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CFT II > Exam 3 - Leptospirosis > Flashcards

Exam 3 - Leptospirosis Flashcards

1
Q

T/F: reservoir hosts of leptospira spp. maintain a carrier state in the renal tubules

A

true

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2
Q

how does leptospira spp. enter the body?

A

penetrate mucosal surfaces or abraded skin

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3
Q

how do dogs typically get lepto?

A

usually through indirect contact with urine of wild animal hosts

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4
Q

T/F: any dog from a lepto endemic area, regardless of breed or lifestyle, is at risk of infection

A

true

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5
Q

what are the reservoir hosts that usually serve as the source of lepto infection for incidental hosts such as dogs & humans?

A

raccoons & rats

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6
Q

T/F: immunity against lepto is serogroup specific

A

true

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7
Q

what should be done for a dog living at home with another dog that is infected with lepto?

A

house mate should be treated empirically with doxycycline or have their titers monitored

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8
Q

does vaccine status rule out the possibility of lepto infection?

A

nope!

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9
Q

how are vaccines used to prevent lepto?

A

can prevent clinical disease & decrease shedding caused by serovars in the vaccine

current vaccines contain serovars icterohaemorrhagiae, canicola, grippotyphosa, & pomona

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10
Q

what preventative measures can be taken against leptospirosis infection?

A

avoid contact with wildlife & standing water

annual vaccination for animals at risk

monitor titers or empirically treat other animals in the home with doxycycline

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11
Q

what in-hospital precautions should be taken with a lepto patient? why?

A

house them in low traffic areas of the hospital that allows for good monitoring, limit their movement & content, clearly label the patient & any samples, walk them in a designated area, minimize urine contamination, at risk humans should contact their health care providers

lepto is considered to be a high risk of transmission to veterinary personnel working with infected dogs, so proper PPE is REQUIRED

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12
Q

when do we consider a hospitalized lepto patient to no longer be contagious?

A

after the patient has been on appropriate antimicrobials for 72 hours - if not properly treated, can shed for months!!!!

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13
Q

what is the prognosis for patients with leptospirosis?

A

survival rate ~80% (generally good with appropriate therapy)

platelets typically improve within 7 days & renal values improve within 10-14 days

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14
Q

T/F: in dogs that survive leptospirosis, if they have acute renal tubulointerstitial injury, they may have residual chronic kidney injury

A

true

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15
Q

what are your suitable antibiotic choices when treating suspected leptospirosis empirically when waiting on pending results?

A

penicillin & doxycycline

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16
Q

how long should doxycycline be given to a dog with leptospirosis? why?

A

2 weeks!!!

need to eliminate organisms from the renal tubules

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17
Q

what dosing is used for antibiotics when treating a hospitalized dog for leptospirosis?

A

ampicillin 20 mg/kg IV every 6 hours in the acute period to treat leptospiremia (can dose reduce if renal dysfunction is present)

can also do 5 mg/kg doxycycline IV every 12 hours

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18
Q

why do we not typically do a blood or urine culture when diagnosing leptospirosis?

A

requires aseptic collection, special media, & incubation for 3-6 months

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19
Q

what is important to consider with patient side testing for leptospirosis in regards to anti-leptospiral antibodies?

A

anti-leptospiral IgM antibodies are detected in the FIRST WEEK OF INFECTION!!!

anti-leptospiral IgG antibodies increase to DETECTABLE LEVELS approximately 2 WEEKS AFTER INFECTION

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20
Q

if you run a witness lepto point of care test on an unvaccinated dog with signs of lepto, what is the test detecting? so, what does a positive result mean? what is the disadvantage of this test?

A

detects IgM

positive result in an unvaccinated dog is consistent with infection

relatively low sensitivity (80%)

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21
Q

why may you see a false positive in a witness lepto test on a dog?

A

dog was vaccinated for lepto within the last 6 months

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22
Q

what does a SNAP lepto point of care test detect?

A

detects antibodies against the LipL32 membrane protein (IgM & IgG))

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23
Q

when may you use patient side testing for leptospirosis?

