The kidneys are commonly involved in leptospirosis. Blood urea and creatinine levels will be elevated although the urine output is normal or high. Leptospirosis causes increased potassium excretion in the urine, which leads to low potassium level in the blood  and low sodium level. Therefore, a urine culture will remain positive for leptospirosis from 10 days until 30 days of infection. For those with liver involvement, mild elevations of transaminases and direct bilirubin can be observed in liver function tests.
The Leptospira Icterohaemorrhagiae serogroup is most commonly associated with jaundice and elevated bilirubin levels. In those with glucosephosphate dehydrogenase deficiency , leptospirosis can contribute to acute hemolytic anaemia and conjugated hyperbilirubinemia. In those who have lung involvement, a chest X-ray may demonstrate diffuse alveolar opacities.
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Other patterns such as interstitial lung disease , pleural effusion , and ground-glass opacity of the lungs are uncommon. For those with severe headache that shows signs of meningitis , a lumbar puncture can be attempted. These findings are consistent with aseptic meningitis.
Typically, isolates of L. This test can quickly determine the diagnosis and help in early treatment of leptospirosis. However, the test specificity depends upon the type of antigen used, the presence of antibodies from previous infections, and the presence of other diseases such as Epstein-Barr virus infection, viral hepatitis , and cytomegalovirus infection can cause false positive results.
The mixture is then examined under a microscope to look for agglutination. The MAT is then read by dark field microscopy. During the acute phase of the disease, MAT is not specific in detecting a serotype of Leptospira because of cross-reactivity between the serovars. Molecular typing such as pulsed-field gel electrophoresis , multilocus sequence typing , multiple loci VNTR analysis can identify Leptospira to species level by analyzing 16S ribosomal RNA gene of isolates.
Leptospira is a slow-growing bacteria. Blood samples containing Leptospira can be cultured in both liquid and solid media with nutrients such as long-chain fatty acids , vitamin B1 and B12 , and ammonium salts. However, since survival of Leptospira is limited in urine, a phosphate buffered saline is used to enhance the bacteria growth in urine culture.
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Since contamination is prevalent in urine cultures , antibiotics such as fluorouracil are used to inhibit the growth of other bacteria in culture. The cultures are examined weekly under a dark field microscope until 13 weeks of incubation. The incidence of leptospirosis cases can be reduced by improving housing, infrastructure, and sanitation standards.
Rodent abatement efforts and flood mitigation projects can also help to prevent leptospirosis. Human vaccines are available only in a few countries, such as Cuba , China  and France. Both human and animal vaccines only cover a few strains of the bacteria. Since the immunity induced by one serovar of Leptospirosis is only protective against that specific serovar of leptospirosis, trivalent vaccines have been developed. Doxycycline has been provided once a week as a prophylaxis to minimize infections during outbreaks in endemic regions.
In another study, doxycycline administered after exposure to antibiotics was found reduce the number of people with symptomatic disease after a heavy rainfall in endemic areas. Pre-exposure prophylaxis may be beneficial for individuals traveling to high-risk areas for a short stay. Most leptospiral cases resolve spontaneously. Early initiation of antibiotics may prevent the progression to severe disease. Therefore, in resource limited settings, antibiotics can be started once leptospirosis is suspected in history taking and examination.
For mild leptospirosis, antibiotic recommendations such as doxycycline, azithromycin, ampillicin and amoxicillin were solely based on in vitro testing. Tetracycline , ampicillin , and amoxicillin can also be used in such cases. Based on a study, intravenous IV benzylpenicillin also known as penicillin G is recommended for the treatment of severe leptospirosis. Amoxicillin, ampicillin, and erythromycin may also be used for severe cases. There was no difference in the resolution of fever and azithromycin is better tolerated than doxycycline.
Those who can be treated as outpatients should receive doxycycline or azithromycin. Doxycycline can shorten the duration of leptospirosis by two days, improve symptoms, and prevent the shedding of organisms in urine. Azithromycin and amoxicillin are given to pregnant women and children. For those with severe leptospirosis, such as potassium wasting with high kidney output dysfunction, intravenous hydration and potassium supplements should be given to prevent dehydration and hypokalemia.
When acute kidney failure occurs, early initiation of haemodialysis or peritoneal dialysis can help to improve survival. For those with respiratory failure, tracheal intubation with low tidal volume improves survival rates. The use of corticosteroids has been proposed for the treatment of leptospirosis because Leptospira infection can induce the release of chemical signals which promote inflammation of blood vessels in the lungs.
However, there is insufficient evidence to determine whether the use of corticosteroids is beneficial.
Those with acute kidney failure may suffer persistent mild kidney impairment post recovery. Thirty percent of affected people may suffer chronic leptospirosis syndrome for up to two years which is characterized by weakness, muscle pain, and headaches. It is estimated that seven to ten million people are infected by leptospirosis annually.
Annual rates of infection vary from 0. In January , leptosprirosis was reinstated as a nationally notifiable disease in the United States. The number of new cases of leptospirosis is difficult to estimate since many cases are not reported. There are many reasons for this, but the biggest issue is differentiating the disease from other conditions with a similar presentation. The number of cases increases during the rainy season in the tropics and during the late summer or early fall in Western countries.
There is no evidence of leptospirosis having any effect on sexual and age-related differences.okta.kz/wp-includes/44-chloroquine-diphosphate.php
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The people at the highest risk for leptospirosis are young people whose age ranges from 5—16 years old, and can also range to young adults. The disease was first described by Adolf Weil in when he reported an "acute infectious disease with enlargement of spleen , jaundice , and nephritis. The disease was most likely brought to the New World by Europeans. Leptospira was first observed in from a post mortem kidney tissue slice by Stimson using silver deposition staining technique. He called the organism Spirocheta interrogans because the bacteria resembles a question mark.
The organism was named Spirocheta icterohaemorrhagiae. The Japanese group also experimented with the first leptospiral immunisation studies in guinea pigs. They demonstrated that by injecting the infected guinea pigs with sera from convalescent humans or goats, passive immunity can be provided to the guinea pigs. In , the Japanese group discovered rats as the carriers of leptospirosis.
They named the organism Spirochaeta nodosa and Spirochaeta Icterogenes respectively. Leptospirosis was subsequently recognised as a disease of all mammalian species. In , Dutch workers reported the isolation of Leptospira canicola which specifically infects dogs. In , the strain that specifically infects cattle was first reported in Russia.
This disease was later known to be caused by leptospirosis. In the s, leptospirosis was recognised as a veterinary disease of major economic importance. In , there were about serovars of Leptospira available for classification. The International Committee on Systematic Bacteriology 's subcommittee on Taxonomy of Leptospira proposed classifying these serovars into two big groups: L. In the same year, Leptospira illini was reclassified as the new genus Leptonema. In , Leptospira parva was classified as Turneriella.
More Leptospira species have been discovered since then. The first meeting was convened in In , LERG estimated that the global annual incidence of leptospirosis is 5 to 14 cases per , population. Animals are also presented with similar clinical features when compared to humans. Incubation time of exposure to first symptoms in animals is anywhere from 2 to 20 days.
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Incubation period can be prolonged in cats. Leptospirosis can cause abortions after 2 to 12 weeks in cattle, and 1 to 4 weeks of infection in pigs. The illness tends to be milder in reservoir hosts. The most commonly affected organs are the kidneys, liver, and reproductive system but other organs can be affected. Vomiting, diarrhea, and abdominal pain may also present.
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Petechiae and ecchymoses may be seen on mucous membranes. Bleeding from the lungs may also be seen in dogs. In chronic presentations, the affected dog may have no symptoms.
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