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LEPTOSPIROSIS

Cause: Leptospira bacteria

Incubation Period: 7-10 days

Mode of Transmission:

Entry of the leptospira bacteria through wounds when in contact with

flood waters, vegetation, moist soil contaminated with the urine of infected

animals, especially rats.

Signs and Symptoms:

Fever

Non-specific symptoms of muscle pain, headache

Calf-muscle pain and reddish eyes for some cases

Severe cases result tot liver involvement, kidney failure or brain

involvement. Thus, some cases may have yellowish body discoloration,

dark-colored urine and light stools, low urine output, severe headache.
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Treatment:

Antibiotics duly prescribed by a physician.

Early recognition and treatment within two days of illness to prevent

complications of leptospirosis, so early consultation is advised.

Prevention and Control:

Avoid swimming or wading in potentially contaminated water or flood

water.

Use of proper protection like boots and gloves when work requires

exposure to contaminated water.

Drain potentially contaminated water when possible.

Control rats in the household by using rat traps or rat poison, maintaining

cleanliness in the house.

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LEPTOSPIROSIS

Clinical Manifestations:

Any individual presenting with acute febrile illness of at least 2 days and

either residing in a flooded area or has high-risk exposure (defined as wading in

floods and contaminated water, contact with animal fluids, swimming in flood

water or ingestion of contaminated water with or without cuts or wounds) and

presenting with at least two of the following symptoms: myalgia, calf tenderness,

conjunctival suffusion, chills, abdominal pain, headache, jaundice, or oliguria

should be considered a suspected leptospirosis case.

Leptospirosis occurs throughout the world but is highest in the tropics. It is

one of the most common zoonosis with human infection occurring commonly

through superficial cuts and open wounds after exposure to a contaminated

environment (e.g. flood), direct contact with infected animals or following rodent

bites. The spectrum of presentation of leptospirosis is protean and varies from a

mild and in apparent form to a severe one involving multiorgan system. Clinicians

should therefore have a high index of suspicion among patients with febrile illness

and high-risk exposures because mortality may be as high as 15%. A review of the

clinical presentation of 353 cases of laboratory confirmed leptospirosis in Hawaii

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from 1974 to 1998 showed that the most common presentation included fever,

myalgia and headache. Leptospirosis is endemic in the Philippines and the number

of cases peak during the rainy months of June to August. Outbreaks have been

associated with wading in flood waters. A review of patients hospitalized for

suspected leptospirosis in the 70s showed abrupt fever, myalgia, headache,

abdominal pain, meningismus, conjunctival suffusion and gastrocnemius or calf

tenderness to be the common symptoms. In the eighties and nineties, other

symptoms observed included oliguria/anuria, diarrhea, thrombocytopenia and

bleeding diatheses. Usually, an average of 680 leptospirosis cases and 40 deaths

from the disease are reported every year in the Philippines.

Which patient will need hospital admission?

Any suspected case of leptospirosis presenting with acute febrile illness

and various manifestations but with stable vital signs, anicteric sclerae, with good

urine output, and no evidence of meningismus / meningeal irritation, sepsis / septic

shock, difficulty of breathing nor jaundice and can take oral medications is

considered mild leptospirosis and can be managed on an out-patient setting. Any

suspected case of leptospirosis presenting with acute febrile illness associated with

unstable vital signs, jaundice/icteric sclerae, abdominal pain, nausea, vomiting and

diarrhea, oliguria/anuria, meningismus / meningeal irritation, sepsis / septic shock,

altered mental states or difficulty of breathing and hemoptysis is considered

moderate sever leptospirosus and best managed in a hospital settings.

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The incubation period of leptospirosis may range from 2 to 28 days. Signs

and symptoms are highly variable. Asymptomatic seroconversion is the most

common result of infection.

The mildest presentation of leptospirosis is fever, headache, and myalgia,

accompanied by other nonspecific findings such as nausea and vomiting, diarrhea,

nonproductive cough, and maculopapular rash. Conjunctival suffusion (red eyes

without exudate) and severe calf pain may be characteristic of acute leptospirosis,

but are not specific.

