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Leptospirosis - Coggle Diagram
Leptospirosis
Complications and Prognosis
Liver dysfunction
Pulmonary complication
Myocarditis, pericarditis, aortitis, arteritis, and vasculitis
Renal injury
Prognosis
Without treatment, Leptospirosis can lead to kidney damage, meningitis (inflammation of the membrane around the brain and spinal cord), liver failure, respiratory distress, and even death.
Diagnostic Algorithm
History taking
Historical illness
Occupation
Main complaint
Additional complaint
Physical examination
Icteric
Anemis?
Conjunctiva suffusion
Tenderness on M. Gastrocnemius
Supporting exam
Complete Blood Count
Serological antibody test
Blood or urine culture
PCR
Etiology and Morphology
Etiology
caused by an infection with the spirochete bacterium Leptospira. It is most often spread through exposure to the urine of infected animals either from direct contact or from contact with soil or water contaminated by the urine. Common animals that transmit Leptospirosis include farm animals such as cattle, pigs, and horses
Morphology
Leptospira are spiral-shaped bacteria that are 6-20 μm long and 0.1 μm in diameter with a wavelength of about 0.5 μm. One or both ends of the spirochete are usually hooked.
Classification of Leptospirosis
Icteric
Accounts 10% of case.
Higher mortality than the mild one.
Jaundice as the “key player” presents.
Also called as “Weil’s disease”
Weil’s Triad: hemorrhage, jaundice, AKD.
Mortality: 5%-15%.
Anicteric
Most common type (90%).
Lower mortality than severe one.
Jaundice as the key different is not found.
Self limited and can present with a headache, cough, non-pruritic rash, fever, rigors, muscle pain, anorexia, and diarrhea.
Treatment of Leptospirosis
Mild
Doxycycline, Amoxicilline, Ampicilline.
Severe
Peniciline, Ceftriaxone, Cefotaxime, Doxycycline.
Clinical Manifestation
Mild: fever, chills, headache, muscle aches, vomiting, or diarrhea, no jaundice.
Severe: May have acute kidney disease and liver injury, jaundice.
Differential Diagnosis
Influenza, dengue and dengue hemorrhagic fever, hanta virus infection, yellow fever and other viral hemorrhagic fevers, rickettsiosis, borreliosis, brucellosis, malaria, pyelonephritis
Leptospirosis Patophysiology
During infection, the triggering of the inflammatory response, especially through the production of cytokines, is essential for the early elimination of pathogens. However, uncontrolled cytokine production can result in a cytokine storm process, followed by a state of immunoparalysis, which can lead to sepsis and associated organ failures.
Risk Factors
Farmers.
Mine workers.
Sewer workers.
Slaughterhouse workers.
Veterinarians and animal caretakers.
Fish workers.
Dairy farmers.
Military personnel.
Education and Prevention
Occupational hygiene by the use of protective clothing and avoiding contaminated surface waters (difficult in case of flooding in developing countries)
Environmental control measures, like rodent and flood control, are difficult to implement
Chemoprophylaxis for adventure travelers, military personnel who visit endemic areas, and after an accidental lab exposure