads to hemorrhages in the sclera and conjunctiva, as well as nasal bleeding.From the prognostic point of view, the earlier a hemorrhagic syndrome has formed in the patient, the more severe the course of the disease should be expected.
There is an increase in the size of the liver and spleen.There may be signs of kidney damage: pain in the lower back, a decrease in urination, urine acquires a reddish hue.
Leptospira are able to penetrate the blood-brain barrier, reaching the brain.Approximately 20% of patients develop meningeal syndrome: headache is worse, it is not eliminated by anesthetics, vomiting, meningeal symptoms.
The duration of the initial period is seven days.
In the second week of illness, the temperature and intoxication begin to decrease.But the patient's condition does not improve.Jaundice, which appeared at the end of the initial period, is becoming more pronounced.As the jaundice increases, there is also an increase in the liver and spleen.It should be noted that jelly-free forms of leptospirosis is not uncommon at all.
During the height of the hemorrhagic syndrome increases: hemorrhages appear on the skin and mucous membranes.In addition, there may be internal bleeding.Thus, with hemorrhage in the lung tissue, the patient experiences signs of respiratory failure.And with a hemorrhage in the adrenal gland develops such a serious condition as the Waterhouse-Frideriksen syndrome.Gradually, signs of anemia increase.
The most characteristic for this period is kidney damage.The patient is progressing to a decrease in urinary output, down to anuria.Renal and hepatic insufficiency are the main causes leading to death with leptospirosis.
With adequate therapy for the third week of the disease, the patient's condition begins to improve.Gradually the skin acquires a natural shade, diuresis is restored.But during this period of illness, one should beware of possible complications. Complications for leptospirosis include:
- Irit, iridocyclitis;
- Hemolytic anemia;
- Infectious-toxic shock;
- Acute renal failure;
- Uremical encephalopathy;
- Edema swelling of the brain;
- Pulmonary edema;
- Hemorrhagic myocarditis.
Approximately every third patient with leptospirosis has recurrence of the disease.Relapses occur with less pronounced signs of intoxication and damage to internal organs.There is fever, which lasts for three to six days.With a recurring course, the disease can last two to three months.On average, the disease lasts three to four weeks.
The jaundiced forms of the disease proceed more favorably with moderate multiple organ dysfunctions.Lethal outcomes are almost not recorded.While with icteric forms the percentage of mortality is 30-50%.It is noteworthy that leptospirosis does not lead to disability even in severe forms, since recovery is followed by the complete restoration of impaired functions.
After the transferred leptospirosis type-specific immunity is formed.
Conducting laboratory tests allows the doctor to determine leptospirosis even with erased forms of the disease. An indicative set of necessary studies is as follows:
- Clinical blood test( neutrophilic leukocytosis, ESR acceleration, anemia, platelet count decrease);
- General analysis of urine( hematuria, cylinders, bile pigments are defined);
- Analysis of cerebrospinal fluid( neutrophilic or mixed pleocytosis, elevated protein content, erythrocytes);
- Biochemical blood test( increased bilirubin, as well as enzymes ALAT, ASAT, alkaline phosphatase, CKK, decreased prothrombin level, increased coagulation time);
- Bacterioscopy( detection of leptospira in blood, cerebrospinal fluid, urine);
- Serological methods ELISA, RA, RNGA( allow to determine specific antibodies to leptospirae with subsequent growth of their titers);
- PCR( allows to detect the DNA of leptospira in the patient's biological materials).
Treatment of leptospirosis
Treatment of patients with leptospirosis should be performed in a hospital.Patients with severe forms of the disease are placed in intensive care wards for constant monitoring of the state of health and the dynamics of laboratory indicators.
The effectiveness of antibacterial drugs depends on when the patient started taking them.So, if the antibiotic is prescribed from the first symptoms of the disease, it has a beneficial effect on the course of the disease.The effectiveness of taking the drug decreases with the appointment at a later date, and after the onset of a period of temperature decrease, they are completely useless.Use drugs such as penicillin, ampicillin, doxycycline, amoxicillin, tetracycline, ceftriaxone.
In addition, anti-leptospirosis gamma globulin is prescribed, which contains antibodies to the most common bacteria serovars.The drug is administered intramuscularly for three days in a row.Previously, the appointment of gamma globulin allows you to reduce the damage to internal organs, to facilitate the course of the disease.
Detoxification therapy includes administration of infusions of solutions of sodium chloride, 2% sodium hydrogen carbonate, 5% glucose.During treatment, it is important to monitor the water balance, because against the background of excessive fluid administration, pulmonary edema, brain, acute heart failure may develop.
In a severe course of the disease, particularly in the defeat of the central nervous system and liver failure, glucocorticosteroids may be given a seven-day course.
Renewal of renal function is prescribed by:
- Drugs that improve renal blood flow( dopamine, euphyllin);
- Diuretics( furosemide);
- Hemodialysis - if diuresis can not be restored with the help of medication.
In the presence of hemorrhagic syndrome, vicasol is shown.And with severe blood loss - a blood transfusion.
Prevention of leptospirosis
To prevent disease, you should avoid bathing in shallow water bodies, as well as drinking water from open water bodies.It is important to prevent the appearance of rodents in places where vegetables are stored( warehouses, cellars).
Groups of people at high risk of infection( veterinarians, livestock keepers, meat factory workers, disinfectors) should wear protective clothing when performing work duties.In addition, these people are subject to vaccination killed by leptospiroznoy vaccine, which is administered subcutaneously in 2 ml twice, with an interval of ten days.In a year, revaccination should be carried out.
After presumed infection, doxycycline may be prescribed as an emergency prophylaxis.
Grigorova Valeria, medical reviewer