A Life Threatening Disease Leptospirosis

Bairagi S.M.¹*, Lande A.A.² and Aher A. A.¹

¹Lecturer, MES College of Pharmacy Sonai, Tal- Newasa, Dist- Ahmednagar, 414105

²Student, MES College of Pharmacy , Sonai, Tal-Newasa, Dist- Ahmednagar,414105

ABSTRACT:

Leptospirosis is a widespread infectious disease that is prevalent in tropical regions due to the favorable environmental survival conditions. The various species of leptospira of the spirochete family are responsible for transmission of disease. Leptospirosis is a biphasic disease that begins flu like symptoms. The first phase resolves and the patient is briefly asymptomatic until the second phase begins. Leptospirosis starts suddenly, with a severe headache, redness in the eyes, muscle pains, fatigue and nausea and a fever of 39°C or above. The diagnosis of Leptospirosis in generally carried out by direct visualization of leptospirosis in blood or urine by darkfield microscopic examination. And various staining methods are also used for the diagnosis. The antibiotic therapy is generally used for the treatment purpose.

KEYWORDS: Leptospirosis, transmission, diagnosis, treatment

INTRODUCTION:

Etiology –

Leptospirosis is an infectious disease caused by various species of Leptospira of the spirochete family."Leptospira” derives from Greek leptos (thin) and Latin spira (coiled). The leptospires are 0.1µ in diameter by 6 to 20 µm in length. Leptospires are now classified into a number of species defined by their degree of genetic relatedness, determined by DNA reassociation. 11,12 There are currently 15 named species, including pathogens (e.g., L. interrogans), nonpathogenic saprophytes (e.g., L. biflexa), and species of indeterminate pathogenicity (e.g., L. inadai). L. interrogans, L. noguchii, L. borgpetersenii, L. santarosai, L. kirschneri, L. weilii , L.alexanderi, Leptospira genomospecies, L. fainei, L. meyeri, L. inadai, L. wolbachii L. biflexa, L. broomii, L. licerasiae.^1,2

History:

Leptospirosis were first visualized in autopsy specimens from a patient thought to have had yellow fever.³ Before Weil's characterization in 1886, the disease known as infectious jaundice was very likely the same as Weil's disease, or severe icteric leptospirosis. During the Egyptian campaign, Napoleon's army suffered from what was probably infectious jaundice. Before Weil's characterization in 1886, the disease known as infectious jaundice was very likely the same as Weil's disease, or severe icteric leptospirosis. During the Egyptian campaign, Napoleon's army suffered from what was probably infectious jaundice.⁴ A little over 100 years ago, Adolph Weil published his historic paper describing the most severe form of infection that would be later known as Weil disease. Diagnostic confusion between severe icteric leptospirosis and yellow fever continued, with prominent researchers such as Stokes and Noguchi dying in their attempts to discover the causative agent.⁵. In October 2010 British rower Andy Holmes died after contracting Weil's Disease.In January 2011, Dr. Drew Pinsky, believes that he contracted leptospirosis while on vacation with his wife in the West Indies due to an outbreak at the time of their visit.In July 2011 a Danish man died after contracting the disease, probably while cleaning up in his cellar after severe flooding.

Transmission:

Leptospirosis can be transmitted direct or indirect contact with urine or tissues of infected animals. Direct contact is important in transmission to veterinariams, workers in milking sheds on dairy farm, works, butchers, hunters and animal handlers. The main important reservoirs are rodent and other small mammals, the live animals are also significant source of human infections. Infection of carrier animals usually occurs during infancy and, once infected, animals may excrete leptospires in their urine intermittently or continuously throughout llife. There has been an increase in leptospirosis cases in dogs in the eastern regions of North America and in the Midwest.⁶

Leptospira species do not multiply outside the host. They require high humidity for survival and are killed by dehydration or temperature greater than 50⁰C. They can remain viable for a few many weeks or month in contaminated soil and for several weeks in cattle slurry.

Disinfections:

The leptospira species can be inactivated by 70 % alcohol, Glutaraldehyde, formaldehyde, detergents and acid. These organisms are sensitive to moist heat and also killed by pasteurization.

Incubation Period:

The mean incubation period is 10 days with range of 5 to 14 days.

