What Is Leptospirosis?

Leptospirosis (Leptospirosis) is an acute systemic infectious disease caused by various types of pathogenic Leptospira (Leptospira), which is a natural epidemic disease. And pigs are the two main sources of infection. Its epidemic is almost all over the world, especially in Southeast Asia. Most provinces, cities, and autonomous regions in China have the presence and prevalence of the disease. The clinical features are rapid onset, early fever, systemic soreness, weakness, conjunctival congestion, gastrocnemius tenderness, and superficial lymphadenopathy. Leptotoxic blood symptoms such as superficial lymphadenopathy may be accompanied by pulmonary hemorrhage, diffuse pulmonary hemorrhage, myocarditis, and hemolysis. Anemia, jaundice, systemic bleeding tendency, nephritis, meningitis, respiratory failure, heart failure and other target organ damage manifestations; most cases recover in the late stage, and a few cases can appear fever, uveal uveitis, and cerebral arterial occlusive inflammation. This type of sequelae is related to allergies after infection. Diffuse pulmonary hemorrhage, myocarditis, hemolytic anemia, and liver and kidney failure are common causes of death.

Basic Information

Visiting department: Infectious Diseases
Common locations: Pathogenic Leptospira

Common symptoms: High fever, sore body, weakness, conjunctival congestion, gastrocnemius tenderness, superficial lymphadenopathy, etc.

Causes of Leptospirosis

Pathogenic Leptospira is the pathogen of this disease. The hook body is slender and thread-like, cylindrical, and the spiral coil is meticulous. It has 12 to 18 spirals, regular and tight, and looks like an unopened spring strap. One or both ends of the hook body are bent into a hook shape, so that the fungus body is in a C or S shape. The length of the bacterial cells ranges from 4 to 20 m, with an average of 6 to 10 m and an average diameter of 0.1 to 0.2 m. The hook body moves lively and rotates along the long axis. The central part of the fungus is stiff, the two ends are soft and have strong penetrating power.

Clinical manifestations of leptospirosis

The incubation period is 2 to 20 days. Because of the difference in the immune level of the infected person and the different infected strains, it can directly affect its clinical manifestations.

1. Early (leptoplasma)

Mostly within 3 days after the onset, the prominent manifestations of this period are: fever, headache, general weakness, conjunctival congestion, gastrocnemius tenderness, and superficial lymphadenopathy. Digestive symptoms such as nausea, vomiting, appetite, and diarrhea may also occur during this period. Respiratory symptoms such as sore throat, cough, throat congestion, and tonsil enlargement. Some patients may have enlarged liver and spleen and bleeding tendency. Very few patients have psychiatric symptoms of poisoning.

2. Mid-term (organ damage period)

From 3 to 14 days after the onset, after this period of patients suffered from early infection and septicemia, organ damage manifestations such as hemoptysis, diffuse pulmonary hemorrhage, jaundice, extensive bleeding of skin and mucous membranes, proteinuria, hematuria, cast urine and Renal insufficiency, meningoencephalitis, etc.

The clinical manifestations of this period are the main basis for the classification of the following types: influenza typhoid type, pulmonary hemorrhage type, jaundice bleeding type, renal failure type, and meningoencephalitis type.

3. Recovery or later onset

The symptoms of the patients gradually subsided after fever, but there were also a few patients who developed fever again after a few days to 3 months or so and developed symptoms. It manifests as symptoms such as post-fever, posterior ocular symptom, posterior nervous system symptom, and anterior tibial fever.

Leptospirosis

1. Routine examination and blood biochemical examination

The total white blood cells and neutrophil counts of patients without jaundice were normal or slightly increased; the white blood cell counts of jaundice patients mostly increased, and the neutrophil counts increased. In routine urine tests, most patients have mild proteinuria, white blood cells, red blood cells, or casts, and jaundice has increased bilirubin. Generally, it continues to increase during the first 1-2 weeks of disease, and gradually declines in the third week. After one month, serum transaminase can increase, but the increase is not parallel to the severity of the disease. As a direct indicator of liver damage. Increased creatine phosphokinase (CPK) in half of the cases (average 5 times the normal value).

2. Specific detection

There are two methods for pathogen isolation and serological testing. All are using the known Leptospira antigen to detect the corresponding antibodies in the blood, and early diagnosis cannot be made. In recent years, latex agglutination inhibition tests, reverse indirect hemagglutination tests, and indirect fluorescent antibody staining tests have been carried out to measure the presence of leptospira in early bleeding, and preliminary results have been obtained for early diagnosis.

Leptospirosis diagnosis

Combined with clinical analysis and laboratory analysis to diagnose.

Leptospirosis treatment

General treatment

Emphasize early bed rest, give a digestible diet, and maintain the balance of body fluids and electrolytes. If the body temperature is too high, physical cooling should be repeated to about 38 ° C. In the patient's home, outpatient or admission within 24 hours, especially within 6 to 24 hours to closely observe the condition, be alert to the Ya-Her reaction and the appearance of diffuse pulmonary bleeding after penicillin treatment. Patients' urine should be disinfected with lime, chlorine-containing lime, and so on.

2. Early and Leptoplasmic Treatment

(1) Antibacterial treatment.

(2) Sedative medication.

(3) Adrenocortical hormone treatment.

3. Treatment of diffuse pulmonary hemorrhage

(1) Antibacterial treatment.

(2) Sedative medication.

(3) Adrenocortical hormone treatment.

(4) Infusion.

(5) Cardiotonic drug treatment.

4. Treatment of jaundice and bleeding

For mild and moderate patients, on the basis of antibacterial therapy, appropriate symptomatic treatment is sufficient. For severe patients, the following treatments should be strengthened.

(1) Bleeding treatment.

(2) Carefully.

(3) Protect the liver.

5. Treatment of Renal Failure

For mild patients, based on antibacterial therapy and appropriate symptomatic treatment, kidney damage can mostly recover on its own. For critically ill patients, dialysis treatment is needed, and attention should be paid to water-electrolyte balance.

6. Treatment of meningoencephalitis

7. Treatment of onset symptoms

Symptoms such as post-fever, reactive meningitis, etc., are usually treated only symptomatically and can be relieved in the short term. If necessary, you can add adrenocortical hormone for a short time, and the recovery will be faster.

Leptospirosis prognosis

Due to different clinical types, the prognosis of the disease reported in different places varies greatly. The prognosis is good in mild or subclinical cases, while mortality is higher in severe or hospitalized cases.

Leptospirosis prevention

Comprehensive measures need to be taken for the prevention and management of leptospirosis. These measures should include the eradication and management of animal hosts, the management of infected water, disinfection and personal protection.