Leptospirosis is an acute natural focal zoonotic infectious disease caused by Leptospira. Leptospirosis in humans occurs with severe intoxication, febrile syndrome, the development of hemorrhagic disorders, acute renal failure (acute renal failure), damage to liver tissue and the central nervous system.
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Kidney damage, as well as the development of jaundice and intoxication syndrome, are mandatory for leptospirosis. The first mention of a disease that occurs with similar symptoms belongs to the Russian doctor Seydlitz (1841). In 1886, a student of S.P. Botkin, N.P. Vasiliev, became interested in this disease. He described seventeen cases of this disease and called it “infectious jaundice.” In the same year, research by Professor Weil appeared, describing similar clinical symptoms in four patients.
Thanks to these studies, the disease was identified as a separate nosological unit called Vasiliev-Weil disease.
The causative agent of leptospirosis was isolated in 1915 by several groups of scientists. They studied various serotypes of the pathogen, so each scientist gave the pathogen its own name. What was common to all isolated serotypes was the presence of a convoluted shape, so they were classified as spirochetes. In 1917 they were united under common name Leptospira (delicate (thin) spirochetes).
In the sixties of the twentieth century, there were more than one hundred and twenty types of Leptospira that could cause diseases in humans. For some time they were divided into various infectious diseases: Vasiliev-Weil icterohemorrhagic leptospirosis, benign anicteric water fever, etc.
Further studies of the pathogen led to the conclusion that the pathogenetic mechanisms, and, consequently, the symptoms of leptospirosis in humans are similar, regardless of which serotype caused the disease. In this regard, since 1973, leptospirosis began to be considered as one nosological unit.
Before, various shapes leptospirosis was called Vasiliev-Weil disease, water, swamp or meadow fever, dog fever, 7-day fever, Nanukai, swineherds disease, etc.
ICD 10 code A27. Icteric-hemorrhagic forms of leptospirosis are classified with code A27.0. Unspecified forms are designated A27.9, and other forms are designated A27.8.
All Leptospira are extremely sensitive to high temperatures. They die instantly when boiled, but can remain highly pathogenic for several months when frozen.
The pathogen is also destroyed by bile, gastric juice and acidic human urine. Slightly alkaline urine of animals can retain the pathogen for several days.
When released into open water bodies, leptospirosis pathogens remain pathogenic and viable for a month. If exposed to damp, wet soil (swamps) – more than nine months. Leptospira can survive in food for several days. Drying and ultraviolet irradiation destroy Leptospira within a few hours.
The pathogen also quickly dies when boiling, salting and pickling foods. Its high sensitivity to disinfectants, penicillin, chloramphenicol and tetracycline is also noted.
How can you get leptospirosis?
Leptospirosis is one of the most common natural focal diseases. The source of infection is only animals. From an epidemic point of view, a sick person is considered a “dead end” of infection and does not pose a danger to others.
The main carriers and sources of infection are rats, voles, hamsters, hedgehogs, shrews, dogs, pigs, sheep and cattle. Leptospirosis is rare in fur-bearing animals (foxes, arctic foxes, nutria).
Path of infection with leptospirosis
Rodents suffer from leptospirosis asymptomatically, actively excreting the pathogen in the urine. Farm animals can be acutely ill, but also suffer the infection asymptomatically.
There is a pronounced summer-autumn seasonality of the disease. Susceptibility to leptospirosis is high. Men get sick more often than women.
After recovery, persistent immunity remains, but it is strictly serovar-specific, that is, it works against the type of Leptospira that caused the disease.
The incubation period for leptospirosis in humans ranges from two to thirty days (on average, the first signs of leptospirosis appear after one to two weeks).
Transmission of leptospirosis to humans is carried out mainly by water, less often by contact or food. Infection occurs during swimming in bodies of water contaminated with leptospira, drinking contaminated water, eating unwashed foods, and contacting sick animals. The maximum incidence of the disease is observed in miners (contact with damp soil) and agricultural workers. IN Lately there has been a significant increase in the incidence of the disease in major cities(Moscow).
Due to the high mobility of the pathogen, it can enter the human body through the mucous membranes oral cavity, nasopharynx, esophagus, conjunctiva of the eyes, etc. In addition to the food transmission mechanism, it is possible to ingest or get water into the eyes while swimming. It is also possible for Leptospira to penetrate through open wounds, scratches, etc.
Inflammation at the site of primary penetration of Leptospira does not develop. Distribution throughout the body occurs hematogenously (through the bloodstream). The first phase of leptospirosis, during which the pathogen penetrates the tissues of the liver, spleen, kidneys, lungs, central nervous system etc. corresponds to the incubation period.
Classification of leptospirosis
Type clinical course There are icteric and anicteric forms.
In connection with the leading syndrome, leptospirosis can be renal, hepatorenal, meningeal or hemorrhagic.
