LEPTOSPIROSIS

LEPTOSPIROSIS: AN IGNORED INFECTIOUS DISEASE FOLLOWING FLOODS

INTRODUCTION:

Natural disasters usually lead to disturbances in the eco system and creates multiple hazards to

human as well as animal health. The most commonly encountered natural disaster include floods,

which are highly prevalent in Asian countries. Floods are commonly caused due to heavy rains,

river and coastal floods, and human interferences (e.g. deforestation). Risk factors such as

overcrowding, disruption of sewage disposal, poor

standards of hygiene, poor nutrition, negligible sanitation

and human contact among refugees provide suitable

conditions for increasing the incidence of infectious

diseases after flooding and can cause epidemics.

Leptospirosis, Schistosomiasis, Melioidosis, Cholera were

some of the infectious diseases documented following

flood events.

Leptospirosis is an infectious disease caused by pathogenic bacteria that belongs to genus

Leptospira. It is transmitted directly or indirectly

from animals to humans (Zoonosis). It affects

humans as well as animals. In humans clinical

manifestations range from mild to lethal with broad

spectrum of signs and symptoms, some of which

may be mistaken for other diseases. However, few

individuals, have no symptoms at all. Leptospirosis

is of two types anicteric and icteric (severe form and

associated with multi organ involvement).

Leptospirosis is widespread all over the world but is

highly prevalent in tropical and sub-tropical regions with high rainfall.

EPIDEMIOLOGY:

The estimated annual incidence of leptospirosis is 0.1 to 1 per 1,00,000 per year in temperate

climates whereas in humid climates it is 10 or more per 1,00,000 per year. It is more prevalent

during rainy/ monsoon season. In developing countries, the disease occurs most commonly in

farmers and low-income people who live in areas with poor sanitation. In developed countries, it

occurs during floods and is a risk to sewage workers and those involved in outdoor activities in

warm and wet areas. Antarctica is the only place not affected by leptospirosis.

CAUSATIVE AGENT:

Leptospira interrogans is pathogenic to humans. It is a

Gram negative, long cork screw shaped obligate aerobe

spirochete, with periplasmic flagella. It resembles like a

question mark when viewed under dark field microscope

(not visible under ordinary microscope).

MODES OF TRANSMISSION:

 Contact with urine from infected animals.

 Contact through skin, mucosa or conjunctiva with water or soil contaminated with urine of

rodents (Rattus norvegicus) or diseased animals

(cattle, pig, dog, horse, wild animals etc..).

 Ingestion of contaminated water.

 Human to human transmission is rare.

 Infected animals may continue to excrete the

bacteria into the environment continuously or

every once in a while, for a few months up to

several years.

 Outbreaks of leptospirosis are usually caused by

exposure to contaminated water, such as floodwaters.

HIGH RISK GROUPS:

 Farmers

 Sewage workers

 Pet shop workers

 Slaughterhouse workers

 Veterinarians and animal caretakers

 Dairy farmers

 Military personnel

 Disaster relief workers

 People involved in outdoor/recreational

activities such as swimming and outdoor sports.

 People with chronic diseases and open skin wounds

PATHOPHYSIOLOGY:



SIGNS AND SYMPTOMS:

The symptoms of leptospirosis occur in two different phases, but in few individuals, symptoms are

not seen and first phase of symptoms resemble to that of flu and last for 3-7 days. First phase

symptoms include

 Headache

 Chills

 Extreme muscle pain

 Red-eye (conjunctival suffusion)

 Extreme abdominal pain

 Skin rash

 Vomiting

 Fatigue

 Diarrhoea

 Jaundice

When such symptoms occur, our immune system starts producing antibodies against the bacteria

Leptospira which help combat the bacteria present in the body. Therefore, around 90% of people

develop only mild symptoms or develop only first phase symptoms of Leptospirosis. A very few of

them experience severe symptoms that include:

 Weil’s Disease

 Hearing loss

 Kidney failure accompanied by bleeding

 Meningitis (infection causing inflammation in the membranes of the brain and spinal cord)

 Pulmonary haemorrhage

 Pneumonitis

 Cardiac arrhythmias

The second phase of Leptospirosis is life-threatening. If it’s not treated early, it may develop serious

complications and may even lead to death.

DIAGNOSIS:

 Leptospirosis has diverse symptoms like hepatitis, dengue fever, malaria, typhoid and other flu-

type illnesses. Therefore, specific tests are carried out for the proper

diagnosis of Leptospirosis.

 It can be detected in cerebrospinal fluid and blood for the first 7-10 days

before it attacks the kidneys. In fresh urine, it is found after 7-10 days.

 To determine the severity of complications, tests like CSF analysis,

Biliary tract ultrasonography, Complete blood cell (CBC) count, Chest

radiography, and Electrocardiography (ECG) are carried out.




TREATMENT:

PROPHYLAXIS:



PREVENTION:



WHO GUIDLINESS FOR PREVENTION OF LEPTOSPIROSIS:




WHY THERE IS LACK OF RECOGNITION OF LEPTOSPIROSIS?

 Broad range of clinical manifestations.

 May mimic other diseases (eg: dengue fever, viral fever etc…)

 Diagnostic capabilities are not readily available.

 Poor surveillance and reporting.

REFERENCES:

1. https://www.cdc.gov/leptospirosis/infection/index.html

2. https://www.who.int/topics/leptospirosis/en/


- POLUDASARI SHRAVAN KUMAR,
Pharm.D,
MALLA REDDY PHARMACY COLLEGE,
CSRPL_INT_WKEND_HYD_0019/20.

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