Leptospirosis

Question 1

Leptospirosis

Main MO

Answer 1

Leptospira interrogans icterohemorrhagiae

Question 2

Leptospirosis

Main primary host

Answer 2

rats

Question 3

Leptospirosis

colonizing site of the spirochete

Answer 3

Proximal conv tubule of the carrier

Question 4

Leptospirosis

Carriers

Answer 4

domestic farm animals- rodents, cattle, dogs, pigs

Question 5

Leptospirosis

Surviving environmental conditions

Answer 5

areas with stagnant waters- paddy fields, ditches, streams, rivers

Question 6

Leptospirosis

How does the MO enter the hosts

Answer 6

enter via intact mucous membranes and through abraded skin

Question 7

Leptospirosis

How does Leptospirosis transmit to humans

Answer 7

• Direct- vet workers
• Indirect- occupational, recreational exposure to water contaminated w infected water
• RARELY human to human- sexual transmission during convalescence ( recovery) phase
• Occupational exposure in labs

Question 8

Leptospirosis

Incubation period

Answer 8

5- 14 days

Question 9

Leptospirosis

Main two clinical phases

Answer 9

• Bacteremic phase
• Immune mediated phase

Question 10

Leptospirosis

Bacteremic phase pathophysio

Answer 10

Direct tissue damage

Question 11

Leptospirosis

Bacteremic phase Sx

Answer 11

• Acute fever
• Headache
• Conjunctival suffusion
• Severe myalgia > arthralgia
• 1/3 pts icteric

Question 12

Leptospirosis

myalgia is characteristic in

Answer 12

calves tenderness

Question 13

Leptospirosis

Lepto pts w icterus is aka

Answer 13

Weil’s disease

Question 14

icterus + Hemorrhage in eye. Dx?

Answer 14

Lepto until proven otherwise

Question 15

Leptospirosis

Immune- mediated phase. Ig…?

Answer 15

IgM

Question 16

Leptospirosis

Immune- mediated phase Sx

Answer 16

• Hepatic failure
• Renal failure ( Interstitial nephritis, ATN) - HYPOKALEMIA
• Hemolytic anemia
• Circulatory failure ( due to myocarditis)
• Aseptic meningitis
• Cardiac failure
• Pulmonary failure ( Hemoptysis, BL infiltrates, ARDS, RS failure)

Question 17

Leptospirosis

life- threatening complication

Answer 17

Pulmonary failure

Question 18

Leptospirosis

complications

Answer 18

• Acute renal failure
• Acute myocarditis w acute LHF
• Acute aseptic meningitis
• Pulm Hemorrhage

Question 19

Leptospirosis

How does it cause AKI and then CKI

Answer 19

• MO»> Direct Kidney Injury»> Acute interstitial nephritis»> AKI»» CKI
• Hypovolemia»> K hypoperfusion»> AKI»> CKI
• Vasculitis»> K hypoperfusion»> AKI»> CKI
• Rhabdomyolysis&raquo_space;> Kidney tubular injury»> AKI»> CKI

Question 20

Leptospirosis

Ix ( Isolate the MO)

Answer 20

• Culture ( clinically useless. takes time to get the report) - Blood, CSF, urine
• Dark ground microscopy
• PCR

Question 21

Leptospirosis

How long does it take to get the MO in urine sample

Answer 21

2nd week

Question 22

Leptospirosis

How long does it take for the CSF sample to detect spirochete

Answer 22

within the first week

Question 23

Leptospirosis

Dark ground microscopy

Answer 23

low sensitivity and specificity. So its not done generally

Question 24

Leptospirosis

PCR

Answer 24

can detect the disease very early but expensive

Question 25

# Leptospirosis the Ix done usually detects...

Answer 25

detect the Ab- IgM ( detected by Day 6- Day 10)

Question 26

# Leptospirosis The test done

Answer 26

Lepto MAT ( microscopic agglutination test)

Question 27

# Leptospirosis Lepto MAT

Answer 27

* detect Ab after a week * >1:320 (four fold rise) is significant * Lasts 3-4 weeks

Question 28

# Leptospirosis Lepto Ab detecting tests

Answer 28

* Lepto MAT * ELISA

Question 29

# Leptospirosis Other supportive tests done

Answer 29

* FBC - Increased WBC, ( Neut) Reduced plts * LFT - ALP>> AST/ALT * UFR- +ve for protein, bile, red cell casts * RFT- SE, S,Cr * Creatine kinase - increased * ECG - non- specific ST, T changes * CXR- pulm edema, hemorrhage

Question 30

# Leptospirosis Why is creatine kinase elevated

Answer 30

coz of muscle damage

Question 31

# Leptospirosis Mx

Answer 31

* Admit * Ix- CBS, FBC, LFT, RFT, UFR,ESR, CRP * Observe for complucations * Monitor- IP/OP chart, QHT * Careful Fluid Mx * Definitive Mx- IV Benzyl penicillin/ IV ceftriaxone/ IV cefotaxime * Mild disease definitive Mx- doxycycline 100mg bd * Mx of complications- HyperK, HD, ARF Mx

Question 32

# Leptospirosis Preventive measures

Answer 32

* Immunise domestic, farm animals * Risk occupations- protective clothing and simple hygienic practice * Chemoprophylaxis in high risk- doxy 200mg bd continued until the exposure is over

Question 33

AST> ALT seen in

Answer 33

* Dengue * Lepto * alcoholic steatohepatitis * cirrhosis

Question 34

# Leptospirosis 1: 80 titre in a blood sample means?

Answer 34

After diluting the sample 80 times, the bacteria is +ve