The severity of the disease can be:
- mild (accompanied only by fever and does not lead to damage internal organs);
- moderate (severe fever and moderate damage to internal organs);
- severe (the disease is accompanied by the development of jaundice, thrombohemorrhagic syndrome, meningitis, acute renal failure).
Also, the infection can proceed uncomplicated, or lead to the development of ITS (infectious-toxic shock), acute hepato-renal failure, acute kidney damage, etc.
Leptospirosis in humans - symptoms and treatment
The onset of the disease is always acute. The first signs of leptospirosis are a rise in body temperature to forty degrees, undulating fever, chills, soreness in the muscles and joints, severe pain in the lower back, headaches, nausea and vomiting, lack of appetite.
Maximum painful sensations observed in the lumbar region, as well as calf muscles. Cervical, dorsal and abdominal muscles less painful. There is a sharp increase in pain when moving (patients' independent movement is limited) and palpating the muscles.
Feverish syndrome and severe intoxication are associated with the accumulation of decay and metabolic products of the pathogen in the blood. The maximum concentration of the pathogen in the phase of secondary bacteremia is observed in the liver. At the same stage, symptoms of capillary damage and active hemolysis of red blood cells may develop due to the production of hemolysin by the pathogen.
The destruction of red blood cells leads to massive release of bilirubin and the development of icteric syndrome. The severity of jaundice increases due to damage to the hepatic capillaries, the development of edema and serous hemorrhages. Inflammation in the liver tissue contributes to a pronounced disruption of the bile-forming and excretory functions of the liver.
Clinically, damage to the liver and red blood cells is manifested by yellowness of the skin, gingival and nasal bleeding, hemoptysis (in severe cases, bleeding from the gastrointestinal tract and uterine bleeding develops).
When the kidneys are damaged, the clinical picture of acute renal failure (lack of urination) develops. IN severe cases death from uremia is possible. The development of uremia is accompanied by vomiting, diarrhea, the appearance of “uremic frost” on the skin and hair, hypothermia, respiratory and heart failure, lethargy, loss of consciousness (coma is possible), and the appearance of an ammonia odor from the mouth.
When the central nervous system is affected by leptospira and their toxins, purulent (less often serous) meningitis or meningoencephalitis develops.
Severe intoxication symptoms and damage to capillary walls contribute to active microthrombosis and the development of disseminated intravascular coagulation (DIC syndrome).
Also, leptospirosis pneumonia, iritis, iridocyclitis, and myositis often develop. In rare cases, leptospirosis myocarditis may occur.
In the abortive (erased) form, the symptoms of leptospirosis are limited to febrile and intoxication syndromes, without signs of damage to organs and systems.
Diagnosis of leptospirosis in humans
On examination, the patient's appearance is striking:
- jaundiced skin;
- yellowness of the sclera (hemorrhages into the conjunctiva are possible);
- puffiness and redness of the face, neck and upper half of the body;
- enlarged lymph nodes (submandibular, cervical);
- polymorphic measles-like or rubella-like (extremely scarlet-like) rash located on the limbs and torso;
- herpetic rash on the nose and lips;
- hemorrhages in the soft palate, hyperemia of the tonsils and back wall throats.
A highly specific symptom is complaints of pain in the lower back and calf muscles, as well as the development of thrombohemorrhagic syndromes (bleeding from the nose, gums, hemorrhages after injections).
Palpation reveals an enlarged, painful liver and spleen, as well as sharp pain in the calf muscles.
Bradyarrhythmia is noted, arterial hypotension, muffled heart sounds, the appearance of various noises. There may be signs of diffuse damage to the heart muscle on the electrocardiogram.
When pneumonia develops, patients complain of chest pain, shortness of breath, and cough. There is a dullness of pulmonary sound upon percussion.
The development of inflammation of the meninges is accompanied by the appearance of meningeal signs and specific changes in the CSF (cerebrospinal fluid).
Urine tests show proteinuria, cylindruria, hematuria, and renal epithelium may be detected. There is a decrease or absence of diuresis.
In the blood, bilirubin, ALT and AST, potassium, urea and creatinine are increased. IN general analysis blood is characterized by high ESR, development of neutrophilic leukocytosis, aneosinophilia, thrombocytopenia, anemia.
Differential diagnosis of leptospirosis and hepatitis Specific diagnostics are provided bacterioscopically, bacteriologically, biologically and serologically.
In the first few days of the disease, it is possible to detect the pathogen during dark-field microscopy of blood, and later - urine and cerebrospinal fluid.
Diagnosis using culture is more reliable, but Leptospira grows extremely slowly, so this method is not suitable for rapid diagnosis.
