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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

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 korthof’s 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
Initial stage leptospiremia toxic symptoms
 (1~3days)





three symptoms:
fever,myalgia,fatigue;
three signs:
conjunctival suffussion;
muscle tenderness;
enlargement of lymphonodes;
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
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


40万 u q6h or q8h im 7days
note: Herxheimer reaction
first time - small amount 5万 u
 im


2). Gentamycin 8万 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