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Micro - Spirochetes (i) (Leptospira Interrogans (from bloodstream it…

- - - - lots of cases in East USA + Ire
      - stage 1
        
        localised
        
        possibly mild systemic symptoms
        
        3-32 days post-bite
        
        erythema migrans rash
        
        bulls-eye appearance
        
        once you see this no lab test required
      - stage 2
        
        disseminated
        
        @ first headache, fever, conjunctivitis, myalgia
        
        wks/months later
        
        neurological manifestations ("neuroborreliosis")
        
        facial N paralysis
        
        meningitis
        
        cardiac manifestations
        
        conduction defects
        
        less common
        
        myocarditis
      - stage 3
        
        persistent
        
        can be yrs later
        
        most common presentation = chronic arthritis (do PCR on joint fluid)
    - - transmitted to humans via bite (spirochete in saliva)
      - widespread in Europe
      - infected risk increases with longer attachment time (min 8 hrs needed)
    - - curable
      - early manifestations: PO amoxicillin/doxycycline for up to 4 wks
      - neuroborreliosis: IV ceftriaxone for 2-4 wks
      - symptoms may persist long after Tx cessation, but no evidence to suggest longer Tx duration speeds up recovery
    - - wear protective clothing + use tick repellent while hiking
      - search for ticks immediately after hike + remove them
- - - - causes Weil's disease
        
        generalised illness (headache, fever, rash shock)
        
        thrombocytopenia - haemorrhage
        
        abnormal liver function (jaundice)
        
        acute kidney injury
        
        ICU needed, mortality = 10-15%
  - - - diffuse tubulointerstitial inflamm
      - tubular necrosis
    - - intra-alv haemorrhage
    - - hepatocyte damage
  - - - initial spirochaetemia (fevere, headache, myalgia, conjunctivitis) either resolves after 5-7 days or progresses to immune phase (aseptic meningitis or Weil's)