The gold standard for diagnosing leptospirosis is serological test. For this purpose, PMA (microagglutination reaction) is performed, since it is characterized by maximum specificity and high sensitivity. In addition to confirming the diagnosis, this method allows you to clarify the serogroup of the pathogen.
A serological test for leptospirosis in humans is informative from the seventh (rarely from the fourth) day of illness, with the appearance of antibodies to the pathogen in the patient’s blood.
Also highly informative linked immunosorbent assay(ELISA) or PCR. PCR analysis is informative even against the background of antibacterial therapy and can be used from the first day of the disease.
Algorithm for diagnosing leptospirosis
Treatment of leptospirosis
Leptospirosis has an unpredictable course and a high risk of severe and fatal complications, so hospitalization of patients is mandatory. The disease cannot be treated at home.
Treatment of leptospirosis is always complex and includes:
- prescribing a gentle dietary diet (No. 7 diet for damage to renal tissue and No. 5 for damage to the liver parenchyma);
- strict bed rest;
- carrying out detoxification;
- dehydration therapy;
- hormonal therapy;
- correction of electrolyte balance and elimination of MA (metabolic acidosis);
- administration of fresh frozen plasma, albumin, platelet mass;
- prevention and treatment of consumption coagulopathy;
- prescribing non-steroidal anti-inflammatory drugs to eliminate febrile syndrome;
- appointment antimicrobial agents(etiotropic treatment).
Antibacterial therapy for leptospirosis
The drugs of choice for the treatment of leptopyrosis are penicillin. The first line antibiotic is benzylpenicillin sodium salt. Reserve drugs (alternative drugs) are doxycycline ®, ciprofloxacin,.
Vaccination against leptospirosis is carried out according to epidemic indications, as well as agricultural workers, people working with dogs (dog handlers), employees of zoos, pet stores and miners (as indicated).
The leptospirosis vaccine is administered subcutaneously (once) in a dose of 0.5 milliliters. After a year, revaccination is indicated. Vaccination against leptospirosis can be given to persons over seven years of age.
Leptospirosis in humans is an acute zoonotic infection. The causative agents are spiral-shaped microorganisms called Leptospira. A disease that provokes disruption of the central nervous system, kidneys, skeletal muscles, the development of jaundice, intoxication, fever and severe myalgia, is also called infectious jaundice, Japanese or water fever.
Features of the development of the disease are due to specific pathogenesis factors characteristic of Leptospira:
- Release of endotoxin, which leads to general intoxication of the body and disruption of the integrity of the vascular endothelium with the leakage of blood from them;
- The presence of flagella, which give the pathogen maximum mobility, the ability for circular, translational, sliding movements;
- Obtaining energy only as a result of oxidative processes in fatty acids;
- The presence of pathogenic enzymes destructive for parenchymal organs in the form of hemolysin, plasmacoagulase, fibrinolysin and lipase.
The causative agent of leptospirosis enters the body through the slightest damage to the skin and mucous membranes. Also, the site of penetration may be the conjunctiva of the eye. For the disease to develop, it is enough to have contact for a short period of time with water in which leptospira lives, or with an infected animal (rodents, pigs, dogs, hedgehogs and cattle are especially susceptible to leptospirosis).
Leptospires use to move around the body lymphatic system without causing inflammation of the lymph nodes. Over a short period of time, the pathogen penetrates various tissues and internal organs, most often the damage affects the lungs, liver, central nervous system and spleen. Here Leptospira actively multiply and accumulate (the incubation period is 14 days), after which destructive processes begin in the above organs, accompanied by intoxication, impaired blood clotting function and destruction of red blood cells.
Leptospirosis in humans is quite common due to significant susceptibility to this infection. The risk group includes the elderly, newborns and people suffering from immunodeficiency. At the same time, there is no species resistance to pathogenic pathogens.
Routes of infection
- Contact - if a person had direct contact with a sick animal or touched contaminated household items or water.
- Nutritional – when eating products from infected animals and infected plant waste products.
- Aerogenic – if in Airways contaminated air enters.
- Transmissible - as a result of flea bites or infected ticks.
Symptoms
The first phase of the disease, called the incubation period, lasts about two weeks, followed by a phase of clinical manifestations. It lasts no more than a month and is divided into three alternating periods.
Generalization
Characteristic acute course and the following symptoms: general intoxication, chills and heat. Fever lasts for 5 days, aggravated by myalgia. Particularly severe pain is observed in the area of the calf muscles, in which focal necrobiotic and necrotic changes occur. In general, the period lasts about a week.
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The duration of this period is about 14 days, during which secondary bacteremia develops and secondary damage to internal organs is observed.
Toxinemia
It is characterized by severe intoxication as a result of the release of endotoxin by gradually dying leptospira. Poisoning of the body results in infectious-toxic shock, multiple organ failure, disruption of the vascular endothelium, and the appearance of bruises on internal organs, mucous membranes and skin (hemorrhages develop).
