A spirochetal disease found throughout the world.
One of the most widespread zoonotic infections in the world.
The global burden of leptospirosis is growing, commonly related to climate change and urbanization.
More than 1 million cases estimated to occur around the world each year.
A zoonotic disease caused by gram-negative spirochetal bacteria belonging to the genius leptospira.
Infects wide spectrum of wild and domestic animals, which then excrete leptospires in their urine and contaminate lakes and standing water.
Extreme weather events with flooding may precipitate outbreaks by facilitating transmission from environment and animal reservoirs.
The bacteria can infect the renal tubules and or shedding the urine of infected mammals.
Many mammals act as reservoirs of the bacteria with rodents being the most common carriers in urban areas.
Humans become infected when in contact with contaminated water, soil, or other aprcts of the environment.
Risk factors for leptospirosis include: crowded habitation, improverished urban settings with rodent infestation, occupational exposures in agriculture, veterinary medicine, and sewers, and water treatment plants, and exposure to pet dogs and domesticated, livestock, particularly around freshwater sources, contact with stagnant water and freshwater swimming.
It is more prevalent in areas with limited resources and in tropical and subtropical the climates.
Rodents are the main reservoir.
Leptospirosis colonize the kidneys of many wild and domestic animals and are shed in their urine.
Human infection occurs usually from contact with contaminated water with an average incubation period of 5-14 days.
Entrance portals are minor skin injuries and mucosal membranes with exposure to contaminated soil or water.
Outbreaks with leptospirosis often occur with dengue virus.
Differential diagnosis include dengue, malaria, yellow fever, influenza, and hantivirus.
Heavy rain and flooding cause outbreaks, as noted by the yearly peak in incidence during the rainy season in poor communities.
Recreational exposure is a risk factor for leptospirosis.
Most cases are mild and self limited.
Widely underdiagnosed due to its variable presentation, and in some cases no symptoms, the presence of non-specific symptoms, and limitations of diagnostic tests.
Incubation period 7-12 days (3-30 days) and is associated with acute influenza like illness and symptoms of fever, headaches, nausea and vomiting, malaise, my allergies, cough, and abdominal pain.
About 10% of cases have renal and hepatic dysfunction and is associated with a mortality associated high as 40%.
With severe disease multiple organs may be affected with liver and kidney injury and is termed Weil’s syndrome.
Hyponatremia and hypokalemia are common manifestations with renal insufficiency.
Lung involvement frequently is associated with pneumonia, hemoptysis or ARDS.
Severe pulmonary hemorrhage is infrequent, but is associated with high mortality.
Conjunctiva suffusion is considered to be a classical clinical sign and occurs in 20-99% of infected patients.
Oral doxycycline, Ampicillin or penicillin are the recommended agents for mild disease, while intravenous penicillin or Ampicillin is suggested for more severe disease.
Antibiotic treatment without delay is recommended when leptospirosis is suspected.
Prophylactic doxycycline can prevent illness.
As is the case for other spirochetal disease initiation of therapy may precipitate a Jarisch-Herxheimer reaction, manifested by fever, chills and hypotension.
The -Herxheimer reaction, an acute immune response to the recent release of bacterial antigens on the initiation of antibiotic therapy, develops in 20-40% of patients may account for sudden clinical deterioration.
Diagnosis is aided by the detection of I GM antibodies against Leptospira obtain during the acute phase of disease.
An increase of Leptospira Aggltutination titer by a factor of four in the convalescent convalescent phase of illness and direct detection of Leptospira species by PCR is confirmatory.
Positive findings on PCR test of the urine, blood, spinal fluid or tissues are confirmatory.
