Leptospirosis

Leptospirosis sounds very alien to me when I first heard it in the wards 2 weeks ago. All of sudden, there were a few leptopspirosis patients admitted which a few I asked said it is really rare. Out of curiosity, which is a very late curiosity for me, I just went to read about it. In the books I owned, none of them actually tell me what leptospirosis is.

Leptospirosis (or known as Weil's disease / syndrome  or canicola fever)

- a bacterial zoonotic disease caused by spirochetes of the genus Leptospira
- transmitted to human by allowing water that has been contaminated by animal's urine to come in contact with unhealed breaks in the skin, eyes or mucous membrane.

Causes
- urine of infected animals & contagious as long as it is moist
- primary host : rats, mice & moles (rarely mammals such as dogs, deer, rabbits, hedgehogs etc)
- transmitted by the semen of infected animals as well. (Slaughterhouse workers are at risk via contact with infected blood / body fluids)
- human become infected via contact with water, food or soil containing urine from infected animals.

Occupations at high risk
- Veterinarian
- Slaughterhouse workers
- Farmers
- Sewer workers
- People working on derelict buildings (abandoned)
- Rowers
- Surfers & whitewater paddlers

Symptoms
- Biphasic disease (After the first phase resolves, patients briefly asymptomatic until the second phase)
- 1st phase : flu-like symptoms (fever, chills, myalgias, intense headache, vomiting)
- 2nd phase : meningitis, liver damage (jaundice), renal failure
- Some presented with abdominal pain, red eyes, diarrhea & rash
- Symptoms appear after 4 to 14 days of incubation period
- Due to wide range of symptoms, its infection is often wrongly diagnosis and not recorded into the statistic.

A few of the different diagnosis for this symptoms : Dengue fever, malaria

Complications : Meningitis, extreme fatigue, hearing loss, respiratory distress, uraemia, renal interstitial tubular necrosis that will lead to renal failure, liver failure and cardiovascular problems.

Some relevant investigations
- The microorganism is found in blood for the first 7 - 10 days, then moves to kidney. Then, it was found in fresh urine after first 7 to 10 days.
- Blood and urine both need to be taken for investigations
- Renal profile
- Liver function test (increased in AST, ALT and Gamma-GT)
- Leptospirosis is confirmed by Enzyme-Linked Immunosorbent Assay (ELISA) and PCR

Management
- Doxycyline as prophylaxis for adventure travelers to high risk areas
- Treatment objectives : To suppress causative agents & to fight complications
- Antibiotics : Cefotaxime, doxycyline, penicillin, ampicillin, amoxicillin
- Supportive treatment : Detoxification, normalize hydro-electrolytic balance, administration of glucose & salt, dialysis in severe case that had caused renal failure, corticosteroid in gradually reduced dose (prednisolone)

Things are MORE serious if it infects dogs....

- Liver and kidney most commonly damaged
- Vasculitis, edema & potentially disseminated intravascular coagulation (DIVC)
- Myocarditis, pericarditis, meningitis, uveitis are the sequel
- Vomiting, failure to eat, reduced urine output (dark/ brown urine), lethargy

- Leptospirosis must be a differential diagnosis for dogs if there is sclera icterus (jaundice of the eyes)

Those not only happens in human, but dog as well...

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