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Leptospirosis
FromWikipedia,thefreeencyclopedia

LeptospirosisisaninfectioncausedbycorkscrewshapedbacteriacalledLeptospira.Signsandsymptomscan
rangefromnonetomildsuchasheadaches,musclepains,andfeverstoseverewithbleedingfromthelungsor
meningitis.[4][5]Iftheinfectioncausesthepersontoturnyellow,havekidneyfailureandbleeding,itisthen
knownasWeil'sdisease.[5]Ifitcauseslotsofbleedingfromthelungsitisknownasseverepulmonary
hemorrhagesyndrome.[5]

Leptospirosis
fieldfever,[1]ratcatcher'syellows,[2]
pretibialfever[3]

Upto13differentgenetictypesofLeptospiramaycausediseaseinhumans.[6]Itistransmittedbybothwild
anddomesticanimals.[5]Themostcommonanimalsthatspreadthediseasearerodents.[7]Itisoftentransmitted
byanimalurineorbywaterorsoilcontaininganimalurinecomingintocontactwithbreaksintheskin,eyes,
mouth,ornose.[4][8]Inthedevelopingworldthediseasemostcommonlyoccursinfarmersandpoorpeople
wholiveincities.[5]Inthedevelopedworlditmostcommonlyoccursinthoseinvolvedinoutdooractivitiesin
warmandwetareasoftheworld.[4]Diagnosisistypicallybylookingforantibodiesagainstthebacteriumor
findingitsDNAintheblood.[9]
Effortstopreventthediseaseincludeprotectiveequipmenttopreventcontactwhenworkingwithpotentially
infectedanimals,washingafterthiscontact,andreducingrodentsinareaspeopleliveandwork.[4]The
antibioticdoxycycline,whenusedinanefforttopreventinfectionamongtravellers,isofunclearbenefit.[4]
VaccinesforanimalsexistforcertaintypeofLeptospirawhichmaydecreasetheriskofspreadtohumans.[4]
Treatmentifinfectediswithantibioticssuchas:doxycycline,penicillin,orceftriaxone.[4]Weil'sdiseaseand
severepulmonaryhaemorrhagesyndromeresultindeathratesgreaterthan10%and50%,respectively,even
withtreatment.[5]
Itisestimatedthatseventotenmillionpeopleareinfectedbyleptospirosisayear.[10]Thenumberofdeathsthis
causesisnotclear.[10]Thediseaseismostcommonintropicalareasoftheworldbutmayoccuranywhere.[4]
Outbreaksmayoccurinslumsofthedevelopingworld.[5]ThediseasewasfirstdescribedbyphysicianAdolf
Weilin1886inGermany.[4]Animalswhichareinfectedmayhavenosymptoms,mildsymptoms,orsevere
symptoms.[6]Symptomsmayvarybythetypeofanimal.[6]InsomeanimalsLeptospiraliveinthereproductive
tract,leadingtotransmissionduringmating.[11]

Leptospiramagnified200foldwithdarkfield
microscope
Classificationandexternalresources
Specialty

Infectiousdisease

ICD10

A27(http://apps.who.int/classification
s/icd10/browse/2016/en#/A27)

ICD9CM

100(http://www.icd9data.com/getICD
9Code.ashx?icd9=100)

OMIM

607948(http://omim.org/entry/60794
8)

DiseasesDB 7403(http://www.diseasesdatabase.co
m/ddb7403.htm)
MedlinePlus 001376(http://www.nlm.nih.gov/medl

Contents

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Contents

ineplus/ency/article/001376.htm)
eMedicine

1 Signsandsymptoms
2 Cause
2.1 Transmission
2.2 Atriskoccupations
3 Diagnosis
4 Prevention
5 Treatment
6 Epidemiology
7 History
7.1 Names
8 Otheranimals
9 References
10 Externallinks

article/220563(http://emedicine.medsc
ape.com/article/220563overview)
article/96569(http://emedicine.medsca
pe.com/article/96569overview)
article/788751(http://emedicine.medsc
ape.com/article/788751overview)