A

may be used when waiting for results of MAT or PCR

looking for the presence of antibodies

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24
Q

how is PCR used to diagnose leptospirosis in dogs?

A

can diagnose an acute infection - PCR on urine & serum prior to starting antibiotics (blood is ideal in the first 7-10 days, then urine, so submit both)

vaccines won’t cause a false positive! chronic carriers could have a positive urine PCR result

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25
Q

does MAT testing reliably predict the infecting serogroup in leptospirosis infections?

A

nope

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26
Q

when do we use microscopic agglutination tests for diagnosing leptospirosis?

A

acute & convalescent serum titers - usually tests against serovars canicola, icterohemorrhagiae, pomona, grippotyphosa, hardjo, bratislava, & +/- autumnalis

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27
Q

how are MAT results interpreted when running titers at acute presentation?

A

detects anti-leptospiral IgG & IgM via agglutination of live leptospires of a panel of serogroups

single titer > 1:800 is considered to be positive in an unvaccinated dog

> 1:1600 is considered to be positive in a vaccinated dog

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28
Q

what should you do if you have negative MAT results for a dog you suspect an acute infection with lepto? how is this interpreted?

A

convalescent titers should be performed in 2-4 weeks

4x change is diagnostic for lepto infection!!!!!!

29
Q

why do you need to send the convalescent titers to the same lab for where you send acute titers to for leptospirosis?

A

considerable inter-lab variability between labs!

30
Q

what is seen on urinalysis of a patient with leptospirosis?

A

azotemia with inadequately concentrated urine is the hallmark of renal injury!!!!

USG may be dilute without azotemia, hyposthenuria is possible (lepto can induce nephrogenic diabetes insipidus)

proteinuria, glucosuria, casts, pyuria, & hematuria - indicates renal tubular damage

31
Q

T/F: leptospires are visible by routine light microscopy

A

false

32
Q

what is seen on a chemistry panel of a patient with leptospirosis?

A

azotemia - prerenal, renal

elevated liver enzymes - especially ALP

hyperbilirubinemia

secondary electrolyte abnormalities

33
Q

what is seen on CBC of a patient with leptospirosis?

A

may see an inflammatory leukogram +/- left shift

thrombocytopenia is common, but typically mild

can be normal

34
Q

what is seen on abdominal ultrasound in a patient with leptospirosis?

A

changes consistent with acute kidney injury may be seen - hyperechoic renal cortices, renomegaly, peri-renal effusion

may see evidence of pancreatitis - enlarged, hyperechoic

other non-specific changes - gastric wall thickening, splenomegaly, & mild lymphadenopathy

35
Q

why run a coagulation panel on a suspected lepto patient?

A

may see elevations in PT/PTT & d-dimers!!

coagulopathy risk

36
Q

what does it mean if serum troponin is increased in a suspected lepto patient?

A

suggests myocardial damage is present

37
Q

T/F: a lepto dog can have disease that is subclinical to peracute

A

true

38
Q

_____, ________ ________, & _______ ___ ______ are common early signs in animals infected with lepto

A

fever, muscle tenderness, & reluctance to move

39
Q

how do dogs with leptospirosis often present clinically?

A

acute kidney failure and/or liver disease

40
Q

why does lepto cause acute kidney injury in dogs? what signs associated with acute kidney injury are seen in lepto dogs?

A

organisms penetrate & colonize the renal tubular cells - causing interstitial nephritis, renal tubular cell swelling, & vasculitis with decreased GFR

pu/pd, oliguria, or anuria

lethargy, dehydration, vomiting, abdominal pain

41
Q

why does lepto cause acute liver injury in dogs? what signs associated with acute liver injury are seen in lepto dogs?

A

lepto causes hepatic necrosis & mild neutrophilic periportal hepatitis

lethargy, dehydration, vomiting

icterus

42
Q

what signs associated with ocular disease are seen in lepto dogs?

A

uveitis

conjunctivitis

43
Q

why may you see abnormal bleeding in lepto patients? what signs indicate vasculitis?

A

from vasculitis, DIC, and/or liver dysfunction

signs of vasculitis - edema, effusion, petechial hemorrhage, epistaxis, melena, pulmonary hemorrhage, etc

44
Q

what environment does lepto survive best in?