Also, symptoms of leptospirosis include the development of jaundice due to destructive changes and hemolysis with aggravation of the process in the form of liver and kidney failure. The result of such disorders in the absence of timely treatment is coma.
An objective examination reveals the following signs of the disease, called the “hood symptom”:
- Facial swelling, redness skin;
- Change in skin color upper section chest and neck (appearance of red pigment);
- Yellowness of the scleral vessels and pronounced injection, with no signs of conjunctivitis.
When Leptospira penetrates the blood-brain barrier, development occurs purulent meningitis or meningoencephalitis with clear signs in the form of stiff neck and positive Brudzinski and Kering symptoms (inability to fully straighten knee-joint due to a reflex spasm of the lower leg muscles, etc.).
Features of hemorrhages (rashes) with leptospirosis
Hemorrhages and rashes can be present both on the mucous membranes and skin, and in the internal organs. The characteristic differences of such manifestations are:
- Similarity in appearance with rubella, measles and scarlet fever;
- Rash affects the abdomen, arms and chest;
- The rash disappears after a couple of hours (in in some cases) with subsequent pigmentation and peeling of the skin;
- Development as a result of decompensation of nasal hemorrhages, abdominal bleeding and hemorrhages (at injection sites).
It should be noted that itching may be a sign of liver failure, so you should pay attention to the obligatory accompanying symptom in the form of yellowness of the skin.
Forms of the disease
Leptospirosis in humans can occur in mild, moderate and severe forms.
Light form
Characteristic signs are fever with an increase in temperature to 38-39 degrees with moderate general intoxication of the body and the absence of pronounced disturbances in the functioning of internal organs.
Moderate form
The fever becomes more pronounced, the picture of the disease becomes more detailed, but there are no manifestations of jaundice yet.
Severe form
Depending on the severity criteria, this form of leptospirosis is divided into types such as hemorrhagic, icteric, renal, meningeal, mixed.
A severe form of the disease is called Weil's disease, the symptoms of which appear three days after disappearance signs of mild forms. Leptospirosis in humans at this stage is determined by such a specific symptom as Weil's syndrome, which is characterized by impaired consciousness in combination with jaundice, anemia and prolonged fever. Maximally expressed this syndrome is getting into full swing.
With liver damage in the area of the organ, characteristic pain occurs, the liver increases in size, and characteristic changes occur in the blood serum. Renal dysfunction is accompanied by symptoms such as hematuria, azotemia, proteinuria and pyuria.
Other specific signs of severe leptospirosis include stomach and nosebleeds, hemoptysis, and the development of aseptic meningtitis. Also, there is a possibility of hemorrhagic pneumonia and hemorrhages in the adrenal glands.
Possible complications
In some cases, acute renal failure can develop in a latent form without hemorrhagic syndrome and jaundice, ending fatal after 3-5 days.
Besides, in acute phase cerebral edema, pneumonia and myocarditis, paralysis or paresis may occur, as well as dangerous complications eye – iridocyclitis, iritis, uveitis, which occur a month after the pathogen enters the body.
Diagnostic measures
When diagnosing leptospirosis in humans, the closest attention is paid to the presence of fever and its degree, the appearance of the patient, thrombohemorrhagic syndrome, the severity of jaundice and the degree of kidney damage. At the same time, a thorough differential diagnosis leptospirosis, taking into account the following symptoms:
- Fever that persists for about 5 days, which is also possible with other infectious diseases, including adenovirus, Infectious mononucleosis, a typhus-like form of salmonellosis.
- Jaundice, to exclude malaria, toxic or viral hepatitis.
- Thrombo hemorrhagic syndrome, which also develops with sepsis, rickettsiosis and hemorrhagic fever.
Diagnosis of leptospirosis involves collecting not only clinical information, but also epidemiological indications, which include the presence of contact with domestic and wild animals, type of activity, the fact of bathing open water. In addition, they take into account the examination data, during which the degree of its enlargement is determined by palpation of the liver, diagnosing hepatomegaly by the following signs: protrusion of the organ a couple of centimeters from under the edge of the costal arch, diffuse aching or radiating pain in the area of the right hypochondrium.
Specific diagnostics using laboratory methods
As part of such activities, leptospirosis is analyzed through bacterioscopic, bacteriological, serological and genetic research. From the moment the first symptoms of leptospira appear in the blood, dark-field microscopy can be detected, more later Urine and cerebrospinal fluid tests are taken (relevant in the presence of positive meningeal signs). After taking the test, the result is expected within 8 days (this period is necessary for the growth of Leptospira).
