1. No2 hospital CMU department of infectious disease Huang Fen
LEPTOSPIROSIS
No2 hospital CMU department
of infectious disease
Huang Fen

2. DEFINITION 1. Leptospirosis is a kind of zoonotic
infectious disease caused by pathogenic leptospires;
2. rats and swine are cardinal source
of infection;
3. the disease often occurs in summer
and fall;

3. DEFINITION 4. clinical features: three symptoms, three signs,
internal organ damage,
seguelae of eyes and nerve system
5. treatment: penicillin.

4. ETIOLOGY 1.pathogen : pathogenic leptospira 2.features of leptospia:
helicoid with hook,
length 6~ 20 um,G -
darkfield microscope;
in korthof’s media;

5. several months in water and 3.Classification:
ETIOLOGY
several months in water and
moist soil (PH7.0~7.5)
3.Classification:
23 serogroups and more then
serotypes in the world;
19 serogroup and 74 serotypes in china.
icterohemorrhagic group,
pomona group

6. EPIDEMIOLOGY
1.Source of infection:
rat: apodemus agrarius,
rice field type;
pigs: flood or rain type;
patient

7. EPIDEMIOLOGY 2.Routes of transmission:
(1) water borne (indirect contact
transmission):
by skin,mucosa,when skin is injured.
(2) direct contact transmission:
(3) food borne
3.Susceptibility of population:

8. EPIDEMIOLOGY 4.Epidemiologic features: (1)season: summer and fall;
(2) nosogenic age:
young and middle age,children
(3)occupation:
farmer,slaughter,
fisher,veterinarian.

9. EPIDEMIOLOGY 4.Epidemiologic features: (4)epidemic type :
rice field type
flood type
rain type

10. PATHOGENESIS leptospira skin,mucosa
Initial stage leptospiremia toxic symptoms
(1~3days) three symptoms:
fever,myalgia,fatigue;
three signs:
conjunctival suffussion;
muscle tenderness;
enlargement of lymphonodes;

11. PATHOGENESIS severe toxic symptoms lesion of organs: influenza form
pneumorrhagic form
middle stage icterohemorrhagic form
(3~10d)
meningoencephalitis
renal failure form.

12. PATHOGENESIS immunopathological reaction after fever;
sequelae of eyes;
reactive
meningitis;
cerebro arteritis
obliterans.
convalescent stage

13. PATHOLOGY 1. basic pathological change is
infective,toxic injured of systemic
capillaries;
2. severe:lung,liver,kidneys,brain.
exudation,hemorrhage,
edema or necrosis.

14. CLINICAL MANIFESTATIONS
Incubation period: 2~28 days
usually 7~13days;
1. Influenza-typhoid type:5~10days
three symptoms:
fever,myalgia and fatigue.
three signs:
conjunctival suffusion,

15. CLINICAL MANIFESTATIONS
three signs:
conjunctival suffusion,
tenderness of
gastrocnemius muscle;
enlargement and tenderness
of superficial lymphnodes.
Inguinal and axillary
lymphodes.

16. CLINICAL MANIFESTATIONS
2. pneumorrhagia form:
1). three symptoms and three signs
2). pneumorrhagia symptoms(3~4d)
(1). mild pneumorrhagia type
cough,expectoration with blood.
a few moist rales.
X-ray of chest: scattering spotty and small fasciola shadow
dyspnea,
palpitaton,aspharyxia,rales.

17. CLINICAL MANIFESTATIONS
2. pneumorrhagia form:
(2) diffuse pneumorrhagia type
short breathing, palpitation,
dysphoria,
massive hemoptysis, asphyxia,
cyanosis,
a lot of moist rales.
X-ray: extensive fasciola shadow .

18. CLINICAL MANIFESTATIONS 3.Icterohemorrhagic type:(Weil ,s disease)
1). three symptoms and three signs
2). jaundice, hemorrage, renal injury
(4~5d)
liver injury:
anorexia,vomiting, jaundice,
abnormal liver function.

19. CLINICAL MANIFESTATIONS 3.Icterohemorrhagic type:(Weil ,s disease)
hemorrhage: petechiae,ecchymoses,hemoptysis,hematemesis etc.
renal injury: proteinuria,
RBC, WBC, cast,
oliguria,azotemia,uremia.

20. CLINICAL MANIFESTATIONS 4.renal failure type:
oliguria, azoteinia, uremia.
5.meningoencephalitis type:
1). three symptoms and three signs
2). 3~4days later, meningitis, encephalitis.
headache,vomiting,meningeal irritation,
lethargy,coma,paralysis or convulsion.

21. CLINICAL MANIFESTATIONS
CSF is abnormal.
pressure increase
pleocytosis<500 × 106/L
protein is normal or elevated slightly.
glucose and chloride is normal.
leptospira isolation: positive.

22. CLINICAL MANIFESTATIONS
SEQUELAE
1. after fever :1~5days after defervascence
2. sequelae of eyes: 1week~1month
iridocycyclitis, choroiditis , uveitis
3.reactive meningitis
4.cerebroarteritis obliterans:2w~2m
hemiplegia aphasia

23. 1). blood routine examination:
LABORATORY FINDINGS:
1. routine examination:
1). blood routine examination:
WBC is increased slightly;
2).urine routine examination:
protein (2/3)
2. serological examination:
1).microscopic agglutination test (MAT)
detect antibody >1:400

24. 2). ELISA: serum and CSF IgM antibody 3. pathogenic test
LABORATORY FINDINGS:
2). ELISA: serum and CSF IgM antibody
3. pathogenic test
1).blood culture:
2).PCR: DNA

25. DIAGNOSIS 1.epidemiologic data: 2.clinical manifestations:
1).epidemic area;
2).epidemic season;
3).a history of contact with contaminated
water;
2.clinical manifestations:
3.Lab findings:

26. DIFFERENTIAL DIAGNOSIS
1.Influenza; Typhoid fever,
2.Lobar pneumonia;
3.Viral hepatitis;
4.Viral meningitis;
5.Epidemic hemorrhagic fever;

27. TREATMENT 1.Pathogenic therapy 1). first choice: penicillin
40万 u q6h or q8h im 7days
note: Herxheimer reaction
first time - small amount 5万 u im
2). Gentamycin 8万 u q8h im

28. TREATMENT 2.Symptomatic therapy 1). Herxheimer reaction
physical cooling, sedative,
hydrocortisone.
2). pneumorrhagia type
sedative, hydrocortisone, cardiotonics
3.treatment of sequlea

29. PREVENTION 1.control of pigs: 1). stable breeding 2.killing of rats,
2).immunized by vaccine
2.killing of rats,
3.cutting route of transmission,
4.vaccination: multivalent vaccine