Leptospirosis – causes, symptoms, treatment
Leptospirosis is caused most frequently by indirect contact with water or soil contaminated with urine of infected animals with leptospire and less frequent through direct contact with animals carrying leptospire.
These leptospire penetrate skin and mucous membranes intact or slightly scarificate. Leptospire can enter also through the conjunctiva, nasal mucosa, or through the lungs (aerosols with leptospire). Leptospirosis can cross the placenta and cause abortion or fetal death. Leptospire enters the lymphatic circulation, and reach the bloodstream and from there in all organs. These leptospire remain viable for weeks or months in tissues away from the action of antibody: renal tubules, central nervous system, anterior chamber of the eye. In acute disease these leptospire multiply in the endothelium of small vessels causing vasculitis in any system or organ: kidney, liver, lung, skin, muscles.
Possible damage of several organs explains the clinical polymorphism of leptospirosis. Leptospirosis can be mild or severe forms, with kidney or liver failure.
Incubation of leptospire infection is 3-30 days, the onset is with high fever, nausea, vomiting, cough, muscle aches and skin rashes.
During the state there may be described a leptospirosis without jaundice or with jaundice. The without jaundice form is generally self-limited and manifests as a flu-like. Jaundice form (Weil’s disease) has a medium or severe evolution and is associated with hemorrhagic syndrome, kidney failure.
Weil syndrome (Weil’s disease), leptospirosis sera, is characterized by jaundice, renal dysfunction, bleeding diathesis and increased mortality. After 4-9 days, jaundice appears, renal and vascular dysfunction as well.
Jaundice in Weil syndrome, which can be enhanced and can occur with orange skin, is not usually associated with hepatic necrosis. Death is rare Weil’s disease due to liver failure. Hepatomegaly and right upper quadrant tenderness are common in Weil syndrome. Splenomegaly occurs in 20% of cases of Weil’s disease.
It may develop kidney failure, often during the second week of illness. Hypovolemia and decreased renal perfusion contributes to the occurrence of acute tubular necrosis with oliguria or anuria. Sometimes dialysis is required, although a number of cases can be treated without dialysis. Kidney function can be completely recovered.
Lung damage is frequent, causes coughing, shortness of breath, chest pain and sometimes haemoptysis and or bloody sputum, respiratory failure. In Weil syndrome are observed bleeding events: epistaxis, petechiae, purpura and bruising, which occur frequently. Meningitis can occur with clear liquid, endotoxic shock, acute cholecystitis without litiasis, interstitial pneumonia, myocarditis, conjunctivitis.
Treatment of leptospirosis
For cases of leptospirosis it is prescribed: penicillin G, amoxicillin, ampicillin or erythromycin. In mild cases, treatment is oral with tetracycline, doxycycline, ampicillin or amoxicillin. Patients with leptospirosis and kidney failure may need dialysis. The Weil syndrome may require transfusion of blood and / or platelets. May need intensive care. Most patients with leptospirosis recover. Mortality is high among older patients and among those with Weil syndrome. Long-term supervision of patients with renal and hepatic dysfunction showed good recovery of renal and liver function.
Prevention: People who may be exposed at contact with leptospire, because of their occupation or recreational use of water should be informed of the risks. Measures to control a disease like leptospirosis include avoiding exposure to urine and tissue from infected animals, vaccination of animals. Doxycycline (200 mg once a week) appeared to be effective for leptospirosis in military personnel, but is indicated only in rare cases of exposure to leptospire on short-term.