Leptospirosis

Leptospirosis is an infection by a pathogenic multiple serotypes of the genus Leptospira. is caused. Symptoms are biphasic. Both phases include acute febrile episodes; the second phase sometimes includes hepatic, renal and meningeal involvement. The diagnosis is made by darkfield microscopy, pathogen culture and serological tests. Treatment is with doxycycline or penicillin.

Leptospirosis is a zoonotic disease that occurs in many domestic and wild animals and can run as unapparent or severe, even fatal disease. There is a carrier state, leptospira eliminated in the animals for several months in the urine. To human infection occurs through direct contact with infected urine or tissue or indirectly by contact with contaminated water or soil. Eruptions frequently occur after contact with contaminated flood. The usual entry points are exposed skin erosions and mucous membranes (conjunctival, nasal, oral). A leptospirosis, an occupational disease represent (z. B. of farmers or sewage works or wastewater technicians), but most patients a rather accidental exposure in the context of recreational activities are exposed (eg. As swimming in contaminated water) in the US. Dogs and rats are more common possible sources of infection.

Leptospirosis is an infection by a pathogenic multiple serotypes of the genus Leptospira. is caused. Symptoms are biphasic. Both phases include acute febrile episodes; the second phase sometimes includes hepatic, renal and meningeal involvement. The diagnosis is made by darkfield microscopy, pathogen culture and serological tests. Treatment is with doxycycline or penicillin. Leptospirosis is a zoonotic disease that occurs in many domestic and wild animals and can run as unapparent or severe, even fatal disease. There is a carrier state, leptospira eliminated in the animals for several months in the urine. To human infection occurs through direct contact with infected urine or tissue or indirectly by contact with contaminated water or soil. Eruptions frequently occur after contact with contaminated flood. The usual entry points are exposed skin erosions and mucous membranes (conjunctival, nasal, oral). A leptospirosis, an occupational disease represent (z. B. of farmers or sewage works or wastewater technicians), but most patients a rather accidental exposure in the context of recreational activities are exposed (eg. As swimming in contaminated water) in the US. Dogs and rats are more common possible sources of infection. Cases of leptospirosis have the Centers for Disease Control and Prevention (CDC) reported (n. D. Übers .: Germany in the local health authority). The 40-100-known annual US cases occur primarily in the late summer and early fall. Since specific clinical symptoms are absent, many cases may not be diagnosed and reported. Symptoms and signs The incubation period ranges from 2 to 20 (usually 7-13) days. The disease characteristically biphasic. The septicemic phase starts abruptly with headache, severe muscle pain, chills, fever, cough, pharyngitis, chest pain and in some patients hemoptysis. Conjunctival suffusion usually occurs on the 3rd or 4th day. Splenomegaly and hepatomegaly are uncommon. This phase lasts 4-9 days and is accompanied by repeated chills and fever often> 39 ° C accompanied. This is followed by afebrile. The second, immunological phase lasts from 6 to 12 days of the disease and correlates with the appearance of antibodies in the serum. The fever and earlier symptoms recur, meningitis may develop. A iridocyclitis, optic neuritis and peripheral neuropathy occur occasionally. If an infection occurs during pregnancy leptospirosis can even cause an abortion during the recovery phase. The disease Weil (icteric leptospirosis) is a severe form with jaundice and usually with azotemia, anemia, clouded mental status and persistent fever. The beginning is similar to the less severe cases. Then, however, hemorrhagic manifestations associated with epistaxis, petechiae, purpura and ecchymosis and rarely to subarachnoid, adrenal progress or gastrointestinal hemorrhages develop due to Kapillarschädigungen. Thrombocytopenia can occur. Between the 3rd and 6th day occur signs of hepatocellular and renal dysfunction. Evidence of renal dysfunction are for. Proteinuria, pyuria, hematuria and azotemia. The Leberzellschädígung is minimal and heals completely. In anicteric patient mortality is 0%, jaundice in 5 to 10%; in patients> 60 years it is higher. Diagnostic blood cultures Serology A similar symptoms caused by viral encephalitis, hemolytic fever with renal syndrome due to hantavirus, other spirochaetal, influenza and hepatitis. Clinical history to a biphasic course can be helpful in the differential diagnosis of leptospirosis. A leptospirosis should also be considered in all patients with FUU if they were potentially exposed to leptospirosis. In patients with suspected. Leptospirosis should be acute and the course is determined (after 3-4 weeks), complete blood count, clinical chemistry parameters and liver blood cultures antibody. In clinical evidence of involvement of the meninges a lumbar puncture spinal tap (lumbar puncture) is required; the Liquorzellzahlen be between 10 and 1000 / ul (usually <500 / ul), in predominantly mononuclear cells. The Liquorglukose is unremarkable; the protein <100 mg / dl. Levels of CSF-Bilirubinsind higher than that of serum bilirubin. The leukocyte count in the peripheral blood is increased inconspicuous or slightly in most patients, but can reach 50,000 / ul in critically ill, jaundiced patients. The presence of> 70% neutrophils helps in differential diagnosis of leptospirosis from a viral illness. Serum bilirubin is increased in proportion to increases in serum transaminases. In jaundiced patients, bilirubin amount usually <20 mg / dl (<342 mol / l), but can reach (684 mol / l) in severe infection and 40 mg / dl. The diagnosis is confirmed when leptospires isolated from clinical samples or are seen in fluids or tissues; if Leptospira agglutination antibody titer ? 4-fold increase (microagglutination); or if titer ? 1: 800 are for patients who have the typical symptoms and signs. Penicillin therapy doxycycline An antibiotic treatment is most effective if started in the early stage of infection. Of major diseases penicillin G 5-6 million units iv every 6 hours or ampicillin 500-1000 mg i.v. recommended every 6 hours. In less severe cases can doxycycline 100 mg po every 12 h, ampicillin, 500-750 mg p.o. every 6 hours or amoxicillin 500 mg p.o. every 6 hours are given over 5-7 days. In severe cases, supportive therapy, u. a. with fluid and electrolyte replacement is important. An isolation of the patient is not required, but the urine must be handled carefully and disposed of. For the prevention of a disease during a known geographic exposure doxycycline 200 mg po given 1 time per week. Important points Leptospirosis is a zoonotic disease that occurs in many domestic and wild animals (especially dogs and rats); Infections in humans are rare and are acquired through contact with infected urine or tissue or contaminated water or soil. There are two phases of the disease: the septicemic and immunological. The septicemic phase starts abruptly with headache, severe muscle pain, fever of> 39 ° C, cough, sore throat and sometimes hemoptysis; This phase lasts 4 to 9 days. The immunological phase begins between the 6th and 12th day of the disease when antibodies appear in the serum; recur fever and other symptoms, and some patients develop meningitis. The disease, because is a severe form with jaundice and usually with azotemia, anemia, clouded mental status and sometimes hemorrhagic manifestations. To help diagnose blood cultures and serological testing methods are used. A serious illness is treated with parenteral penicillin G or ampicillin and less serious cases with oral doxycycline, ampicillin or amoxicillin.

Health Life Media Team

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