Mild leptospirosis may resolve spontaneously without requiring

antimicrobial therapy. Severe manifestations of leptospirosis include any

combination of jaundice, renal failure, hemorrhage (most commonly pulmonary),

myocarditis, and hypotension refractory to fluid resuscitation.

Other complications include aseptic meningitis and ocular involvement

including uveitis. As originally described in the 19th century, Weils disease is

characterized by a triad of fever, jaundice, and splenomegaly. Current usage of the

term Weils disease refers to fever, jaundice, and renal failure and is often

considered synonymous with severe leptospirosis.19 Clinical features associated

with increased risk for mortality include altered mental status, respiratory

insufficiency (rales, infiltrates), hemoptysis, oliguric hyperkalemic acute renal

failure, and cardiac involvement (myocarditis, complete or incomplete heart block,

atrial fibrillation). In a retrospective study of 68 patients with leptospirosis in a

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teaching hospital of Pointe-a-Pitre in French West Indies, prognostic factors

independently associated with mortality were: dyspnea, oliguria, WBC >12,900/cu

mm, repolarization abnormalities on EKG and alveolar infiltrates on chest

radiograph. In a more recent case-control study of 89 mortalities and 281

discharged confirmed leptospirosis patients in Brazil, predictors of mortality

included age > 40 years, development of oliguria platelet count 3mg/dl and

pulmonary involvement.

In the urban epidemic of 326 cases of severe leptospirosis in Salvador,

Brazil, altered mental status was the strongest independent predictor of death).

Other significant predictors identified were age > 37 years, renal insufficiency and

respiratory insufficiency. Locally, severe jaundice, acute renal failure and bleeding

diatheses have consistently been described among those who died. Concomitant

comorbid illnesses and advanced age contributed to poor prognosis. In a review of

83 presumptive leptospirosis patients at Jose Reyes Memorial Hospital,

leukocytosis (WBC >10,000) thrombocytopenia (platelet count 6 days) were

significantly associated with poor outcome.

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LEPTOSPIROSIS

Introduction

Leptospirosis is a zoonosis of worldwide distribution, endemic mainly in

countries with humid subtropical or tropical climates and has epidemic potential. It

often peaks seasonally, sometimes in outbreaks, and is often linked to climate

changes, to poor urban slum communities, to occupation or to recreational

activities. The clinical course in humans ranges from mild to lethal with a broad

spectrum of symptoms and clinical signs. Leptospirosis is underreported in many

countries because of difficult clinical diagnosis and the lack of diagnostic

laboratory services.

Causal Agent

Pathogenic leptospires belong to the genus Leptospira (long corkscrew-

shaped bacteria, too thin to be visible under the ordinary microscope); dark-field

microscopy is required. The more than 240 pathogenic serovars cannot be

differentiated on the basis of morphology.

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Main Modes of Transmission

Feral and domestic animals constitute the reservoir of the agent,

transmitted through contact of mucous membranes or (broken) skin with water

(swimming or immersion), moist soil or vegetation contaminated with the urine of

infected animals; occasional infection occurs through ingestion/inhalation of

food/droplet aerosols of fluids contaminated by urine. The incubation usually lasts

about 10 days (2 to 30 days).

Clinical Description

The usual presentation is an acute febrile illness with headache, myalgia

(particularly calf muscle) and prostration associated with any of the following

symptoms/signs: Conjunctival suffusion, Anuria, Oliguria, Jaundice, Cough,

hemoptysis and breathlessness and Hemorrhages (from the intestines; lung

bleeding is notorious in some areas) Meningeal irritation and Cardiac arrhythmia

or failure and Skin rash.

Laboratory Criteria

Presumptive diagnosis:

A positive result of a rapid screening test such as IgM ELISA, latex

agglutination test, lateral flow, dipstick etc.

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Confirmatory Diagnosis:

Isolation from blood or other clinical materials through culture of

pathogenic leptospires. A positive PCR result using a validated method (primarily

for blood and serum in the early stages of infection). Fourfold or greater rise in

titre or seroconversion in microscopic agglutination test (MAT) on paired samples

obtained at least 2 weeks apart. A battery of Leptospira reference strains

representative of local strains to be used as antigens in MAT.