A

warm, stagnant, or slow moving water

45
Q

does lepto replicate outside of its host?

A

nope!

46
Q

how long does incubation of lepto last?

A

variable, but <7 days

47
Q

how long does bacteremia last in an animal with lepto?

A

up to 10 days

48
Q

what are some possible risk factors for leptospirosis?

A

exposure to water

male dogs

herding or working breeds

49
Q

what may be seen on thoracic radiographs of a dog with lepto?

A

mild interstitial pattern

nodular interstitial to alveolar pattern with leptospiral pulmonary hemorrhage syndrome

50
Q

what is included in PPE that should be used when treating dogs with lepto?

A

gloves, gown, mask/eyewear/face shield

wastes are biohazard - label all as lepto suspect!!!

51
Q

what testing is used for detecting anti-leptospira antibodies?

A

patient side tests

MAT

52
Q

what testing is used for detecting lepto organisms?

A

PCR on blood or urine

tissue biopsy

dark field microscopy on blood or urine

culture using specific media

53
Q

what should you do if you get a negative result on a witness lepto test in a dog that is very suspicious for lepto?

A

retest them in 3-7 days

54
Q

if a lepto patient isn’t clinically dehydrated, but you’re starting them on fluids, what do you assume? how long do you take to correct the dehydration?

A

estimate 5% dehydrated

correct it over 4-6 hours

55
Q

when looking at urine output in a patient with an acute kidney injury, what is your target level of production? what value would indicate oliguria?

A

target is > 2 ml/kg/hr

oliguria is < 1 ml/kg/hr

56
Q

what is included in insensible losses? what is the estimate we use for insensible losses?

A

losses that can’t be measured - evaporation, drooling, fecal loss

20 ml/kg/day

57
Q

how do you determine your fluid rate for a patient with an acute kidney injury when considering the ‘ins’ & ‘outs’?

A

outs - urine output & fluid loss through vomiting/diarrhea

insensible losses - 20 ml/kg/day

in - matched to outs, iv fluids +/- oral intake

fluid rate = urine output + 20 ml/kg/day +/- ongoing losses

58
Q

how do you determine what fluid therapy you need in a patient with a urinary catheter?

A

rate = (measured urine output/hour) + (20 ml/kg/day)

match ins to outs & recalculate every 2-4 hours monitoring urine output/kg/hr each time

may need higher fluid rates due to the polyuria

59
Q

T/F: a patient with oliguria/anuria is at high risk of getting volume overload

A

true

60
Q

what are some signs of volume overload?

A

moist mucus membranes, gelatinous skin elasticity, serous nasal discharge, chemosis, tachypnea/dyspnea, cough, pleural effusion, SQ edema, & ascites

61
Q

how do you manage oliguria/anuria in a patient with an acute kidney injury?

A

urine production is < 1 ml/kg/hr & patient is well hydrated

administer furosemide or mannitol - no mannitol is patient if over-hydrated

target urine production of > 2 ml/kg/hr

62
Q

T/F: in a patient with oliguria/anuria, persistent oliguria or anuria is an indication for dialysis

A

true

63
Q

what should you do for treatment of AKI if your kidney values plateau?

A

if the patient feels well - taper fluids while monitoring!

if the patient has a poor quality of life due to uremia - look at dialysis or euthanasia

64
Q

what should you do for treatment of AKI if your kidney values become normal?

A

taper & stop fluids while monitoring kidney values

65
Q

what should you do for treatment of AKI if your kidney values worsen?

A

dialysis or euthanasia

66
Q

how is tapering fluids done for patients with AKI?

A

patient needs to feel well & have a stable creatinine

taper 25-50% every 12-24 hours (same number of days as diuresis), monitoring their body weight & azotemia

outs should decrease as ins are decreased

67
Q

what are some negative prognostic factors associated with leptospirosis?

A

oliguria/anuria

hypocoagulable state

albumin is low

cardiac involvement

68
Q

are these factors predictive of outcome in a patient with lepto?

organs affected, severity of creatinine elevation, DIC, or SIRS

A

nope!

CFT II (28 decks)

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