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LEPTOSPIROSIS. No2 hospital CMU department of infectious disease Huang Fen. DEFINITION. 1. Leptospirosis is a kind of zoonotic infectious disease caused by pathogenic leptospires; 2. rats and swine are cardinal source of infection; 3. the disease often occurs in summer

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leptospirosis

LEPTOSPIROSIS

No2 hospital CMU department

of infectious disease

Huang Fen

definition
DEFINITION
  • 1. Leptospirosis is a kind of zoonotic
  • infectious disease caused by pathogenic leptospires;
  • 2. rats and swine are cardinal source
  • of infection;
  • 3. the disease often occurs in summer
  • and fall;
definition1
DEFINITION
  • 4. clinical features:
  • three symptoms,
  • three signs,
  • internal organ damage,
  • seguelae of eyes and nerve system
  • 5. treatment: penicillin.
etiology
ETIOLOGY
  • 1.pathogen : pathogenic leptospira
  • 2.features of leptospia:
  • helicoid with hook,
  • length 6~ 20 um,G -
  • darkfield microscope;
  • in korthof’s media;
slide5
ETIOLOGY
  • several months in water and
  • moist soil (PH7.0~7.5)
  • 3.Classification:
  • 23 serogroups and more then 200
  • serotypes in the world;
  • 19 serogroup and 74 serotypes in china.
  • icterohemorrhagic group,
  • pomona group
epidemiology
EPIDEMIOLOGY
  • 1.Source of infection:
  • rat: apodemus agrarius,
  • rice field type;
  • pigs: flood or rain type;
  • patient
slide7
EPIDEMIOLOGY
  • 2.Routes of transmission:
  • (1) water borne (indirect contact
  • transmission):
  • by skin,mucosa,when skin is injured.
  • (2) direct contact transmission:
  • (3) food borne
  • 3.Susceptibility of population:
slide8
EPIDEMIOLOGY
  • 4.Epidemiologic features:
  • (1)season: summer and fall;
  • (2) nosogenic age:
  • young and middle age,children
  • (3)occupation:
  • farmer,slaughter,
  • fisher,veterinarian.
epidemiology1
EPIDEMIOLOGY
  • 4.Epidemiologic features:
  • (4)epidemic type :
  • rice field type
  • flood type
  • rain type
pathogenesis
PATHOGENESIS
  • leptospira
  • skin,mucosa
  • Initial stage leptospiremia toxic symptoms
  • (1~3days) three symptoms:
  • fever,myalgia,fatigue;
  • three signs:
  • conjunctival suffussion;
  • muscle tenderness;
  • enlargement of lymphonodes;
slide11
PATHOGENESIS
  • severe toxic symptoms
  • lesion of organs:
  • influenza form
  • pneumorrhagic form
  • middle stage icterohemorrhagic form
  • (3~10d)
  • meningoencephalitis
  • renal failure form.
slide12
PATHOGENESIS
  • immunopathological reaction
  • after fever;
  • sequelae of eyes;
  • reactive
  • meningitis;
  • cerebro arteritis
  • obliterans.
  • convalescent stage
pathology
PATHOLOGY
  • 1. basic pathological change is
  • infective,toxic injured of systemic
  • capillaries;
  • 2. severe:lung,liver,kidneys,brain.
  • exudation,hemorrhage,
  • edema or necrosis.
clinical manifestations
CLINICAL MANIFESTATIONS
  • Incubation period: 2~28 days
  • usually 7~13days;
  • 1. Influenza-typhoid type:5~10days
  • three symptoms:
  • fever,myalgia and fatigue.
  • three signs:
  • conjunctival suffusion,
clinical manifestations1
CLINICAL MANIFESTATIONS
  • three signs:
  • conjunctival suffusion,
  • tenderness of
  • gastrocnemius muscle;
  • enlargement and tenderness
  • of superficial lymphnodes.
  • Inguinal and axillary
  • lymphodes.
clinical manifestations2
CLINICAL MANIFESTATIONS
  • 2. pneumorrhagia form:
  • 1). three symptoms and three signs
  • 2). pneumorrhagia symptoms(3~4d)
  • (1). mild pneumorrhagia type
          • cough,expectoration with blood.
          • a few moist rales.
          • X-ray of chest: scattering spotty and small fasciola shadow
  • dyspnea,
      • palpitaton,aspharyxia,rales.
clinical manifestations3
CLINICAL MANIFESTATIONS
  • 2. pneumorrhagia form:
  • (2) diffuse pneumorrhagia type
          • short breathing, palpitation,
  • dysphoria,
          • massive hemoptysis, asphyxia,
  • cyanosis,
          • a lot of moistrales.
          • X-ray: extensive fasciola shadow
  • .
slide18
CLINICAL MANIFESTATIONS
  • 3.Icterohemorrhagic type:(Weil ,s disease)
  • 1). three symptoms and three signs
  • 2). jaundice, hemorrage, renal injury
  • (4~5d)
        • liver injury:
  • anorexia,vomiting, jaundice,
  • abnormal liver function.
slide19
CLINICAL MANIFESTATIONS
  • 3.Icterohemorrhagic type:(Weil ,s disease)
          • hemorrhage: petechiae,ecchymoses,hemoptysis,hematemesis etc.
          • renal injury: proteinuria,
          • RBC, WBC, cast,
          • oliguria,azotemia,uremia.
slide20
CLINICAL MANIFESTATIONS
  • 4.renal failure type:
  • oliguria, azoteinia, uremia.
  • 5.meningoencephalitis type:
  • 1). three symptoms and three signs
  • 2). 3~4days later, meningitis, encephalitis.
        • headache,vomiting,meningeal irritation,
        • lethargy,coma,paralysis or convulsion.
slide21
CLINICAL MANIFESTATIONS
      • CSF is abnormal.
          • pressure increase
          • pleocytosis<500 × 106/L
          • protein is normal or elevated slightly.
          • glucose and chloride is normal.
          • leptospira isolation: positive.
slide22