Recommended Types of Surveillance

Immediate case-based reporting of suspected or confirmed cases from

peripheral level (hospital/general practitioner/laboratory) to intermediate level. All

cases must be investigated since investigation can identify environmental point

sources of transmission and lead to control measures. Routine reporting of

aggregated data of confirmed cases from intermediate to central level. Hospital-

based surveillance may give information on severe cases of leptospirosis.

Serosurveillance may give information on whether leptospiral infections occur or

not in certain areas or populations. International. The International Leptospirosis

Society collects worldwide data:

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Recommended Minimum Data Elements

Case-based record include age, sex, geographical information, occupation.

Clinical symptoms (mortality; severe clinical manifestations of jaundice, acute

renal failure or hemorrhage)

Hospitalization include date of onset, exposure (animal contact, flooding)

Microbiological and serological data, date of diagnosis includes.

Aggregated data reporting includes, number of suspect and confirmed

cases number of hospitalizations and number of deaths and number of cases by

type (causative serovar/serogroup) of leptospirosis.

Recommended data analyses, presentation, reports include number of

cases by: age, sex, occupation, area, date of onset, causative serovars/serogroups,

(presumptive) infection source, transmission conditions (graphs, tables, maps).

Frequency distribution of signs and symptoms by case and causative serovar

(tables). y Reports of outbreaks, preventive measures, surveillance of the human

population and populations of feral and domestic animals.

Performance indicators for surveillance include completeness and

timeliness of reporting, proportion of suspect and confirmed cases, number of

detected and investigated outbreaks and number of reported cases compared with

serosurveillance data.
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Case Management

Early treatment with antibiotics. Severe cases usually treated with high

doses of IV benzylpenicillin (30 mg/kg up to 1.2 g IV 6-hourly for 5-7 days). Less

severe cases treated orally with antibiotics such as doxycycline (2 mg/kg up to 100

mg 12-hourly for 5-7 days), tetracycline, ampicillin or amoxicillin. Third-

generation cephalosporins, such as ceftriaxone and cefotaxime, and quinolone

antibiotics may also be effective. Jarisch-Herxheimer reactions may occur after the

start of antimicrobial therapy. Monitoring and supportive care as appropriate, e.g.

dialysis, mechanical ventilation.

Prevention

The large number of serovars and of infection sources and the wide

difference in transmission conditions make leptospirosis an unlikely candidate for

national eradication. Preventive measures should be based on knowledge of those

groups at higher risk of infection and of local epidemiological factors; they

include: Identifying and controlling the source of infection (e.g. open sewers,

contaminated wells). Control of feral reservoirs is often not feasible but control

measures can be highly effective in small, defined animal populations (dogs,

certified cattle herds) Selective rodent control may be important. Interrupting

transmission, thereby preventing infection or disease in the human host: wearing

protective clothes and equipment; disinfecting contaminated surfaces such as

stable and abattoir floors; marking areas with increased risk exposure (warning

signs). Preventing infection or disease in human hosts: antibiotic prophylaxis of

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exposed persons in areas of high exposures may be effective, e.g. soldiers

(doxycycline 200mg in one weekly dose); raising awareness of the disease and its

of modes of transmission.

Epidemics

Conditions under which epidemics may occur. Conditions leading to an

increase of contaminated surface water or soil, such as rain, floods and disasters

increase the risk of leptospirosis and may lead to epidemics. During periods of

drought both humans and animal reservoirs may be attracted to spare water places,

hence increasing the risk of infection. Social and recreational activities that expose

persons to a contaminated environment.

Management of Epidemics

In a suspected outbreak, attempts to diagnose leptospirosis must be

encouraged to enable prompt treatment. For outbreaks in remote or areas with poor

access, local use of screening tests to detect antibody is helpful. When an outbreak

of leptospirosis is suspected or identified, and if it has been possible to identify the

serovar concerned, the source must be identified and appropriate environmental

measures implemented, with public information to people at risk (including

clinicians and health care workers and health authorities).