Serological analysis for leptospirosis is based on the use of a microagglutination reaction, which involves the determination of antibodies and antigens that are related to each other and form agglomerates. If the increase in antibody titer exceeds 1:100, it is stated positive reaction. It is advisable to conduct such a study after the end of 7 days from the moment signs of the disease appear. As for genetic research, it is used to identify the DNA of the pathogen in the patient’s biological material. For this purpose, polymerase chain reaction is used.
Nonspecific diagnosis of leptospirosis
Such laboratory research involve taking tests to determine the level of ESR, residual nitrogen, bilirubin of direct and indirect fractions, protein, urobilinogen, ketone bodies, neutrophilic leukocytosis, TAM.
Medical therapy
Treatment of leptospirosis consists of etiotropic, pathogenetic and symptomatic therapy(prescribing antibiotics, preventing complications and alleviating the condition, respectively). Antibiotic therapy can be carried out with the prescription of penicillin (in the absence of allergic reaction), drugs from the tetracycline group, gamma globulin contained in hyperimmune bovine serum.
Leptospirosis in humans mild form can be treated on an outpatient basis without the need for hospitalization. As a rule, a 5-6-day course of antibiotics (tetracycline or penicillin) is given. During development adverse reactions Erythromycin may be used in the form of vomiting, nausea or diarrhea. If the patient complains of muscle pain and headaches, elevated temperature Additionally, ibuprofen or paracetamol may be prescribed. To avoid relapse of the disease, the course of treatment should not be interrupted.
Treatment of severe forms must be carried out in a hospital under the supervision of doctors. Antibiotics are administered intravenously, adding droppers to support the patient nutrients. The need for pathogenetic therapy arises with the development of renal failure, cerebral edema, acute cardiovascular failure or DIC syndrome. To alleviate the patient's condition, hemodialysis and infusion therapy are carried out with the introduction of appropriate drugs (diuretics for impaired renal function, ascorbic acid and cardiac glycosides for cardiac dysfunction, brain metabolites for cerebral edema, detoxification drugs and protease inhibitors in the case of DIC).
The duration of treatment depends on the condition of the body, the degree of damage to internal organs and the response to therapy.
Rehabilitation period
After successful treatment leptospirosis patients should be registered with a dispensary for a period of about six months. During this period, rehabilitation measures are carried out, consisting of consultations with an ophthalmologist, neurologist, therapist or pediatrician (if the patient is a child). After six months, the patient must appear every month for an appointment with a therapist, who, if necessary, will prescribe an examination with a specialized specialist. During the first two months of rehabilitation, clinical and laboratory examinations are carried out regularly.
If, at the end of the rehabilitation period, the test for leptospirosis does not give positive results, the patient is removed from the register. Otherwise, observation with appropriate rehabilitation measures lasts for 2 years.
Preventive measures
Effective prevention of leptospirosis is possible only if the following conditions are met:
- Timely vaccination, testing and treatment of pets. Vaccination against leptospirosis helps protect against such insidious disease not only your pets, but also your family members.
- Avoid visiting fresh water bodies if there are abrasions or cuts on the skin.
- Hygienic shower after swimming in rivers and lakes.
- High-quality hygiene of farm workers, the use of gloves and protective masks when in contact with animals.
- Regular hand washing, especially after playing with pets and returning from the street, eating only washed fruits, vegetables and herbs.
Important nuances
Unlike animals, a person infected with leptospirosis does not pose a danger to others, since he is a biological dead end in the chain of spread of the disease.
Treated leptospirosis in humans does not guarantee lifelong immunity due to the type specificity of the disease. If the body is infected with another Leptospira serovar, infection can occur again.
As you can see, leptospirosis is easier to prevent than to treat. The main thing is to be attentive to your own body and contact specialists at the first suspicion. Only professional diagnostics, timely treatment and a responsible approach become the key to successful recovery without the development of life-threatening complications.
Leptospirosis is an infectious disease that is caused by specific pathogens of the Leptospira genus. The pathological process primarily affects the capillaries, as well as the liver, kidneys and muscles.
Pathogen of this disease penetrates the body through wounds on the skin and mucous membranes. After some time, it penetrates the blood and spreads throughout the body, affecting large organs. But that's it life cycle Leptospira does not end. In the affected organs they begin to grow and multiply rapidly, and after a while they re-enter bloodstream. Gradually, the level of leptospira in the blood will begin to increase. This will be accompanied by severe intoxication. The patient will develop a fever, nausea, headache. Symptoms become more and more pronounced. Without proper treatment, it can develop hemorrhagic diathesis or death will occur.
Causes
In the process of spreading this disease among people, animals play a priority role. Leptospirosis in humans can occur after close contact with them. Therefore, it is important to take preventive measures in a timely manner to prevent the development of pathology. An effective remedy– leptospirosis vaccine.
The disease is transmitted:
- by contact, if there is damage to the skin - when swimming in reservoirs, cutting up carcasses;
- in a nutritional way. Anyone can become infected if they consume water from naturally occurring open water or unprocessed foods such as milk or meat.
