{"id":376,"date":"2023-09-16T22:10:04","date_gmt":"2023-09-16T21:10:04","guid":{"rendered":"https:\/\/microregistrar.com\/?p=376"},"modified":"2023-09-16T22:10:04","modified_gmt":"2023-09-16T21:10:04","slug":"leptospira-spp","status":"publish","type":"post","link":"https:\/\/microregistrar.com\/?p=376","title":{"rendered":"Leptospira spp."},"content":{"rendered":"\n<p>This is from a presentation. The pictures were my slides. Feel free to download them if you wish.<\/p>\n\n\n\n<p>Leptospirosis, a zoonosis, is caused by a pathogenic Spirochaeta of the genus Leptospira.<br>The name is derived from the Greek leptos (thin) and the Latin spira (coiled).<\/p>\n\n\n\n<p>Leptospirosis is a multisystem disease first described by Albert Weil in 1986 (in Heidelberg). It was called infectious jaundice and was often confused with yellow fever.<\/p>\n\n\n\n<figure class=\"wp-block-image\"><img decoding=\"async\" src=\"https:\/\/microregistrar.com\/wp-content\/uploads\/2021\/07\/image-10.jpeg\" alt=\"Albert Weil, Heidelberg (1886) \" class=\"wp-image-6494\"\/><\/figure>\n\n\n\n<p>Leptospira was first isolated from an autopsy specimen \u2013 the patient was suspected of having yellow fever. Many scientists, like stokes and Noguchi, died trying to isolate the organism.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">The Bacteria<\/h3>\n\n\n\n<ol class=\"wp-block-list\">\n<li><strong>Leptospira spp, is a Spirochaeta, has two methods of classification.<\/strong><\/li>\n<\/ol>\n\n\n\n<p><strong>Older serological method:<\/strong><br>Leptospira was divided into two species \u2013 L interrogans (pathogenic) and L biflexa (non-pathogenic). There were many serovars of L interogans based on somatic O antigen. Related serovars were grouped into serogroups.<\/p>\n\n\n\n<figure class=\"wp-block-image\"><img decoding=\"async\" src=\"https:\/\/microregistrar.com\/wp-content\/uploads\/2021\/07\/image-11.jpeg\" alt=\"Leptospira \nL. interrogans \nPathogenic \n&gt;250 \nserovars \nL. biflexa \nNon pathogenic \" class=\"wp-image-6495\"\/><\/figure>\n\n\n\n<p><strong>Genetic classification:&nbsp;<\/strong>Classification is based on the genetic similarity supported by the 16S RNA sequence. The species are classified as pathogenic, non-pathogenic and pathogenicity uncertain.<\/p>\n\n\n\n<figure class=\"wp-block-image\"><img decoding=\"async\" src=\"https:\/\/microregistrar.com\/wp-content\/uploads\/2021\/07\/image-12.jpeg\" alt=\"Pathogenic group \nL. interrogans \nL. noguchii \nL. weilii \nL kirschnerii \nL santarosaj \nIntermediate group \nn-pathogenic \n(Pathogenicity \n(Saprophytes) \nuncertain) \nL. biflexa \nL. inadai \nL meyeri \nL. wolfii \nL wolbachii \nL. fainei \" class=\"wp-image-6496\"\/><\/figure>\n\n\n\n<p><strong>2. Leptospira is motile using two axial flagella underlying the membrane sheath.<\/strong><\/p>\n\n\n\n<figure class=\"wp-block-image\"><img decoding=\"async\" src=\"https:\/\/microregistrar.com\/wp-content\/uploads\/2021\/07\/image-13.jpeg\" alt=\"Sheath \nAxial flagella \nLeptospira, \nbacteria \" class=\"wp-image-6497\"\/><\/figure>\n\n\n\n<p>https:\/\/www.youtube.com\/embed\/BMo7cOvJxYc?feature=oembed<a href=\"https:\/\/youtu.be\/BMo7cOvJxYc\">The mechanism of two-phase motility in the spirochete Leptospira: Swimming and crawling<\/a><\/p>\n\n\n\n<p><strong>3. Leptospira has a worldwide distribution.<\/strong><\/p>\n\n\n\n<figure class=\"wp-block-image\"><img decoding=\"async\" src=\"https:\/\/microregistrar.com\/wp-content\/uploads\/2021\/07\/image-15.jpeg\" alt=\"Global burden of Leptospirosis \nTorgerson et al, PLOS Neglected Tropical Diseases \n08 \n60-70 \n70-1m \" class=\"wp-image-6502\"\/><\/figure>\n\n\n\n<p>4.