Leptospirosis

DR.
SNEHAL PATIL
MD MED (HOM)
INTRODUCTION
• Leptospirosis is essentially animal infection by several
serotypes of Leptospira (Spirocheates) and transmitted to man
under certain environmental conditions.
• The disease manifestations are many and varied, ranging in
severity from a mild febrile illness to severe, and sometimes
fatal disease with liver and kidney involvement.
• Weils disease is one of the many manifestations of human
leptospirosis.
PROBLEM STATEMENT
• Leptospirosis is considered to be the most widespread of the
disease transmissible from animal to man.
• It has high prevalence in warm humid tropical countries.
• Out breaks mostly occur as a result of heavy rainfall and
consequent floodings.
• Although the global burden of disease is unknown, ~ 500,000 cases
of leptospirosis are estimated to occur worldwide each year.
• The incidence in some areas may be as high as 975 cases per lac
population.
• During the past decade, the occurrence of outbreak has highlighted
the strong links between leptospirosis and extreme weather events
in Guyana, India, Philippines and Thailand etc.
EPIDEMIOLOGICAL DETERMINANTS
Agent factors
a) AGENT :
• Leptospira are thin and light motile spirocheates
0.1-0.2 μm wide and 5-15 μm long with hooked
ends.
• Only the strains of L. interrogans are pathogenic.
• The organisms are visible by dark-field
illumination and silver staining.
• At present, 23 sero-groups and 200 serovars have
been recognized from various parts of the world.
b) SOURCE OF INFECTION: Leptospira are excreted

in the urine of infected animals for a long time,
often for an entire life time in cases of rodents.
c) ANIMAL RESERVOIRS :
• Leptospirosis affects wild and domestic animals
worldwide especially rodents such as rats, mice and
voles.
• Most domestic animals including cattle, sheep, goats,
water buffalo, pigs and horses may be infected through
grazing in areas contaminated by the urine of the carrier
host.
• Pet animals, particularly dogs may also be infected.
• Infection may spread from wild animals to domestic
livestock, and thence to humans.
• Rats and small rodents - particularly R. norvegicus and
Mus musculus are the most important reservoirs.
Host factors
(a) AGE : Children acquire the infection from dogs more
frequently than do adults. Human infection is only accidental.
(b) OCCUPATION : Human infections are usually due to
occupational exposure to the urine of infected animals, e.g,
agricultural and livestock farmers, workers in rice fields,
sugarcane fields, and underground sewers, abattoir workers,
meat and animal handlers, veterinarians etc. Leisure time
activities such as swimming and fishing may also carry risks.
(c) IMMUNITY : A specific immunity follows infection.
Environmental factors
• Leptospirosis infection is unique in that it is acquired through
contact with an environment contaminated by urine and
faeces from carrier (reservoir) animal or other infected animals.
• Leptospira shed in the urine can survive for weeks in soil and
water, so environmental contamination may reach high levels in
areas where carrier animals frequently urinate.
• The association of poor housing, limited water supply,
inadequate method of waste disposal, all combine to make the
disease a significant risk for the poor population in both urban
and rural areas.
MODE OF TRANSMISSION
1. Direct contact with urine or tissue of infected animal

Through skin abrasions, intact mucus membrane
2. Indirect contact
Broken skin with infected soil, water or vegetation
Ingestion of contaminated food & water
3. Droplet infection
Inhalation of droplets of infected urine
No human to human transmission
INCUBATION PERIOD
• Usually 10 days with a range of 4 to 20 days.

CLINICAL FEATURES
• Leptospiral infection in humans causes a range of symptoms.
– fever accompanied by chills,
– intense headache,
– severe myalgia (muscle ache),
– abdominal pain,
– conjunctival suffusion (red eye), and
– occasionally a skin rash.
• The first phase (acute or septic phase) ends after 3–7 days of illness.
• The disappearance of symptoms coincides with the appearance of antibodies
against Leptospira and the disappearance of all the bacteria from the bloodstream.
• The patient is asymptomatic for 3–4 days until the second phase begins with another
episode of fever.
• The hallmark of the second phase is meningitis (inflammation of the membranes
covering the brain).
• The classic form of severe leptospirosis is known as Weil's disease, which is
characterized by liver damage (causing jaundice), kidney failure, and bleeding.
• Additionally, the heart and brain can be affected, meningitis of the outer layer
of the brain, encephalitis of brain tissue with same signs and symptoms; and
lung affected as the most serious and life-threatening of all leptospirosis
complications.
• The infection is often incorrectly diagnosed due to the nonspecific symptoms.
• Other severe manifestations include extreme fatigue, hearing loss, respiratory
distress, and azotemia.
LABORATORY TESTS
• Haemogram
• Serum Bilirubin / SGOT/ SGPT
• Blood Urea, Creatinine & Electrolytes
• Chest X-Ray; ECG
• Tests for diagnosis of Leptospirosis
– Culture for Leptospira: Positive
– MAT; Sero conversion or 4 fold rise/ high titer
– ELISA / MSAT : positive
• MAT: Microscopic agglutination test
• (M)SAT: Microscopic slide agglutination Test
CONTROL
(a) ANTIBIOTICS : Penicillin is the drug of choice but other

antibiotics (tetracycline or doxycycline) are also effective. The
dosage of penicillin is 6 million units daily intravenously.
(b) ENVIRONMENTAL MEASURES : This includes preventing
exposure to potentially contaminated water, reducing
contamination by rodent control and protection of workers
in hazardous occupation. Measures should be taken to control
rodents, proper disposal of wastes and health education etc.
VACCINATION
• Immunization of farmers and pets prevent disease.

• It is important that they should incorporate strains of the
serotypes that predominate in the particular area since
immunity to one type of Leptospira may not protect against
infection by another.
THANK YOU!!!

Leptospirosis

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DR.

b) SOURCE OF INFECTION: Leptospira are excreted

1. Direct contact with urine or tissue of infected animal

• Usually 10 days with a range of 4 to 20 days.

(a) ANTIBIOTICS : Penicillin is the drug of choice but other

• Immunization of farmers and pets prevent disease.

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