Leptospirosis

 

– A zoonosis caused by spirochetes of the genus Leptospira, affecting many domestic and wild animals (especially rodents, mainly sewer rat).

– Human contamination is indirect (contact the excoriated skin or mucous membranes with water contaminated with animal urine, when swimming, for example) and more rarely directly through contact with infected animals.

LeptospirosisClinical signs :

Diagnosis is difficult because of the variety of clinical presentations. There are usually of moderate (most common, of favorable development) and severe (with multiple organ involvement).

Moderate form

• After 3 weeks of incubation flu syndrome (high fever, chills, headache, myalgia) often associated with digestive disorders (anorexia, abdominal pain, nausea, vomiting) and sometimes lung (cough, chest pain). Other signs: conjunctival hemorrhage, hepatosplenomegaly, multiple lymph nodes. Mild jaundice may be present but this form is most often anictérique.

• The signs regress after 5-6 days, then reappear, sometimes with meningeal syndrome may be complicated by encephalitis or myelitis.

Severe form or Weil syndrome

The onset of the disease is identical to the less severe forms of leptospirosis. After a few days reached acute infectious hepatorenal with fever, jaundice, renal failure with oligoanuria; diffuse haemorrhagic syndrome (purpura, ecchymosis, epistaxis, etc.), pulmonary signs (cough, chest pain, hemoptysis) or heart (myocarditis, pericarditis).

Laboratory:

– Isolation Culture Leptospira in blood, CSF (1st phase) or urine

(2nd phase).

– Serologic tests: immunofluorescence or ELISA (antibodies are recovered from the 8th day).

– Blood cell count: polymorphonuclear leukocytosis.

– In case of meningeal syndrome: lumbar puncture shows a clear liquid with often lymphocytosis and neighboring protein concentration of 1 g / liter.

– Urine: proteinuria, pyuria, hematuria and sometimes cylindruria.

Treatment:

– Rest and treatment of fever: paracetamol PO

Acetylsalicylic acid (aspirin) is against-indicated (bleeding risk).

– Antibiotic treatment to begin as soon as possible:

Moderate form

PO amoxicillin

Children: 50 mg / kg / day divided into 2 or 3 doses for 7 days

Adult: 2 g / day in divide into 2 or 3 doses for 7 days

or

doxycycline PO (except in pregnant or breastfeeding women and children under 8 years)

Children over 8 years: 100 mg / day in 2 divided doses for 7 days

Adult: 200 mg / day in 2 divided doses for 7 days

or

erythromycin PO

Children: 50 mg / kg / day divided into 2 or 3 doses for 7 days

Adults: 2 to 3 g / day in 2 or 3 doses for 7 days

Severe form

IV ampicillin

Children: 100 mg / kg / day in 3 injections

Adult: 4-6 g / day in 3 injections

Skip to the oral route as soon as possible with amoxicillin to complete 7 days of treatment.

or

erythromycin IV

Children: 50 mg / kg / day divided into 3 or 4 injections

Adult: 2 g / day in 4 divided injections

Switch to oral route as soon as possible to complete 7 days of treatment.

Prevention:

– Avoid bathing notion endemic.

– Fight against rats, sanitation, water hygiene.

– Vaccination only for professional presentations.

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