&nbsp;<strong>Host and carriers:<\/strong><\/p>\n\n\n\n<p>The most important carrier of this infection is rodents and other small animals. Leptospira causes chronic renal infection in these animals, causing prolonged shedding of the bacteria in the urine, often lifelong. Other domestic and wild animals could get infected by these carriers.<br>Human-to-human transmission has not been reported.<\/p>\n\n\n\n<figure class=\"wp-block-image\"><img decoding=\"async\" src=\"https:\/\/microregistrar.com\/wp-content\/uploads\/2021\/07\/image-16.jpeg\" alt=\"uman to huma ansmissio \" class=\"wp-image-6510\"\/><\/figure>\n\n\n\n<p><strong>It<\/strong>&nbsp;<strong>is transmitted to humans by direct or indirect contact with animal urine. Professions like abattoirs, and vets, may acquire the infection through<\/strong> direct contact. Indirect contact may occur with<strong> farmers (contaminated soil\/ water), sewage workers, and firefighters (during a flood). Leptospirosis has also been reported after recreational activities.<\/strong><\/p>\n\n\n\n<figure class=\"wp-block-image\"><img decoding=\"async\" src=\"https:\/\/microregistrar.com\/wp-content\/uploads\/2021\/07\/image-14.jpeg\" alt=\"Zoonotic disease \nr\u00c5i s\u00e5bkistence \nUrban slum dwellers \nfirefighters \nSewage workers \nrs, hunters \nRisk group \nand \nAdventure tourism \nassociation \nRecreational facility \n\/ heavy rainfall \nOther natural calamity \nLate summer to early fall \nclimate) \" class=\"wp-image-6501\"\/><\/figure>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>Portal of entry and Incubation period<\/strong><\/h3>\n\n\n\n<p>Leptospira can enter humans through the mucous membrane (mouth, gut), conjunctiva, cuts, abrasions, and aerosol.<\/p>\n\n\n\n<p>After entering the blood, it causes systemic vasculitis, which facilitates the entry of the bacteria into various tissues.&nbsp;<strong>The incubation period is approx 10 days (range 2-26 days)<\/strong><\/p>\n\n\n\n<figure class=\"wp-block-image\"><img decoding=\"async\" src=\"https:\/\/microregistrar.com\/wp-content\/uploads\/2021\/07\/image-8.png\" alt=\"\" class=\"wp-image-6511\"\/><\/figure>\n\n\n\n<figure class=\"wp-block-image\"><img decoding=\"async\" src=\"https:\/\/microregistrar.com\/wp-content\/uploads\/2021\/07\/image-9.png\" alt=\"Incubation period (median)= 10 days \" class=\"wp-image-6512\"\/><\/figure>\n\n\n\n<p><strong>Virulence &amp; pathogenicity:<\/strong><\/p>\n\n\n\n<p>Leptospira pathogenicity is poorly understood, but some mechanisms are as follows.<br>1. Ability to evade TLR4 (innate immune system).<br>2. Toxin-mediated damage of tissues<br>3. Ability to produce superantigen in some individuals (HLA- DQ6 positive)<br>4. Immune-mediated damage<\/p>\n\n\n\n<figure class=\"wp-block-image\"><img decoding=\"async\" src=\"https:\/\/microregistrar.com\/wp-content\/uploads\/2021\/07\/image-17.jpeg\" alt=\"Human Toll like receptors 4 \nare unable to bind \nLeptospira LPS \nHaemolytic toxin causes \ndirect tissue damage \nLeptospira produces \nuperantigen leading to non \nspecific activation of T cells \nut\u00f6lmrnuriifwuntipiate \nand anti-cardiolipin antibod \nImmune complex mediated \" class=\"wp-image-6513\"\/><\/figure>\n\n\n\n<h3 class=\"wp-block-heading\">Leptospirosis \u2013&nbsp;<strong>Signs and symptoms:<\/strong><\/h3>\n\n\n\n<p>Most Leptospira infections are subclinical and self-limiting.