Anatomy and pathophysiology

Causative Agent

Infection comes form contaminated food and water, and infected wild life and domestic
animals especially rodents.

1. Rats ( L. leterohemoragiae) are the source of Weil’s disease frequently observed

among miners, sewer, and abattoir workers.
2. Dogs (L. canicola) can also be the source of infection among veterinarians,
breeders, and owners of dogs.
3. Mice (L. grippotyphosa) may alos be a source of infection that attacks farmers
and flax workers.

Rats (L. bataviae) are the source of infection that attacks ricefield workers

BACTERIA OF THE GENUS Leptospira

Characteristics of Leptospira Interrogans

spirochete
motile
both gram-positive and gram-negative characteristics
poor staining, therefore, dark-field or phase-contrast microscopy are necessary
beta-hemolytic
Modes of Transmission

Incubation Period:

• 6 – 15 days/ 2 – 8 week
Clinical Manifestations:

1st stage: Septicemic/ Leptospiremic Phase (4 – 7 days)

- onset of high remittent fever, chills, headache, anorexia, nausea & vomiting,
abdominal pain, joint pains, muscle pains, myalgia, severe prostration, cough,
respiratory distress, bloody sputum.

2nd stage: Immune/ Toxic Phase (4 – 30 days)

- if severe, death may occur between the 9th & 16th day

2 types:

• Anicteric (without jaundice) – return of fever of a lower degree with rash,

conjunctival injection, headache, meningeal manifestations like disorientation,
convulsions & signs of meningeal irritations (with CSF finding of aseptic meningitis)

• Icteric (with jaundice) – Weil syndrome; hepatic & renal manifestations:

hemorrhage, hepatomegaly, hyperbilirubinemia, oliguria, anuria with progressive
renal failure; shock, coma & congestive heart failure in severe cases

3rd stage: Convalescence Phase

- Relapses may occur during 4th or 5th week

Complications:

• Pneumonia can lead to atelectasis

• iridocyclitis, optic neuritis
• peripheral neuritis
• renal and hepatic failure
• brain damage
• death

Prognosis:

• cause of death: renal & hepatic failure

• disease usually last 1 – 3 weeks but may be more prolonged; relapse may occur

Diagnosis:

• culture: blood (1st week)

CSF (5th to 12th day)

Urine (after 1st wk til pd of convalescence)

• agglutination tests ( 2nd or 3rd week

Treatment:

• specific measures: beneficial if done < 4 days of dse

• Aqueous penicillin G (50,000 units/kg/day in 4-6 divided doses intravenously for

7-10 days
• Tetracycline (20-40 mg/kg/day in 4 doses); may not be given to children < 8 years
old

• general measures

• symptomatic & supportice care

• administration of fluid, electrolytes & blood as indicated
 • peritoneal dialysis (for renal failure)

Nursing Interventions:

• isolation of patient: urine must be properly disposed

• health teachings: keep a clean environment