Often the disease affects people whose prof. activity involves constant contact with animals.
Outbreaks of the disease often occur in the summer. The disease most often affects people living in places with high humidity.
Forms
Except known form pathology accompanied by a febrile period, in the presence of organ damage, the disease can occur in an erased or abortive form. It is characterized by a short-term and slight increase in temperature, as well as the absence of organ damage.
The incubation period for leptospirosis is from 3 to 30 days. On average, symptoms first appear in infected people between 7 and 10 days.
Pathogenesis
The causative agent of the disease easily penetrates the human body through injured skin or through mucous membranes. Then, entering the bloodstream, it moves to the parenchymal organs, where it multiplies for almost two weeks (the average duration of the incubation period). After which the pathogen returns to the bloodstream and releases a huge amount of toxins that destroy the endothelium of the capillaries. Toxins also “attack” the links of hemostasis.
Leptospira begins to leave the human body a week after infection. This process may continue for several months or weeks. It all depends on the form of the disease and the severity of its course.
Symptoms
- V acute period There is an increase in body temperature to 39–40 degrees. The progression of the disease is accompanied by chills. A person’s temperature can last a very long time – for 6–10 days;
- the person is very thirsty;
- symptoms of intoxication of the body are expressed (noticeable even in incubation period) due to poisoning by toxins secreted by Leptospira;
- pain in the lumbar region;
- puffiness of the face;
- . Muscle pain appears even in the initial period of development of the disease. The calf muscles hurt the most;
- the skin of the neck and face is hyperemic. The whites of the eyes also turn red;
- in some clinical situations there is redness soft palate and pharynx;
- the posterior cervical muscles increase in size The lymph nodes(characteristic symptom).
In some cases, as leptospirosis progresses, a rash appears. The place of its primary localization is the torso, as well as the limbs. Its elements can be quite diverse:
- red spots;
- papules;
- rubella-like rash;
- herpetic rashes (on the nose and lips).
- with liver damage in the acute period, people experience hepatomegaly, yellowness of the skin and whites of the eyes;
- when the CVS is damaged, the patient’s heartbeat becomes much less frequent, blood pressure falls;
- If a person develops hemorrhagic syndrome, then petechial rashes appear on the body. Possible nosebleeds and hemorrhages in the whites of the eyes;
- signs of central nervous system damage - dizziness, impaired consciousness.
Diagnostics
Diagnosis of leptospirosis is quite specific. It is important to immediately seek medical help when the first symptoms of the disease appear. The earlier such a disease is detected, the easier it will be to cure. Clinicians consider:
- the fact of a close relationship with wild or domestic animals;
- whether the sick person swam in open natural reservoirs;
- the patient's profession.
To make an accurate diagnosis, you will need to undergo several studies:
- Leptospira can be detected in blood smears using a dark-field microscope (the most accurate method for diagnosing leptospirosis);
- bacteriological method;
- detection of antibodies to a specific pathogen in the patient’s blood.
Treatment
At the first symptoms of the disease, people are immediately sent to a medical facility, since leptospirosis is a complex disease and can only be treated in inpatient conditions. Treatment of leptospirosis is a very long and complex process.
Antibiotic therapy is prescribed taking into account the infectious agent, as well as its sensitivity to certain drugs.
If the disease progresses and the patient develops infectious-toxic shock, then he should immediately begin to provide first aid medical care. IV is administered saline solutions, fresh frozen plasma. In more severe clinical situations, hemodialysis is prescribed.
Diet plays an important role in the treatment of leptospirosis. The patient is given a diet that is limited in fats and salts.
Complications
- uremic coma;
- purulent encephalitis;
- DIC syndrome;
- iritis;
- hemorrhagic syndrome;
- death.
Prevention
You can protect yourself from infection by limiting contact as much as possible with possible carriers of the disease - rodents, wild and agricultural animals. All existing preventive actions can be roughly divided into 2 groups. The first includes measures that people themselves must take to avoid becoming infected. The second group includes activities, the responsibility for the implementation of which lies with the epidemiological control authorities.
Basic rules of personal prevention:
- vaccination against leptospirosis. Effective prophylactic. The leptospirosis vaccine is administered intramuscularly and for a long time protects a person from infection;
- animal vaccination. All domestic and farm animals must be vaccinated. They are also given the leptospirosis vaccine;
- extermination of rodents in the house;
- refusal to swim in untested places;
- strict adherence to safety rules during outdoor recreation.
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Diseases with similar symptoms:
Jaundice – pathological process, the formation of which is influenced by a high concentration of bilirubin in the blood. The disease can be diagnosed in both adults and children. Call this pathological condition Any disease can, and they are all completely different.