<\/p>\n\n\n\n<figure class=\"wp-block-image\"><img decoding=\"async\" src=\"https:\/\/microregistrar.com\/wp-content\/uploads\/2021\/07\/image-19.jpeg\" alt=\"90% of \ninfections \nare self \nlimiting \n\u2022 Self limiting \n\u2022 Severe infection \" class=\"wp-image-6515\"\/><\/figure>\n\n\n\n<p>The disease often follows two phases (although it may not occur in all patients). In a septicaemic phase, the bacteria could be found in the blood and then an immune phase. In the&nbsp;<strong>immune phase,<\/strong>&nbsp;Leptospira disappears from the blood, and IgM appears. This phase shows signs and symptoms of organ involvement.<\/p>\n\n\n\n<figure class=\"wp-block-image\"><img decoding=\"async\" src=\"https:\/\/microregistrar.com\/wp-content\/uploads\/2021\/07\/image-18.jpeg\" alt=\"Septicaemic phase \nFever. \nHeadache, chills, rigors. \nMyalgias (esp. calf and lumbar areas). \nRed eye. \nAbdominal pain; anorexia, nausea, and \nvomiting, diarrhoea. \nCough and pharyngitis. \nPretibial maculopapular cutaneous \nEruption. \nHepatosplenomegaly \nLymphadenopathy \n5 -7 days \nImmune phase \nJaundice, \nRenal failure, \nCardiac arrhythmias, \nPulmonary symptoms, \nAseptic meningitis, \nConjunctiva' \nsuffusion\/haemorrhage. \nPhotophobia, eye pain. \nMuscle tenderness. \nAdenopathy, Pancreatitis \nHepatosplenomegaly \n4 - 30 days \" class=\"wp-image-6514\"\/><\/figure>\n\n\n\n<p><strong>Aseptic meningitis<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>In the immune phase (80% cases).<\/li>\n\n\n\n<li>Headache (frontal, bi-temporal), photophobia.<\/li>\n\n\n\n<li>Lymphocytic pleocytosis, Protein \u2013 mild elevation, glucose \u2013 normal.<\/li>\n<\/ul>\n\n\n\n<p><strong>Weil\u2019s disease:&nbsp;<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>In some cases, the severe form of Leptospira infection may start immediately after the acute phase.<\/li>\n\n\n\n<li>High fever and rapid onset of organ failure.<\/li>\n\n\n\n<li>&nbsp;Liver failure- conjugated bilirubinaemia, ALT usually &lt;200 IU\/L.<\/li>\n\n\n\n<li>Renal impairment \u2013 non-oliguric hypokalaemia, impaired sodium reabsorption.<\/li>\n\n\n\n<li>Thrombocytopenia; no DIC.<\/li>\n\n\n\n<li>Severe pulmonary haemorrhage syndrome.<\/li>\n<\/ul>\n\n\n\n<p><strong>Mortality rate:&nbsp;<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Up to 50% of hospitalised patients.&nbsp;<\/li>\n\n\n\n<li>The adverse outcome is associated with \u2013 older age, CNS involvement, jaundice and renal failure.<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>Laboratory diagnosis:<\/strong><\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Leptospira can be isolated from blood, CSF, Peritoneal fluid etc., for up to&nbsp;10 days (longer from urine). However, culture and microscopy have low sensitivity. Dark ground microscopy was used to look for Leptospira.<\/li>\n\n\n\n<li>Culture media- EMJH media.<\/li>\n\n\n\n<li>Stain \u2013 Immunofluorescence&nbsp;stain (see image from&nbsp;<a href=\"https:\/\/phil.cdc.gov\/Details.aspx?pid=1346\">CDC, PHIL<\/a>), silver stain etc.<\/li>\n\n\n\n<li>Identification can also be made using \u2013 16S ribosomal RNA PCR, PFGE etc.<\/li>\n<\/ul>\n\n\n\n<figure class=\"wp-block-image\"><img decoding=\"async\" src=\"https:\/\/microregistrar.com\/wp-content\/uploads\/2021\/07\/image-25.jpeg\" alt=\"\" class=\"wp-image-6521\"\/><\/figure>\n\n\n\n<p><\/p>\n\n\n\n<h4 class=\"wp-block-heading\">The methods used in National Leptospirosis service are \u2013<\/h4>\n\n\n\n<p><strong>PCR<\/strong>&nbsp;\u2013 in the acute stage of infection (within 5 days of symptoms onset).<br><strong>Serological assays (ELISA or MAT) later in the illnes<\/strong>s.