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Leptospirosis. Clinical Medicine 3 Neal Villanueva, DVM. Definition. Gram negative spirochete (helical) 200 serovars Most common serovars affecting dogs L. canicola - Dog is the reservoir host L. icterohemorrhagiae L. grippotyphosa L. pomona L. bratislava Rare in cats. Pathophysiology.

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leptospirosis

Leptospirosis

Clinical Medicine 3

Neal Villanueva, DVM

definition
Definition
  • Gram negative spirochete (helical)
  • 200 serovars
    • Most common serovars affecting dogs
      • L. canicola- Dog is the reservoir host
      • L. icterohemorrhagiae
      • L. grippotyphosa
      • L. pomona
      • L. bratislava
    • Rare in cats
pathophysiology
Pathophysiology
  • Penetrate skin or mucous membranes and enters the bloodstream (4-7 days)
  • Spreads systemically (2-4 days)
    • Transitory fever, leukocytosis and anemia.
  • Capillary and endothelial cell damage  petechial hemorrhages
  • Liver-
      • hepatic necrosis
  • Kidney-
      • damages renal tubules and replicates in the tubular epithelial cells
  • Death
      • Secondary to renal failure
      • Acute septicemia and/or DIC
transmission
Transmission
  • Direct
    • Host to host
      • Contact with infective urine
      • Postabortion discharge
      • Sexual contact
  • Indirect
    • Exposure to infective urine to a contaminated environment where the organism can survive.
      • Vegetation
      • Soil
      • Food, water
      • bedding
slide8
Environmental factors
    • Warm and moist environment
      • Wet season/high rainfall areas of temperate regions
      • Low-lying areas (marsh, muddy, irrigated)
      • Tropical and subtropical
      • T°- 7-10°C (44.6-50°F) to 34-36°C (93-96°F)
    • Water
      • ↑ survival in stagnant water
      • Slightly alkaline pH
    • Can survive 180 days in wet soil, longer in standing water.
signalment
Signalment
  • Species
    • Dogs
    • Cats- rare
  • Age
    • Young dogs without passive maternal antibodies
      • Severe disease
    • Old dogs with adequate antibody titer levels seldom exhibit clinical disease unless exposed to a serovar not in the vaccine
      • No cross immunity between serovars
clinical signs
Clinical Signs
  • History
    • Peracute to subacute disease
      • Fever
      • Sore muscles, stiffness
      • Weakness
      • Anorexia
      • Depression
      • Vomiting
      • Dehydration
      • Diarrhea +/- blood
      • Death
slide12
Chronic
    • Sub-clinical illness
    • Fever of unknown origin
    • PU/PD
      • Chronic renal failure
slide13
Physical Exam- peracute to acute
    • Tachypnea
    • Rapid, irregular pulse
    • Poor capillary perfusion
    • Hematemesis
    • Hematochezia
    • Melena
    • Epistaxis
    • Injected mucous membranes
    • Petechial/ecchymotic hemorrhages
    • Reluctance to move, hyperesthesia and stiff gait
    • Hematuria
    • Conjuctivitis,rhiniteis
slide14
Diagnosis
    • Suggestive history
      • Exposure to stagnant water, host animals and wooded areas
      • Lack of prior vaccination
      • Fever and renal and/or hepatic involvement are suggestive.
    • Increased risk factors
      • Middle-aged dogs
      • Large breed, mixed breed, hound dogs
      • Dogs living in urban areas
        • Terriers, toy breeds
slide15
Laboratory findings
    • CBC
      • Leukopenia during leptospiremia  leukocytosis +/- left shift.
      • Thrombocytopemia
      • Normocytic normochromic anemia
    • Serum chemistry
      • Azotemia, hyperphosphatemia, hypercalcemia
      • Hyponatremia, hypochloremia, hypokalemia if vomiting
      • Hyperkalemia w/ oliguria or anuria
      • +/- elevated hepatic values (AALT, AST, ALKPhos, Tbil)
slide16
Specific Tests
    • Microscopic Agglutination Test (MAT)
      • 4 fold increase in titers over a 2-4 week period
      • Or a single test result of 1:800 + is diagnostic
      • Unable to differentiate b/t infection and vaccination
    • Polymerase Chain Reaction test (PCR)
      • Positive before seroconversion  earlier diagnosis
      • 100% sensitivity, 83% specificity
      • Sensitivity may result in false positives
slide17
Treatment
    • Supportive care and fluid therapy
    • Elimination of leptospiremia
      • Ampicillin
      • Amoxicillin
      • Penicillin
    • Elimination of carrier state
      • Doxcycline
      • Tetracycline
      • azithromycin
slide18
Prevention
    • Vaccination
      • L. canicola
      • L. icterohaemorrhagiae
      • L. pomona
      • L. gryppotyphosa
      • Only lasts 6-8 months, recommend booster q6m.
      • No cross protection from other serovars
slide20
Zoonotic potential
    • Recreational water sources, floods
    • Occupational
      • Keep lepto suspect animals separate
      • Handle urine/urine contaminated items with latex gloves
      • Facemasks and goggles when hosing contaminated areas