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Adviento | Aguila | Alcantara | Alea

Leptospirosis: Overview

- Causative agent: Leptospira interrogans

- Zoonosis of worldwide distribution
- Source of infection: urine from infected animal
(reservoir)
- Direct contact
- Indirect contact
- Droplet transmission
- High incidence in humid areas and unsanitary area
- Seasonal epidemic potential
Leptospirosis: Case Definition
Acute febrile illness with history of exposure to water and/or
environment possibly contaminated with infected animal urine
with ANY of the following symptoms:
● Headache
● Myalgia particularly associated with the calf muscles and
lumbar region
● Arthralgia
● Conjunctival suffusion
● Meningeal irritation
● Anuria or oliguria and/or proteinuria
● Jaundice
● Haemorrhages (from the intestines and lungs)
● Cardiac arrhythmia or failure
● Skin rash
● Gastrointestinal symptoms such as nausea, vomiting,
abdominal pain, diarrhea.
Leptospirosis: Case Classification
Probable:
A clinically compatible case with at least one of the following:
● Involvement in an exposure event (e.g., adventure race,
triathlon, flooding) with known associated cases, or;
● Presumptive laboratory findings, but without
confirmatory laboratory evidence of Leptospira
infection.

Confirmed:
A case with confirmatory laboratory results

Epidemiologic Linkage:
Involvement in an exposure event (e.g., adventure race,
triathlon, flooding) with associated laboratory-confirmed
cases.
Global Statistics and Principles
- reinstated as a nationally notifiable disease as of January 2013
- estimated that 100-150 Leptospirosis cases are identified annually in the United States
- 50% of cases occur in Puerto Rico
- considered to be the most widespread zoonotic disease in the world
- estimated that more than 1 million cases occur worldwide each year, including an about
59,000 deaths
- Case fatality rate of 5–15%
Global Statistics and Principles
● Infection usually occurs in adolescents
○ Men > Female
○ Wherein a peak incidence in men is at age 30-39
● It is seend worldwide, except in polar regions
○ It is endemic in most temperate and tropical
climates
○ In temeprate climates = 1 per 100,000 cases
○ In tropical climates = 10-100 per 100,000 cases
○ 300,000-500,000 cases per year
Global Statistics and Principles
National Statistics and Principles
- Most cases are reported during
rainy season
- Median Age affected = 30 yrs old
- Age mostly affected = 40 yrs old
- 86% of cases were males
- 358% increase from the 268
recorded cases during the same
period in 2017
- 105% increase in cases: 2,229
cases as of August 2018, as
compared to the 1,085 cases
during the same period in 2017
- 50% of the burden of
leptospirosis in the Philippines
was from Metro Manila
There is a 71.1% increase in mortality rate from 2016 to
2017

Out of 910 cases, 96 deaths were recorded from january

1 to August 5, 2017

VS.

Out of 532 cases, 50 deaths were recorded at the same

period during 2016
Natural History of Disease: SUSCEPTIBILITY
MAIN PORTALS OF ENTRY:

Wounds or breaks on skin

Prolonged exposure to contaminated water (in flooded areas)

Immunocompromised state

Not known to spread between humans

Natural History of Disease: PRE-SYMPTOMATIC
DISEASE

INCUBATION PERIOD

7 to 12 days
Natural History of Disease: CLINICAL DISEASE
First Symptomatic Phase (Septicemic)

3 to 7 days after incubation period

Asymptomatic Phase (Interphase)

3 to 4 days after first symptomatic phase

Second Symptomatic Phase (Immune Phase)

Weil’s Syndrome, Meningitis

Natural History of Disease: DISEASE OUTCOME
Complications:

Acute kidney disease

Respiratory problems

Multiple organ failure

Death
 Entry of contaminated
water thru open wounds

7 to 12 days (incubation period)

Asymptomatic/Mild Afebrile Severe

Infection Leptospirosis

Complete Recovery Death

Levels of Prevention: PRIMARY LEVEL
- PRE-PATHOGENESIS
PERIOD
Levels of Prevention: SECONDARY LEVEL
- PATHOGENESIS
PERIOD
- Early diagnosis
- Prompt treatment
 Levels of Prevention: SECONDARY LEVEL
MILD MODERATE - SEVERE ANTIBIOTIC THERAPY

Penicillin G
Doxycycline Cefotaxime 7 days
Amoxicillin Ceftriaxone 3 days
Azithromycin dihydrate Parenteral Azithromycin (Azithromycin dihydrate)
dihydrate

Philippine Society Of Microbiology and Infectious Diseases. Leptospirosis

Clinical Practice Guidelines 2010
Levels of Prevention: TERTIARY LEVEL
- STAGE OF DISEASE OUTCOME
- Kidney failure
- Meningitis
- Lung problems
- Organ damage
- Follow-ups or check-ups
Levels of Prevention: TERTIARY LEVEL
- Rest kidneys
- Maintain fluid & electrolyte
homeostasis
- Provide ample time for recovery
END.