PatientUK Leptospirosis(http://patient.info/docto
r/leptospirosisweilsdisease)
MeSH

C01.252.400.511(https://www.nlm.ni
h.gov/cgi/mesh/2016/MB_cgi?mode=
&term=Leptospirosis&field=entry#Tre
eC01.252.400.511)

Signsandsymptoms
Leptospiralinfectioninhumanscausesarangeofsymptoms,andsomeinfectedpersonsmayhavenosymptomsatall.Leptospirosisisabiphasicdiseasethat
beginssuddenlywithfeveraccompaniedbychills,intenseheadache,severemyalgia(muscleache),abdominalpain,conjunctivalsuffusion(redeye),and
occasionallyaskinrash.[12]Thesymptomsappearafteranincubationperiodof712days.Thefirstphase(acuteorsepticphase)endsafter37daysofillness.[13]
ThedisappearanceofsymptomscoincideswiththeappearanceofantibodiesagainstLeptospiraandthedisappearanceofallthebacteriafromthebloodstream.
Thepatientisasymptomaticfor34daysuntilthesecondphasebeginswithanotherepisodeoffever.[12]Thehallmarkofthesecondphaseismeningitis
(inflammationofthemembranescoveringthebrain).[14]
90percentofcasesofthediseasearemildleptospirosis.Therestexperienceseveredisease,whichdevelopsduringthesecondstageoroccursasasingle
progressiveillness.[15]TheclassicformofsevereleptospirosisisknownasWeil'sdisease,whichischaracterizedbyliverdamage(causingjaundice),kidney
failure,andbleeding.[16]Additionally,theheartandbraincanbeaffected,meningitisoftheouterlayerofthebrain,encephalitisofbraintissuewithsamesigns
andsymptomsandlungaffectedasthemostseriousandlifethreateningofallleptospirosiscomplications.Theinfectionisoftenincorrectlydiagnosedduetothe
nonspecificsymptoms.
Otherseveremanifestationsincludeextremefatigue,hearingloss,respiratorydistress,andazotemia.

Cause
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LeptospirosisiscausedbyspirochaetebacteriabelongingtothegenusLeptospira.21speciesofLeptospirahavebeen
identified.[6]13speciescausediseaseorhavebeendetectedinhumancases.[6][17]
Leptospiraarealsoclassifiedbasedontheirserovar.About250pathogenicserovarsofLeptospiraarerecognized.The
diversesugarcompositionofthelipopolysaccharideonthesurfaceofthespirocheteisresponsiblefortheantigenic
differencebetweenserovars.Antigenicallyrelatedserovarsaregroupedinto24serogroups,whichareidentifiedusingthe
microscopicagglutinationtest(MAT).Agivenserogroupisoftenfoundinmorethanonespecies,suggestingthattheLPS
genesthatdeterminetheserovarareexchangedbetweenspecies.[17]
Thetraditionalserologicsystemcurrentlyseemsmoreusefulfromadiagnosticandepidemiologicstandpointbutthis
maychangewithfurtherdevelopmentandspreadoftechnologieslikepolymerasechainreaction(PCR).

Scanningelectronmicrographofa
numberofLeptospirasp.bacteria
atopa0.1mpolycarbonatefilter

