3 nonspecific symptoms of mild form of Leptospirosis
FHM
fever
headache
myalgia
3 symptoms of Severe Leptospirosis
JRH
Jaundice
Renal dysfunction
Hemorrhagic diathesis
Severe lepto is a.k.a
Weil’s syndrome
pathologic species of Leptospirosis
a. L. interrogans
b. L. biflexia
c. both
d. neither
A, L. biflexia is free living
How many pathogenic species are there?
10
T/F vast majority of infections with leptospira cause no or only mild disease in humans
T
Severe potentially fatal complications is in what percentage of the patients?
1%
2 phases of leptospirosis
leptospiremic phase
immune phase
organisms proliferate, cross tissue barriers and disseminate hematogenously to all organs, leptospires can be isolated from the bloodstream. Which phase?
leptospiremic phase
binding to this allows Leptosires to evade complement mediated killing
Factor H
T/F blood cultures taken during immune phase will yield positive results,
F. appearance of antibodies coincides with disappearance of leptospires from the blood
Renal pathology in immune phase
a. acute tubular damage
b. interstitial nephritis
c. both
d. neither
C
Histopathology of the liver in leptospirosis
NIB
necrosis, focal
inflammation, foci of
Bile cannaliculi, plugging of
T/F platelet consumption plays an important role in the pathogenesis of leptospirosis
T
endothelial cell activation is reflected by
elevated plasma levels of soluble E-selectin and vWF
T/F there is swelling of activated endothelial cells, vasculitis, necrosis
F; no evident vasculitis, necrosis
The only leptospiral virulence factor shown to satisfy Koch’s postulate. This encodes a surface-exposed protein with an unkown function
loa22
TLRs involved in innate immunity in leptospirosis
TLR2
TLR4
Incubation period of leptospirosis
1-2 weeks (1-30 days)
How long is the leptospiremic phase
3-10 days
during the immune phase, culture sample should be taken from ______ to demonstrate leptospires
urine
All cases of leptospirosis always include a second phase
F
natural course of mild leptospirosis usually involves spontaneous resolution within
7-10 days
Characteristics of leptospirosis patients with higher mortality rates
My HAAIR
mental status, altered Hypotension Arryhtmias Age >40 Insufficiency, respiratory Renal failure, acute
Electrolyte abnormality due to acute kidney injury in leptospirosis
Hypokalemia
Hyponatremia
Loss of magnesium in urine
ECG changes in leptospirosis
nonspecific ST-T wave changes
CSF shows pleocytosis that can range from a few cells to
> 1000 cells/uL
CSF glucose levels in leptospirosis
normal
pulmonary radiographic abnormalities in severe leptospirosis
patch bilateral alveolar pattern
Definitive diagnosis of leptospirosis is made by
isolation of the organism form the patient
positive result in PCR
seroconversionor a rise in antibody titer
standar serologic procedures for leptospirosis
MAT and 1145 ELISA
real-time PCR is most effective when?
first 5 days of illness
Treatment for severe leptospirosis
IV penicillin
Treatment for mild cases
doxycycline
reaction to endotoxin-like products released by death of harmful microorganisms that resembles sepsis, fever, chills, rigor, hypotension, headache, tachycardia, hyperventilation, vasocilation. This develops within hours after initiation of antimicrobial tx
Jarisch-Herxheimer reaction
Treatment for patients with oliguri renal failure
peritoneal dialysis or hemodialysis
T/F most patients with leptospirosis recover
T
Mortality rates are highest among patients
PEP
Pulmonary hemorrhage, Weil’s
Elderly
pregnancy - fetal mortality