&nbsp;&nbsp;<br>Microscopic&nbsp;agglutination test&nbsp;(MAT) \u2013 gold standard (see image) and the confirmatory test. Agglutinating antibodies are usually present 5 days after the onset of the disease. It is necessary to examine at least 2 serum specimens taken at least 7 days apart.<br><strong>Typing \u2013 MLST<\/strong><\/p>\n\n\n\n<figure class=\"wp-block-image\"><img decoding=\"async\" src=\"https:\/\/microregistrar.com\/wp-content\/uploads\/2021\/07\/image-23.jpeg\" alt=\"\" class=\"wp-image-6519\"\/><\/figure>\n\n\n\n<p><\/p>\n\n\n\n<figure class=\"wp-block-image\"><img decoding=\"async\" src=\"https:\/\/microregistrar.com\/wp-content\/uploads\/2021\/07\/image-21.jpeg\" alt=\"1st week \nFever \n2nd week \n3rd week \n4th week \nIncubation period 10 \ndays (5-21) \nPresence of \nLeptospira\/Culture\/ \nPCR \nBlood \nCSF \nUrine \nSerology \nAntibody response \n(Early antibiotic \ntreatment may lead to \nLow antibody \nresponse) \nFever \nAcute phase serology \nand onwards \nImmune mediated disease \nuveitis \nConvalescent serology \" class=\"wp-image-6517\"\/><\/figure>\n\n\n\n<h3 class=\"wp-block-heading\">Treatment<\/h3>\n\n\n\n<figure class=\"wp-block-image\"><img decoding=\"async\" src=\"https:\/\/microregistrar.com\/wp-content\/uploads\/2021\/07\/image-10-1024x512.png\" alt=\"Antibiotic \nMild cases: \n\u2022 Doxycycline \n\u2022 Amoxicillin \n\u2022 Azithromycin \nSevere cases: \nDoxycycline \n\u2022 Ceftriaxone \n. penicillin \nOther supportive \nmeasures \n\u2022 Ventilation \n\u2022 renal suppport \n\u2022 Fluids \n\u2022 Correcting electrolyte \nimbalance etc \nProphylaxis \n\u2022 Avoid high risk exposure \nRodent control \n\u2022 Animal immunisation \n\u2022 Human immunisation \n(less common) \n\u2022 Weekly doxycycline (200 \nmg) Prophylaxis \" class=\"wp-image-6522\"\/><\/figure>\n\n\n\n<p><\/p>\n","protected":false},"excerpt":{"rendered":"<p>This is from a presentation. The pictures were my slides. Feel free to download them if you wish. Leptospirosis, a [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":377,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"default","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","ast-disable-related-posts":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ngg_post_thumbnail":0,"footnotes":""},"categories":[36],"tags":[76,94,95,96,97],"class_list":["post-376","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-bacteria","tag-bacteria","tag-leptospira","tag-leptospirosis","tag-spirochaeta","tag-weils-disease"],"_links":{"self":[{"href":"https:\/\/microregistrar.com\/index.php?rest_route=\/wp\/v2\/posts\/376","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/microregistrar.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/microregistrar.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/microregistrar.com\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/microregistrar.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=376"}],"version-history":[{"count":3,"href":"https:\/\/microregistrar.com\/index.php?rest_route=\/wp\/v2\/posts\/376\/revisions"}],"predecessor-version":[{"id":638,"href":"https:\/\/microregistrar.com\/index.php?rest_route=\/wp\/v2\/posts\/376\/revisions\/638"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/microregistrar.com\/index.php?rest_route=\/wp\/v2\/media\/377"}],"wp:attachment":[{"href":"https:\/\/microregistrar.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=376"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/microregistrar.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=376"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/microregistrar.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=376"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}