Transmission
Leptospirosisistransmittedbytheurineofaninfectedanimalandiscontagiousaslongastheurineisstillmoist.AlthoughLeptospirahasbeendetectedin
reptilesandbirds,onlymammalsareabletotransmitthebacteriumtohumansandotheranimals.[18]Rats,mice,andmolesareimportantprimaryhostsbuta
widerangeofothermammalsincludingdogs,deer,rabbits,hedgehogs,cows,sheep,raccoons,opossums,skunks,andcertainmarinemammalscarryandtransmit
thediseaseassecondaryhosts.InAfrica,thebandedmongoosehasbeenidentifiedasacarrierofthepathogen,likelyinadditiontootherAfricanwildlife
hosts.[19]Dogsmaylicktheurineofaninfectedanimaloffthegrassorsoil,ordrinkfromaninfectedpuddle.
Housebounddomesticdogshavecontractedleptospirosis,apparentlyfromlickingtheurineofinfectedmiceinthehouse.Thetypeofhabitatsmostlikelytocarry
infectivebacteriaincludesmuddyriverbanks,ditches,gullies,andmuddylivestockrearingareaswherethereisaregularpassageofwildorfarmmammals.The
incidenceofleptospirosiscorrelatesdirectlywiththeamountofrainfall,makingitseasonalintemperateclimatesandyearroundintropicalclimates.
Leptospirosisalsotransmitsviathesemenofinfectedanimals.[20]
Humansbecomeinfectedthroughcontactwithwater,food,orsoilthatcontainsurinefromtheseinfectedanimals.Thismayhappenbyswallowingcontaminated
foodorwaterorthroughskincontact.Thediseaseisnotknowntospreadbetweenhumans,andbacterialdisseminationinconvalescenceisextremelyrarein
humans.Leptospirosisiscommonamongwatersportenthusiastsinspecificareas,asprolongedimmersioninwaterpromotestheentryofthisbacterium.Surfers
andwhitewaterpaddlers[21]areatespeciallyhighriskinareasthathavebeenshowntocontainthesebacteria,andcancontractthediseasebyswallowing
contaminatedwater,splashingcontaminatedwaterintotheireyesornose,orexposingopenwoundstoinfectedwater.[22]

Atriskoccupations
Occupationsatriskincludeveterinarians,slaughterhouseworkers,farmers,sewermaintenanceworkers,wastedisposalfacilityworkers,andpeoplewhoworkon
derelictbuildings.[23]Slaughterhouseworkerscancontractthediseasethroughcontactwithinfectedbloodorbodyfluids.Rowers,kayakersandcanoeistsalso
sometimescontractthedisease.[24]Itwasoncemostlyworkrelatedbutisnowoftenalsorelatedtoadventuretourismandrecreationalactivities.[5]
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Diagnosis
Oninfectionthemicroorganismcanbefoundinbloodandcerebrospinalfluid(CSF)forthefirst7to10days(invoking
serologicallyidentifiablereactions)andthenmovingtothekidneys.After7to10daysthemicroorganismcanbefoundin
freshurine.Hence,earlydiagnosticeffortsincludetestingaserumorbloodsampleserologicallywithapanelofdifferent
strains.
Kidneyfunctiontests(bloodureanitrogenandcreatinine)aswellasbloodtestsforliverfunctionsareperformed.Thelatter
revealamoderateelevationoftransaminases.Briefelevationsofaspartateaminotransferase(AST),alanine
aminotransferase(ALT),andgammaglutamyltransferase(GGT)levelsarerelativelymild.Theselevelsmaybenormal,
eveninchildrenwithjaundice.
Diagnosisofleptospirosisisconfirmedwithtestssuchasenzymelinkedimmunosorbentassay(ELISA)andpolymerase
chainreaction(PCR).TheMAT(microscopicagglutinationtest),aserologicaltest,isconsideredthegoldstandardin
diagnosingleptospirosis.Asalargepanelofdifferentleptospiramustbesubculturedfrequently,whichisbothlaborious
andexpensive,itisunderused,especiallyindevelopingcountries.