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Procurement of Equipment and Laboratory Services

Several levels of laboratory service can be considered: Primary level:

simple screening methods for anti-Leptospira antibodies. Basic equipment:

containers for serum, (Pasteur) pipettes, centrifuge, freezer. Limited provincial or

national level: more complex serological methods and cultures. Additional

equipment: darkfield microscope; also (optional) ELISA reader, pH meter,

incubator, micropipettes.

Elaborate provincial or national level: complex diagnostic methods, a

quality control system with a check of activities at second level, provisional typing

of isolates. Additional equipment: sterile syringes, Millipore filters, autoclave

(traditional pressure cooker), deep-freezer, automatic dispensers, accurate scales,

PCR equipment.

International/regional reference laboratory for culture collections, typing,

outbreak investigations, reference strains, reagents and antisera, and quality checks

on performance in other laboratories

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Special Considerations and Other Interventions

Leptospirosis is often confused with other diseases or not considered at all.

In all cases of fever with unknown origin, leptospirosis must be included in the

differential diagnosis. Exposure to infection sources may not always be obvious to

the clinician or patient.

It is advisable to include veterinary experts and departments in the control

management team. Serology by microscopic agglutination test (MAT) may

provide presumptive information on causative serogroups. If possible, isolate

Leptospira, type isolates so as to assess locally circulating serovars. Questioning

patients may provide clues to infection source and transmission conditions. Animal

serology may give information on serogroup status. Isolation followed by typing

gives definite information on serovar.

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LEPTOSPIROSIS

The bacteria that cause leptospirosis are spread through the urine of

infected animals, which can get into water or soil and can survive there for weeks

to months. Many different kinds of wild and domestic animals carry the bacterium.

These can include, but are not limited to: cattle, pigs, horses, dogs, rodents,

wild animals. When these animals are infected, they may have no symptoms of the

disease. Infected animals may continue to excrete the bacteria into the

environment continuously or every once in a while, for a few months up to several

years.

Humans can become infected through:

Contact with urine (or other body fluids, except saliva) from infected animals.

Contact with water, soil, or food contaminated with the urine of infected

animals.

The bacteria can enter the body through skin or mucous membranes (eyes,

nose, or mouth), especially if the skin is broken from a cut or scratch. Drinking

contaminated water can also cause infection. Outbreaks of leptospirosis are usually
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caused by exposure to contaminated water, such as floodwaters. Person to person

transmission is rare.

Signs and Symptoms

In humans, Leptospirosis can cause a wide range of symptoms, including:

high fever, headache, chills, muscle aches, vomiting, jaundice (yellow skin and

eyes), red eyes, abdominal pain, diarrhea, and rash

Many of these symptoms can be mistaken for other diseases. In addition,

some infected persons may have no symptoms at all.

The time between a person's exposure to a contaminated source and

becoming sick is 2 days to 4 weeks. Illness usually begins abruptly with fever and

other symptoms. Leptospirosis may occur in two phases:

After the first phase (with fever, chills, headache, muscle aches, vomiting, or

diarrhea) the patient may recover for a time but become ill again.

If a second phase occurs, it is more severe; the person may have kidney or

liver failure or meningitis. This phase is also called Weil's disease.

The illness lasts from a few days to 3 weeks or longer. Without treatment,

recovery may take several months.

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Risk of Exposure

Leptospirosis occurs worldwide, but is most common in temperate or

tropical climates. It is an occupational hazard for many people who work outdoors

or with animals, such as: farmers, mine workers, sewer workers, slaughterhouse

workers, veterinarians and animal caretakers, fish workers, dairy farmers, and

military personnel

The disease has also been associated with swimming, wading, kayaking,

and rafting in contaminated lakes and rivers. As such, it is a recreational hazard for

campers or those who participate in outdoor sports. The risk is likely greater for

those who participate in these activities in tropical or temperate climates.

In addition, incidence of Leptospirosis infection among urban children

appears to be increasing.

Treatment

Leptospirosis is treated with antibiotics, such as doxycycline or penicillin,

which should be given early in the course of the disease.

Intravenous antibiotics may be required for persons with more severe

symptoms. Persons with symptoms suggestive of leptospirosis should contact a

health care provider.