Clinical Sign:

Infection in human varies from asymptomatic to severe. Many cases are mild or unrecognized. In human leptospirosis is a biphasic disease that begins flu like symptoms ( fever,chills, myalgias and intence headache). The first phase resolves and the patient is briefly asymptomatic until the second phase begins. Leptospirosis starts suddenly, with a severe headache, redness in the eyes, muscle pains, fatigue and nausea and a fever of 39°C (102°F) or above. There is sometimes a red non-blanching pinprick rash on the skin, similar to that seen in meningitis. Young children can be tired or distressed and may show an aversion to bright light. The severe headache is almost always present and can be incapacitating. Nausea may or may not cause vomiting. Muscle pains can be extreme and are often particularly bad in the calf and back areas - muscles will be sore to move and to touch. A rapid pulse is also common in the first few days. The skin rash develops in the first one or two days and often the skin is warm and pink just beforehand, with the patient complaining of feeling warm. Rashes can occur anywhere but in some cases are confined to local regions of skin such as the front of the legs. Sometimes they will be itchy, but rashes are only seen in about 30% of all cases so the lack of any rash is not too significant. Psychological changes are often seen, with patients feeling depressed, confused, aggressive and sometimes psychotic - with schizophrenia and hallucinations, personality changes and violence. This phase lasts between three and five days, then the patient (temporarily) recovers. During this phase the bacteria are active in the patient's bloodstream (so it is sometimes called the septecaemic phase) and so can be detected by lab tests.

Second phase: In many mild cases this doesn't happen at all, but where the infection is more severe, the patient enters a second phase of illness after a few days of apprent recovery. The initial symptoms and fever return, accompanied with chest and abdominal pain, some renal problems and psychological changes. Increased symptoms of meningitis are often seen with neck stiffness and vomiting, but in most mild cases the patient will not suffer kidney or liver failure and will eventually recover. There may be a sore throat and dry cough, with a little blood. With treatment, mild cases will recover within a few weeks. During this second phase the bacteria are only really active in the tissues of the patient, and so can be difficult to find in the bloodstream, making lab tests a problem. This second phase is usually called the 'tissue' or 'immune' phase.

Diagnosis:

Direct detection Method: Direct visualization of leptospirosis in blood or urine by darkfield microscopic examination has been used for diagnosis. A range of staining method has been applied to direct detection, including immunofluorescence staining, immunoperoxide staining and silver staining. These methods are not widely used because of the lack of commercially available reagents and their relatively low sensitivity. Several polymerase chain reaction (PCR) assay have been developed for the detection of leptospires but few have been evaluated in clinical studies.^7,8,9

Urine from selectively ill patient is often highly concentrated and contains significant inhibitory activity. Histologic diagnosis (fig.1) traditionally relied on silver impregnation staining but immune histochemical staining offers greater sensitivity and specificity.^10,11

Kidney sections stained by silver staining (A) and immunohistochemical staining (B) showing presence of multiple leptospires in tubules.

Treatment:

Severer leptospirosis is treated with antibiotics, specially tetracyclines, penicillin, ampicillin, streptomycin and fluroquinolones. The therapeutic benefit is difficult to demonstrate in populations in which patient present for medical care with late and severe disease. The supportive therapy fluid therapy and blood transfusion is also necessary. Penicillin G 100,000 U/kg/24 hours (given in divided doses every 3 to 4 hours) or tetracycline 25 to 40 mg/kg/day (given in divided doses every six hours) or, preferentially, doxycycline at a dosage of 100 mg orally, twice daily over 7 days is the most effective drug regimen ^12,13

Prevention:

The leptospirosis is prevented by avoidance of high-risk exposures, adoption of preventive measures. The leptospirosis vaccines are available for cattle, pigs and dogs. The vaccines are prevent the infection of the organisms.

High risk exposure to leptospirosis includes swimming in contaminated water, contact with the infected animals and indirect contact with urine-contaminated soil and water. Sanitation and prevention of contact with contaminated environment or infected wildlife, particularly rodent can decrease the risk of infection.

Human immunization is not widely practiced. A vaccine containing serovar Icterohaemorrhagie is available in France for workers in high risk occupation, and a vaccine has been developed for human use in Cuba.( Martínez R, Pérez A, Quiñones MdC, et al. ¹⁴

Morbidity and Mortality

Leptospirosis has a mortality rate about 5%.¹⁵ Hemorrhagic phenomena are relatively common in Weil’s syndrome, and they may occur in the skin, mucosa, or internal organs. Pulmonary hemorrhages may vary from ordinary hemoptoic sputum to massive pulmonary bleeding. ^16,17,18.

Death in severe leptospirosis often results from acute renal failure or eventually from irreversible myocardial failure. Myocardiopathy probably occurs more frequently than is recognized. Leptospirosis is often asymptomatic or mild in adult pigs, and reproductive signs are the main evidence of infection. The mortality rate is higher in young or weak piglets.

The infection in the dogs is higher in hunting dogs, with access to water such as ponds. The kidney and liver damage is fatal in infectious dogs. The fatality rate is approximately 10 % in the dogs.

ACKNOWLEDGEMENT:

We would like to thanks to the principal MES College of pharmacy for their valuable support in preparation of the review article.

REFERENCES:

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Received on 05.12.2011

Modified on 18.12.2011

Accepted on 24.12.2011

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Research J. Pharmacology and Pharmacodynamics. 4(1):Jan. - Feb., 2012, 41-44