Pneumonia (officially pneumonia) is inflammatory process in one or both respiratory organs, which is usually infectious in nature and is caused by various viruses, bacteria and fungi. In ancient times, this disease was considered one of the most dangerous, and although modern means Treatments allow you to get rid of the infection quickly and without consequences; the disease has not lost its relevance. According to official data, in our country every year about a million people suffer from pneumonia in one form or another.
Leptospirosis Leptospirosis is a group of natural focal non-transmissible zoonoses, similar in etiology and clinical manifestations. The causative agents of leptospirosis are microorganisms of the genus Leptospira, families Leptospiracea, order Spirohaetales. Genus Leptospira combines pathogenic and saprophytic species of Leptospira. The taxonomy of both pathogenic and saprophytic Leptospires is based on antigenic differences. The main taxon of Leptospira is the serovar; serovars with related antigenic structure are grouped into serogroups. The etiological structure of human leptospirosis is dominated by pathogens of serogroups Grippotyphosa, Icterohaemorrhagiae, Canicola, Pomona, Sejroe.
In Russia, leptospirosis is registered in all federal districts, the highest incidence occurs in the Central federal district(Moscow and Moscow region, Smolensk, Tula regions), Northwestern Federal District (Vologda Region, St. Petersburg), Southern Federal District (Krasnodar Territory), Volga Federal District (Republic of Mordovia, Republic of Udmurtia, Kirov Region, Perm region). The reservoir hosts of Leptospira in natural foci are rodents: gray rats, common voles, field and house mice, and insectivores: hedgehogs and shrews. In anthropurgic foci, Leptospira circulates among pigs, large and small cattle, horses, dogs, and in populations of rats and house mice.
Human infection can occur through the water of fresh natural and artificial reservoirs (by swimming, fishing, drinking water, etc.), by consuming leptospira infected food products, direct contact with sick animals. Leptospirosis is characterized by autumn-summer seasonality, but you can get infected from leptospirosis-carrying pets at any time of the year. Both sporadic incidence and epidemic outbreaks are recorded.
The incubation period lasts from 7 to 20 days, during which short-term asymptomatic leptospiremia develops, followed by parenchymal diffusion of leptospira into the liver, kidneys, adrenal glands, spleen, lungs, and possible penetration into brain tissue. The second phase, or the initial period of the disease, which usually lasts 3–7 days, consists of the development clinical picture diseases: high fever, headache, nausea, that is, manifestations of intoxication of the body caused by endotoxins of leptospira when leptospira re-enters the blood; the second phase ends with repeated parenchymal diffusion. At the height of the disease, there is a maximum level of toxemia and damage to internal organs: liver, kidneys, lungs, endocardium; the disease can be complicated by hemorrhagic phenomena of varying severity (hemorrhagic rash on the skin and mucous membranes, minor diapedetic organ hemorrhages, internal and external bleeding), the development of infectious-toxic shock, acute renal or acute hepatic-renal failure. One month left possible development complications from the kidneys, heart, central nervous system; after 1.5 months, as a rule, the stage of convalescence and the formation of long-term serogroup-specific immunity begins.
Differential diagnosis
- Infectious diseases: HFRS, hemorrhagic fevers, viral hepatitis, yersiniosis, meningococcal infection, Infectious mononucleosis, tick-borne encephalitis, borreliosis, acute intestinal infections, pneumonia and serous meningitis of other etiologies;
- somatic diseases: pyelonephritis, pancreatitis, renal colic, blood diseases;
- poisoning
Indications for examination
Fever with general intoxication syndrome in persons who have been in an area endemic for leptospirosis in the last 1.5 months, especially in the presence of symptoms: acute onset of the disease, high fever, pain in the calf muscles, facial hyperemia, scleral injection and conjunctival hyperemia, exanthema, multiple hemorrhagic rashes on various parts of the body, lower back pain, micro- and macrohematuria, oligo- or anuria, enlarged liver, development of jaundice.
Material for research
- Blood, CSF, urine - DNA detection, cultural studies;
- blood serum - determination of AT;
- blood - microscopic examination.
Etiological laboratory diagnostics includes visual detection of leptospira using microscopy, isolation of the microorganism by inoculation on special media, detection of leptospira DNA, determination of IgM and IgG antibodies or total antibodies to leptospira antibodies.
Comparative characteristics of laboratory diagnostic methods
Diagnostic sensitivity of Leptospira DNA detection PCR method in the blood of patients taken in the first week of the disease is 55–90%, in the second week of the disease – 30–40%, in the third week of the disease Leptospira DNA is found in the blood in 15–25% of patients. Specific antibodies using microagglutination methods (MMA) or macroagglutination reactions on glass (slide agglutination) are detected in 18–30% of patients in the first week of the disease, in 70–80% in the second or third week of the disease, in 4 weeks 90% have When using the ELISA method, IgM and IgA antibodies can be determined in the first week of illness, maximum values these ATs reach by the third week. The detection of IgG antibodies begins on days 5–6 of the disease, their maximum concentration is observed in the 5th week of the disease. In severe cases of leptospirosis, suppression of immunogenesis is observed, resulting in a slowdown in the primary appearance of antibodies or their absence.