Kidneytissue,usingasilverstaining
technique,revealingthepresenceof
Leptospirabacteria

Differentialdiagnosislistforleptospirosisisverylargeduetodiversesymptoms.Forformswithmiddletohighseverity,thelistincludesdenguefeverandother
hemorrhagicfevers,hepatitisofvariousetiologies,viralmeningitis,malaria,andtyphoidfever.Lightformsshouldbedistinguishedfrominfluenzaandother
relatedviraldiseases.Specifictestsareamustforproperdiagnosisofleptospirosis.
Undercircumstancesoflimitedaccess(e.g.,developingcountries)tospecificdiagnosticmeans,closeattentionmustbepaidtothemedicalhistoryofthepatient.
Factorssuchascertaindwellingareas,seasonality,contactwithstagnantcontaminatedwater(bathing,swimming,workingonfloodedmeadows,etc.)orrodents
inthemedicalhistorysupporttheleptospirosishypothesisandserveasindicationsforspecifictests(ifavailable).
LeptospiracanbeculturedinEllinghausenMcCulloughJohnsonHarrismedium(EMJH),whichisincubatedat28to30C.[25]Themediantimetopositivityis
threeweekswithamaximumofthreemonths.Thismakesculturetechniquesuselessfordiagnosticpurposesbutiscommonlyusedinresearch.

Prevention
Doxycyclinehasbeenprovidedonceaweekasaprophylaxistominimizeinfectionsduringoutbreaksinendemicregions.[26]However,thereisnoevidencethat
chemoprophylaxisiseffectiveincontainingoutbreaksofleptospirosis.[27]Preexposureprophylaxismaybebeneficialforindividualstravelingtohighriskareas
forashortstay.[28]
Effectiveratcontrolandavoidanceofurinecontaminatedwatersourcesareessentialpreventivemeasures.Humanvaccinesareavailableonlyinafewcountries,
suchasCubaandChina.[5]Animalvaccinesonlycoverafewstrainsofthebacteria.Dogvaccinesareeffectiveforatleastoneyear.[29]
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Treatment
EffectiveantibioticsincludepenicillinG,ampicillin,amoxicillinanddoxycycline.Inmoreseverecasescefotaximeorceftriaxoneshouldbepreferred.
Glucoseandsaltsolutioninfusionsmaybeadministereddialysisisusedinseriouscases.Elevationsofserumpotassiumarecommonandifthepotassiumlevel
getstoohighspecialmeasuresmustbetaken.Serumphosphoruslevelsmaylikewiseincreasetounacceptablelevelsduetokidneyfailure.
Treatmentforhyperphosphatemiaconsistsoftreatingtheunderlyingdisease,dialysiswhereappropriate,ororaladministrationofcalciumcarbonate,butnot
withoutfirstcheckingtheserumcalciumlevels(thesetwolevelsarerelated).Administrationofcorticosteroidsingraduallyreduceddoses(e.g.,prednisolone)for
710daysisrecommendedbysomespecialistsincasesofseverehemorrhagiceffects.Organspecificcareandtreatmentareessentialincasesofkidney,liver,or
heartinvolvement.

Epidemiology
Itisestimatedthatseventotenmillionpeopleareinfectedbyleptospirosisannually.[10]Onemillioncasesofsevereleptospirosisoccurannually,with58,900
deaths.[30]Annualratesofinfectionvaryfrom0.02per100,000intemperateclimatesto10to100per100,000intropicalclimates.[26]Thisleadstoalower
numberofregisteredcasesthanlikelyexists.

History
ThediseasewasfirstdescribedbyAdolfWeilin1886whenhereportedan"acuteinfectiousdiseasewithenlargementofspleen,jaundice,andnephritis."
Leptospirawasfirstobservedin1907fromapostmortemrenaltissueslice.[31]In1908,InadaandItofirstidentifieditasthecausativeorganism[32]andin1916
noteditspresenceinrats.[33]
LeptospirosiswaspostulatedasthecauseofanepidemicamongNativeAmericansalongthecoastofpresentdayMassachusettsthatoccurredimmediatelybefore
thearrivalofthePilgrimsin1620andkilledmostofthenativepopulation.[34]Earlierproposalsincludedplague,yellowfever,smallpox,influenza,chickenpox,
typhus,typhoidfever,trichinellosis,meningitis,andsyndemicinfectionofhepatitisBwithhepatitisD.[35][36][37][38]Thediseasemayhavebeenbroughttothe
NewWorldbyEuropeansandspreadbythehighriskdailyactivitiesoftheNativeAmericans.[34]
BeforeWeil'scharacterizationin1886,thediseaseknownasinfectiousjaundicewasverylikelythesameasWeil'sdiseaseorsevereictericleptospirosis.During
theEgyptiancampaign,Napoleon'sarmysufferedfromwhatwasprobablyinfectiousjaundice.[39]InfectiousjaundiceoccurredamongtroopsduringtheAmerican
CivilWar.[40]