CLINICAL MANIFESTATIONS

  • SEQUELAE
  • 1. after fever :1~5days after defervascence
  • 2. sequelae of eyes: 1week~1month
  • iridocycyclitis, choroiditis , uveitis
  • 3.reactive meningitis
  • 4.cerebroarteritis obliterans:2w~2m
  • hemiplegia aphasia
laboratory findings
LABORATORY FINDINGS:
  • 1. routine examination:
  • 1). blood routine examination:
  • WBC is increased slightly;
  • 2).urine routine examination:
  • protein (2/3)
  • 2. serological examination:
  • 1).microscopic agglutination test (MAT)
  • detect antibody >1:400
laboratory findings1
LABORATORY FINDINGS:
  • 2). ELISA: serum and CSF IgM antibody
  • 3. pathogenic test
  • 1).blood culture:
  • 2).PCR: DNA
diagnosis
DIAGNOSIS
  • 1.epidemiologic data:
  • 1).epidemic area;
  • 2).epidemic season;
  • 3).a history of contact with contaminated
  • water;
  • 2.clinical manifestations:
  • 3.Lab findings:
differential diagnosis
DIFFERENTIAL DIAGNOSIS
  • 1.Influenza; Typhoid fever,
  • 2.Lobar pneumonia;
  • 3.Viral hepatitis;
  • 4.Viral meningitis;
  • 5.Epidemic hemorrhagic fever;
treatment
TREATMENT
  • 1.Pathogenic therapy
  • 1). first choice: penicillin
  • 40万 u q6h or q8h im 7days
  • note: Herxheimer reaction
        • first time - small amount 5万 u
        • im
  • 2). Gentamycin 8万 u q8h im
treatment1
TREATMENT
  • 2.Symptomatic therapy
  • 1).Herxheimer reaction
  • physical cooling, sedative,
  • hydrocortisone.
  • 2). pneumorrhagia type
  • sedative, hydrocortisone, cardiotonics
  • 3.treatment of sequlea
prevention
PREVENTION
  • 1.control of pigs:
  • 1). stable breeding
  • 2).immunized by vaccine
  • 2.killing of rats,
  • 3.cutting route of transmission,
  • 4.vaccination: multivalent vaccine