When using AT determination results for laboratory confirmation of leptospirosis, it is necessary to examine blood samples taken at intervals of 7–10 days (paired sera). When using PMA using a panel of leptospira of various serogroups relevant for the territory where the patient was infected, it is possible to determine the serogroup affiliation of the identified antibodies, which is important for subsequent epidemiological examination of the outbreak.
For visual detection of Leptospira by microscopy and their isolation using cultural methods, it is recommended to examine blood samples in the 1st week of the disease, CSF (with the development serous meningitis) - in the 2nd week, urine - in the 3rd week.
Detection of Leptospira in samples of biological material using microscopy is a fairly simple method for early confirmation of the leptospirosis etiology of the disease. Usage microscopic studies limited by low analytical sensitivity: 106 cells/ml. Restriction on use this method also imposes a short period of survival of Leptospira in urine: at a temperature of 20–25°C, the material must be examined within 6–8 hours from the moment the sample is taken.
Leptospires are slow-growing microorganisms, so isolating a culture is only important for retrospective confirmation of the clinical diagnosis of leptospirosis and a more detailed deciphering of the etiology of a case or outbreak.
Features of interpretation of laboratory results
The clinical diagnosis of leptospirosis is considered confirmed by the isolation of an infectious agent identified as a Leptospira species pathogenic for humans; when detecting IgM or IgA antibodies by ELISA and an increase in IgG titers during the study of blood samples taken over time; when detecting an increase in AT titers in blood samples taken over time using PMA and slide agglutination methods. Detection of Leptospira DNA in the patient's blood and CSF is the basis for a preliminary diagnosis.
Epidemiology of the disease
The infection occurs on all continents, with the exception of Antarctica. Leptospirosis is especially widespread in countries with tropical humid climates. The carriers of the disease are wood mice, water rats, dogs, cattle, pigs, rats and some other animals. In people diagnosed with leptospirosis, symptoms appear after consuming meat and milk from infected animals, cutting meat, or prolonged contact with water contaminated with the excretions of carriers. The specificity of the pathogen entering the body determines the risk groups. The most frequently affected people are livestock farm workers, shepherds, milkmaids, veterinarians and people working in wet meadows. Typically, leptospirosis is diagnosed in people during the summer months, especially August, when conditions are ideal for the bacteria to multiply.
Leptospirosis - symptoms of the disease
The incubation period of infection lasts from 2 weeks to 1 month. The disease begins with acute symptoms:
- severe chills;
- a sharp increase in body temperature to 39-40 degrees;
- headache;
- pronounced muscle pain (the calf muscles hurt very much);
- changes in the skin of the face - it becomes hyperemic, puffy. Patients experience dilation blood vessels and conjunctival hyperemia, which often leads to hemorrhages.
In the first week after the onset of the disease, exanthems may appear of various nature. At severe forms diseases, hemorrhagic rashes are observed, localized on the elbows and in the armpits. In addition, when leptospirosis is diagnosed, treatment includes correction of the liver, kidneys and cardiovascular system, since patients develop urinary retention, Pasternatsky's symptom, rapid breathing, decreased blood pressure and tachycardia.
Signs of fever are observed for about a week, after which the temperature returns to normal. After 3-4 days, a new increase in temperature is possible, but this time it subsides after 1-2 days. In some cases, lectospirosis in humans leads to the development of icterus, which is accompanied by a significant enlargement of the liver and a change in the color of urine.
If left untreated, the disease causes serious complications - acute hepatic or renal failure, meningitis, iritis, iridocyclitis and encephalitis. Depending on condition immune system a person may experience other serious consequences.
Diagnosis of the disease
To determine the presence of Leptospira, blood samples are examined using direct microscopy. In addition, the pathogen is isolated when blood is cultured on nutrient media. The diagnosis can also be confirmed serologically using the RIGA, RSK, microagglutination-lysis reactions.
Leptospirosis - treatment of the disease
All patients are subject to mandatory hospitalization. Etiotropic therapy consists of taking penicillin. The standard dosage of the drug is 6,000,000-12,000,000 units/day. The main treatment for leptospirosis is doxycycline. Doctors also use gammaglobulin. Since there is a danger of developing renal pathologies, osmo- and saluretics are recommended for patients. Hemodialysis is prescribed when symptoms of acute renal failure occur.
For prevention purposes, it is necessary to regularly vaccinate personnel of livestock farms and enterprises involved in processing meat and dairy products.
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