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ItwasalsoreportedamongtroopsatGallipoliandotherbattlesofWorldWarI,wherethesoddenconditionsoftrenchwarfarefavoredinfection.Termsusedin
early20thcenturydescriptionsofleptospirosisincludethepseudodengueofJava,sevendayfever,autumnfever,Akiyamadisease,andmarshorswampfever.L
icterohaemorrhagiaewasidentifiedasthecausativeagentinpreWorldWarIIoutbreaksinJapan,whichwerecharacterizedbyjaundiceandahighmortalityrate.
InOctober2010BritishrowerAndyHolmesdiedaftercontractingWeil'sDisease.[41]Hisdeathhasraisedawarenessofthediseaseamongthepublicandmedical
professionals.[42]

Names
Leptospirosishasmanydifferentnamesincluding:"7dayfever",[1]"harvestfever",[1]"fieldfever",[1]"canefieldfever",[1]"mildfever",[1]"ratcatcher's
yellows",[2]"FortBraggfever",[3]and"pretibialfever".[3]
Ithashistoricallybeenknownas"blackjaundice"[43]andinJapanitiscalled"nanukayamifever".[44]Weil'sdiseaseorWeil'ssyndromeisalsoknownas
spirochaetosisicterohaemorrhagica.[45]

Otheranimals
Incubation(timeofexposuretofirstsymptoms)inanimalsisanywherefrom2to20days.Indogs,leptospirosismostoftendamagestheliverandkidney.In
addition,recentreportsdescribeapulmonaryformofcanineleptospirosisassociatedwithseverehemorrhageinthelungssimilartohumanpulmonary
hemorrhagicsyndrome.[46][47]Vasculitismayoccur,causingedemaandpotentiallydisseminatedintravascularcoagulation(DIC).Myocarditis,pericarditis,
meningitis,anduveitisarealsopossiblesequelae.[24]
AtleastfiveimportantserovarsexistintheUnitedStatesandCanada,allofwhichcausediseaseindogs:[24][46][48]
Icterohaemorrhagiae
Canicola
Pomona
Grippotyphosa
Bratislava
IndogswhenleptospirosisiscausedbyL.interrogansitmaybereferredtoas"canicolafever".[44]Leptospirosisshouldbestronglysuspectedandincludedaspart
ofadifferentialdiagnosisifthescleraeofadog'seyesappearjaundiced(evenslightlyyellow).Theabsenceofjaundicedoesnoteliminatethepossibilityof
leptospirosis,anditspresencecouldindicatehepatitisorotherliverpathologyratherthanleptospirosis.Vomiting,fever,failuretoeat,reducedurineoutput,
unusuallydarkorbrownurine,andlethargyarealsoindicationsofthedisease.
Indogs,penicillinismostcommonlyusedtoendtheleptospiremicphase(infectionoftheblood),anddoxycyclineisusedtoeliminatethecarrierstate.
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Externallinks
U.S.DiseaseControlandPreventionCenterpageonLeptospirosis(http://www.cdc.gov/leptospirosis/index.html)
"Leptospira".NCBITaxonomyBrowser.171.
Retrievedfrom"https://en.wikipedia.org/w/index.php?title=Leptospirosis&oldid=741501039"
Categories: Bacteriumrelatedcutaneousconditions Bovinediseases Dogdiseases Rodentcarrieddiseases Spirochaetes Zoonoses
Zoonoticbacterialdiseases

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