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Background
Most common zoonosis in the world.
Global warming: Re-emerging among animals and
humans
Distributed worldwide (sparing the Polar Regions)
Most common in the tropics.
Leptospirosis
Dr Debasis Biswas
Infected
Animal
24 d
Soil/ Fresh water
Urine
16 d
Indirect
Contact
Skin/ Mucosa
Occupational Risks
Occupational exposure: 30-50% of human leptospirosis.
Agricultural
Veterinarians
workers
Slaughterhouse/
abattoir workers
Milkers
Workers in the
fishing industry
Sewer workers
Plumbers
Coal miners
Military
troops
Infected
Animal
Indirect
Contact
Skin/ Mucosa
Accidental
Human
Host
4/5/2015
Manifestations
Antibiotics
Uncomplicated infections:
Oral doxycycline decreases duration of fever and
most symptoms.
Hospitalized patients:
IV Penicillin G: treatment of choice.
Bacteria
Axial endoflagella
Spirochetes
Thin, coiled, gram-negative, aerobic: 6-20 m in length.
Motile, with hooked ends and paired axial flagella (one
on each end), enabling them to burrow into tissue.
Continual spinning motion on the long axis.
Only spirochetes to be isolated on artificial media.
Leptospira:
SEM Image
Classification
Traditionally:
Antigenic differences in the LPS envelope
2 species:
Leptospira interrogans pathogenic
218 serovars
Leptospira biflexa nonpathogenic, free-living
60 serovars.
Currently:
DNA homology
> 7 pathogenic species of leptospires.
Organisms that are identical serologically may be
different genetically, and organisms with the same
genetic makeup may differ serologically.
Animal Reservoirs
L ballum
L icterohaemorrhagiae
L canicola
Dogs
4/5/2015
Pathogenesis
Infected
Animal
24 d
Soil/ Fresh water
Urine
16 d
Indirect
Contact
Skin/ Mucosa
Accidental
Human
Host
Pathologic effects
A b r a s i o n s i n s k i n / S o d d e n o r w a t e r l o g ge d s k i n /
A n i m a l o r R o d e n t B i t e / Mu c o u s m e m b r a n e s o r
Conju nc t i v a/ L u ngs/ Pl acent a
Infection
Liver:
Centrilobular Necrosis
Kupffer Cell Proliferation
JAUNDICE
Immune Response
Opsonizing immunoglobulin: rapid immune clearance
Inflammatory reaction: secondary end-organ injury.
Persistence for weeks to months in immunologically
privileged sites:
Renal tubules, brain, and aqueous humor
Eye: Chronic or recurrent uveitis.
Diagnosis
Lab Tests
Purposes:
To confirm the diagnosis
To determine the extent of organ involvement and
severity of complications.
Confirmation:
Isolation of the pathogen
Serology
Lab work-up:
Dark ground Microscopy : In acute cases
Culture: Long incubation; Low recovery
Serology: Microscopic agglutination testing (MAT)
Gold standard
Only at reference laboratories.
4/5/2015
Isolation
Culture Media
Gold standard.
Slow-growing: May be 8 wks
Low recovery rates
Body fluid/ Tissue
Urine: Highest sensitivity
Contains leptospires from the onset of symptoms
till the 3rd week of infection.
Rabbit Serum
Kortoffs/ Stuarts/ Fletchers Media
Semisynthetic: EMJH
Serology
Paired acute and convalescent sera
Acute sera: 1-2 weeks after onset of symptoms
Convalescent sera: After 2 weeks
Delayed diagnosis
Microscopic agglutination test (MAT)
Gold standard for serodiagnosis
Only in specialized reference labs
Panel of live leptospira belonging to different serovars
Panel to represent circulating serovars in a geographic
area
A 4-fold rise in MAT titer between acute and
convalescent sera with any of these antigens confirms
the diagnosis of leptospirosis.
MAT
MAT
Severity Assessment
4/5/2015
Severity Assessment
Urinalysis: Proteinuria
RBCs, WBCs, Hyaline and granular casts
IgM ELISA
PCR
Histologic Findings
Silver staining & Immunofluorescence
Can identify leptospires in the liver, spleen, kidney,
CNS, muscles, and heart.
During the acute phase of leptospirosis, histology
reveals these organisms without much inflammatory
infiltrate.