LEPTOSPIROSIS DEFINITION - PowerPoint Presentation

Slide1

LEPTOSPIROSIS

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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;

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DEFINITION

4. clinical features:

three symptoms,

three signs,

internal organ damage,

seguelae of eyes and nerve system

5. treatment: penicillin.

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ETIOLOGY

1.pathogen : pathogenic leptospira

2.features of leptospia:

helicoid with hook,

length 6~ 20 um,G

-

darkfield microscope;

in korthof’s media;

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ETIOLOGY

several months in water and

moist soil (PH7.0~7.5)

3.Classification:

23 serogroups and more then 200

serotypes in the world;

19 serogroup and 74 serotypes in china.

icterohemorrhagic group,

pomona group

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

EPIDEMIOLOGY

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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:

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EPIDEMIOLOGY

4.Epidemiologic features:

(1)season: summer and fall;

(2) nosogenic age:

young and middle age,children

(3)occupation:

farmer,slaughter,

fisher,veterinarian.

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EPIDEMIOLOGY

4.Epidemiologic features:

(4)epidemic type :

rice field type

flood type

rain type

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PATHOGENESIS

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

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PATHOGENESIS

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

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PATHOGENESIS

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

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PATHOLOGY

1. basic pathological change is

infective,toxic injured of systemic

capillaries;

2. severe:lung,liver,kidneys,brain.

exudation,hemorrhage,

edema or necrosis.

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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,

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CLINICAL MANIFESTATIONS

three signs:

conjunctival suffusion,

tenderness of

gastrocnemius muscle;

enlargement and tenderness

of superficial lymphnodes.

Inguinal and axillary

lymphodes.

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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.

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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

.

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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.

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CLINICAL MANIFESTATIONS

3.Icterohemorrhagic type

:(Weil

,

s disease)

hemorrhage: petechiae,ecchymoses,hemoptysis,hematemesis etc.

renal injury: proteinuria,

RBC, WBC, cast,

oliguria,azotemia,uremia.

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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.

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CLINICAL MANIFESTATIONS

CSF is abnormal.

pressure increase

pleocytosis<500

×

10

6

/L

protein is normal or elevated slightly.

glucose and chloride is normal.

leptospira isolation: positive.

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SEQUELAE

1. after fever :1~5days after defervascence2. sequelae of eyes: 1week~1month iridocycyclitis, choroiditis , uveitis3.reactive meningitis4.cerebroarteritis obliterans:2w~2m hemiplegia aphasia

CLINICAL MANIFESTATIONS

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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

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LABORATORY FINDINGS:

2). ELISA: serum and CSF IgM antibody

3. pathogenic test

1).blood culture:

2).PCR: DNA

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DIAGNOSIS

1.epidemiologic data:

1).epidemic area;

2).epidemic season;

3).a history of contact with contaminated

water;

2.clinical manifestations:

3.Lab findings:

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DIFFERENTIAL DIAGNOSIS

1.Influenza; Typhoid fever,

2.Lobar pneumonia;

3.Viral hepatitis;

4.Viral meningitis;

5.Epidemic hemorrhagic fever;

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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

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TREATMENT

2.Symptomatic therapy

1).

Herxheimer reaction

physical cooling

,

sedative,

hydrocortisone.

2). pneumorrhagia type

sedative, hydrocortisone, cardiotonics

3.treatment of sequlea

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PREVENTION

1.control of pigs:

1). stable breeding

2).immunized by vaccine

2.killing of rats,

3.cutting route of transmission,

4.vaccination:

multivalent vaccine