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LEPTOSPIROSIS
KASIGAIRE DANIEL MUTOME
2021-08-07054
BMS 4.2 KIU

Outline
Defn
Epidemiology
Pathophysiology
Clinical manifestations
Diagnosis
Treatment
Prognosis

• Definition
Leptospirosis is a widespread and potentially fatal
infectious disease affecting both humans and animals
(zoonosis) that is caused by pathogenic spirochetes of
the genus Leptospira
A k.a Weil's disease, Swineherd's disease, rice-field
fever, waterborne fever, nanukayami fever, cane-
cutter fever, swamp fever, mud fever, Fort Bragg
fever, Stuttgart disease, Mgunda fever, and Canicola
fever e.t.c

LEPTOSPIROSIS-DANIEL MUTOME12345678.pptx

Epidemiology
Lepospirosis is considered the most common
zoonosis in the world and is associated with settings of
; poor sanitation and agricultural occupations involving
contact with animals or water. Increasingly,
adventurous travel and"mud run" sports or races
involving fresh water or soil exposure put humans at
risk.
Other epidemiologic factors are linked to specific
hosts. Hosts vary in susceptibility depending on age,
genetic factors (e.g., HLA-DQ6), skin integrity, and
whether protective clothing (e.g., gloves and boots)
are worn.

• The prevalence of leptospirosis in Uganda varies by
study, but is generally estimated to be between 35%
and 4.7%: A study of patients at Mulago National
Referral Hospital found a prevalence of 4.7%.
• Another study found that 35% of participants in
Hoima District were seropositive for Leptospira
antibodies.
• Globally , leptospirosis has caused more than one
million cases and 58,900 deaths per year.
• It's estimated that leptospirosis causes about 2.9
million disability-adjusted life-years (DALYs) lost
worldwide.

• When high levels of leptospiremia occur during
infection, innate immune mechanisms eventually
trigger tissue-based and systemic responses to
infection that lead to severe outcomes such as a
sepsis-like syndrome or organ failure.
• Patients with severe leptospirosis have evidence of
a “cytokine storm” with higher levels of IL-6, TNF-
alpha, and a number of other cytokines than
patients with mild disease

Clinical manifestations
Leptospirosis ranges in severity from asymptomatic to a mild illness Or to a
multisystemic syndrome with unique features.
Mild illness is unspecific and characterized by sudden onset of the followingthat
are also present in other causes of acute febrile syndrome ie malaria, dengue fever
and influenza :
• Fever (38-40°C)
• Rigors
• Headache, retro-orbital pain, photophobia
• Muscle pain localized to the calf and lumbar areas
• Conjunctival suffusion
• Dry cough
• Nausea and vomiting, diarrhea
More severe disease manifests as icteric leptospirosis, also known as Weil's
disease, with the following features:
• Icterus or frank jaundice
• Renal failure with oliguria
• Hemorrhagic features
• Systemic inflammatory syndrome or shock

Laboratory studies used to confirm the diagnosis of
leptospirosis include the following:
a. Microscopic agglutination testing (MAT; criterion
standard for serologic identification of leptospires,
available at reference laboratories)
b. Single titer ≥1:200 or 4-fold rise in serum drawn
between the first and fourth week of illness is
considered diagnostic
c. DNA PCR of blood, urine, CSF, tissue
d. Culture of leptospires from body fluids or tissue
(criterion standard, but requires specific media and
several weeks’ incubation, thus usually limited to
reference laboratory)

Treatment
• In most cases, leptospirosis is characterized by mild
clinical signs, which can improve spontaneously
• oral doxycycline is recommended for the
treatment of mild leptospirosis.
• In this regard, it is recommended to consume a dose
of 100 mg doxycycline twice a day for a week.
• Amoxicillin (500 mg/day for 1 week to 10 days)
• ampicillin (500–750 mg/day for 1 week to 10 days)
• azithromycin (500 mg/day for 3 days) can also be
orally administered .

Cont.
Patients with severe leptospirosis, which normally
manifests as renal and hepatic failure, are
administered penicillin G (penicillin G sodium; at a
dose of 1.5 million U/6 IV for a week .
Amoxicillin and azithromycin should be
administered to children and pregnant women
instead of doxycycline .

Prevention
This involves ;
Rodent control
Avoid contact with water contaminated by animals
Vaccination for both humans and animals

Prognosis of leptospirosis
• The mild form of leptospirosis rarely is fatal, and
an estimated 90% of cases fall into this category.
• The mortality rate in severe leptospirosis averages
approximately 10%, but has been described as
ranging from 5-40%.
• Elderly and immunocompromised people are at
the highest risk for mortality overall. Most deaths
occur from renal failure, massive hemorrhage, or
acute respiratory distress syndrome (ARDS).

References
1. Palaniappan RU, Ramanujam S, Chang YF.
Leptospirosis: pathogenesis, immunity, and
diagnosis. Curr Opin Infect Dis. 2007 Jun.
20(3):284-92. [QxMD MEDLINE Link].
2. CDC. From the Centers for Disease Control and
Prevention. Update: outbreak of acute febrile illness
among athletes participating in Eco-Challenge-Sabah
2000--Borneo, Malaysia, 2000. JAMA. 2001 Feb 14.
285(6):728-30.
3. Abela-Ridder B, Sikkema R, Hartskeerl RA.
Estimating the burden of human leptospirosis. Int J
Antimicrob Agents. 2010;36(Suppl 1):S5–S7. doi:

4. Beri, D., Moola, S., Jagnoor, J., Salam, A., and
Bhaumik, S. (2021). Prevention, control and
management of leptospirosis in India: an evidence gap
map. Trans. R. Soc. Trop. Med. Hyg. 115, 1353–1361.
doi: 10.1093/trstmh/trab036.
5. Chacko, C. S., Jayakumar, A., Binu, S. L., Pant, R. D.,
Giri, A., Chand, S., et al. (2021). A short review on
leptospirosis: clinical manifestations, diagnosis and
treatment. Clin Epidemiol Global Health. 11:100741.
doi: 10.1016/j.cegh.2021.100741

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