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CURRICULUM VITAE

PRINZNOEL R. TAON, RN, CNN

74B Tindalo St. Mulawin, Maricaban Pasay City

Philippines
0905-219-1397
prinz_22@yahoo.com.ph

EDUCATION

2016 - Present CONCORDIA COLLEGE

Master of Science in Nursing, 36 units

2010-2014 MANILA TYTANA COLLEGES (formerly known

Manila Doctors College)
Bachelor of Science in Nursing, May 2014

2006 2010 Philippne School of Doha

Highschool Diploma, March 2010

2000-2006 Maricaban Elementary School

WORK EXPERIENCE

Dec. 2014 March 2015 PRIVATE DUTY NURSE

Kalayaan Ave., Makati City

July 2015 Sept. 2015 Nurse Orientee / On-call

Philippine Kidney Dialysis Foundation

Jan. 4 Feb. 27 2016 Staff Nurse Trainee

VRP Medical Center., Mandaluyong City

September Present St. John Biocare and Dialysis Center (Core Renal Center)
Santillan St. Pasong Tamo, Makati City
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SEMINARS ATTENDED

August 28, 2016 RENAP: CLINICAL CHALLENGES IN

REACHING AND
MAINTAINING ADEQUACY OF TRAINING
DELIVERY: MANAGER ACCOUNTABILITY

April 24, 2016 RENAP: MANAGEMENT OF NEUROPATHIC

PAIN IN RENAL DISEASE
Dr. Avenilo P. Aventura Hall (formerly MAB),
Philippine Heart Center East Ave., Quezon City

September 2013 COPAR: AN EMPIRICAL NURSING APPROACH

TO HEALTH IN THE HANDS OF THE PEOPLE
Pres. Diosdado Macapagal Blvd., Metropolitan Park,
Pasay City
STORIES AND EMBODIED MEMORIES IN
DEMENTIA: A SYMPOSIUM
Pres. Diosdado Macapagal Blvd., Metropolitan Park,
Pasay City

CERTIFICATION AND LICENSURE

July - September 3, 2016 Hemodialysis Nurse Training (St. John Biocare and
Dialysis
Center)

June July 3, 2015 Hemodialysis Nurse Training (Philippine Kidney

Dialysis
Foundation

Feb 2015 Basic Intravenous Therapy Training Program for

Nurses by the Association of Nursing Service
Administrators of the Philippines Inc. (ANSAP)
conducted at Medical Center Paranaque

Basic Life Support for Healthcare Providers by the

American Heart Association conducted by AHMC
training center
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Advanced Cardiac Life Support by the American

Heart Association conducted by AHMC training
center

ECG & Pharmacology Course by the American Heart

Association conducted by AHMC training center

Nov 2014 Philippine Nurse Licensure Examination Board

Passer

PERSONAL INFORMATION

Age: 22 y/o

Birth Date: February 22, 1994

Birthplace: San Juan City

Nationality: Filipino

Hobbies & Interest: Dancing and playing basketball. Knowledgeable in research

paper, formulation.

_______________________
Prinznoel R. Taon, RN, CNN
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Message to the Next Batch

Hi! Im Prinznoel R. Taon, and I am honored that I have the chance to give

any message to the next batch who will undergo MSN MS major. I am glad that

you realized that continuing education is beneficial, not just for us, but for our

patients.

One thing I would like to tell you guys is you have to make time for yourself

to study because without studying youll be lost in MSN MS Major. Many

students and professionals taken this course for granted just for having the MSN

title. In this course, you will have to unlock your inner potentials in order to know

yourself and your capabilities. MS 1 would be the foundation of your MS 2 so you

better listen to every reporter. I know youll get tired because of other personal

stuff, but make sure when you enter the classroom, you are ready to absorb the

knowledge that will be imparted to you. You should also be considerate of others

because everyone is given the chance to stand in front. You listen to them, and

they will listen to you.

___________________________

Prinznoel R. Taon, RN, CNN

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REFERENCES:

1.) Department of Health Leptospirosis (September 11, 2015)

http://www.doh.gov.ph/node/364

2.) Philippine Society for Microbiology and Infectious Disease

3.) World Health Organization Leptospirosis

4.) Centers for Disease Control and Prevention - Leptospirosis