Update: October 2018 Leptospirosis is called zoonosis
(a disease whose pathogen lives within certain
animals), common throughout the world, except the polar regions.
During the previous few decades, this pathology
undeservedly ignored, being considered low-risk. But yчастившиеся
outbreaks, and about half a million severe cases of the disease per year,
registered on all continents, forced to turn on her
It turned out that the effects of leptospirosis in humans can be very
dangerous. This is an inflammation of the lining of the brain (meningitis), and
damage to the liver, lungs, and heart failure. Most
Acute renal disease is a dangerous complication of this disease.
failure to help only what is carried out
Hemodialysis (artificial kidney) procedure. It was she
often becomes impossible due to incessant
bleeding resulting from acute liver damage.
Causes of disease
Leptospirosis has many names. This and the “7-day
fever “and” reed fever “and” Fort Bragg fever “.
Historically, it is known as “black jaundice”, and in Japan
it is called “nanukaya fever.”
The disease is caused by leptospirae bacteria. In general
The structure identified 21 species of this microbe. 13 of them can
cause disease in people and some are completely
13 species of human pathogenic leptospira are also divided by
the structure of their shell, more precisely, for the antigens that they
exhibit on its surface. Depending on the set and
combinations of these antigens emit as many as 250 species of bacteria.
Accordingly, if a person has suffered a disease caused by one
from leptospira, it will not protect it from 249 other bacteria.
For reference, explain about the mentioned antigens. Every cell,
existing in the body and getting into it from the outside, is obliged
introduce themselves to the immune system (they do not “know how” in a different way). For
that she puts on the surface of particular molecules – antigens,
something resembling antennas. Immune cell fit
your special section is connected to these “antennas”
scans the cell, and if it is listed “on the list”, the immunity is not
activated for protection, and the immune cell goes further. �”Memorize”
their lymphocyte cells accounted for even during intrauterine
period, and errors in this case can turn into the hardest
autoimmune diseases, when the body “bombs” some of its own
tissue, and treatment is to suppress this immunity (and
thus removing protection from infections and cancer).
How is leptospirosis transmitted to humans? Bacteria spread like
wild and domestic animals:
- dogs (they have leptospirosis called Stuttgart’s disease, and his
can be seen in an animal);
- wild boars;
The main sources of infection are rodents: mice and rats.
The animal is not always visible, whether it is sick or not.
From person to person the disease is not transmitted.
For того, чтобы лептоспира попала в человеческий организм,
the person must contact the skin on which there are
microcracks (this is mainly the skin of the hands), the mucous membrane of the mouth
or the nose or directly with the urine of an infected animal, or with
water / soil containing the urine of an infected animal. To become infected
it is also possible if urine or soil / water particles containing it,
hit the eyes of a man. It is also possible food infection: when
drinking raw water from natural reservoirs, drinking raw or
poorly roasted meat, unboiled milk.
Natural foci of leptospirosis exist mainly in
marshy areas and where there are many surface
fresh water bodies: reservoirs, lakes, rivers, canal systems.
Extend the spread of the pathogen and improve it
environmental survival natural phenomena such as
cyclones, showers and floods occurring in the warm season.
The current increase in the incidence of scientists attributed to global
warming In addition, the frequency of leptospirosis depends on
amount of precipitation. Therefore, in a temperate climate, this disease
is seasonal, and in tropical – year-round.
Other factors that cause the spread of infection in
temperate climate are socio-economic phenomena:
- intensive migration of people: they can tolerate leptospira,
purchased in tropical regions (where there are ideal
conditions for infecting it) in new habitats;
- deterioration of the economic status of individuals and families (they
become poor or homeless, with the result that they have
hygiene level suffers);
- the emergence of deserted neighborhoods of settlements that
become refuges for rodents;
- Settlement of uninhabited, often wooded, areas.
It has now been found that the source of infection may be
dogs and cats, although previously these animals were considered insensitive
to leptospiram. You can also infect from agricultural
animals, therefore, despite the improvement in the protective equipment that
man uses during agricultural work risk
getting infected while performing such an activity increases.
More than 50 years ago, the scientist Burgdorfer experimentally
demonstrated the possibility of transmitting leptospira to argazid and
ixodic tongs. A little later, 2 Russian researchers –
Krepkogorskaya and Rementsova – identified 35 types of Dermacentor ticks
margatus, which, parasitizing on cattle, suffer
It must be said in many countries (especially in the subtropical
geographic belt) and diagnostic is poorly performed, and
educational work. As a result, people do not notice at home.
painful symptoms, and treatment accordingly begins
be late, often already at the hepatic and renal stages
Leptospirosis risk categories
Higher chances of getting sick from such people:
- veterinarians (especially working in rural areas who are
have to come into contact with those who are born and stillborn
farm animals and parts of their placenta);
- slaughterhouse workers;
- those who work in sewer systems;
- pigsty workers, cowsheds;
- the soldiers;
- workers of fish farms and fish depots;
- port workers;
- rock climbers;
- engaged in kayaking, rafting.
How is the disease manifested
It should take from 2 to 30 days after contact with skin or
leptospira bacteria mucous membranes before the first symptoms
leptospirosis in humans will appear. On average, the incubation period
Lasts 1-2 weeks, therefore, suspecting this disease, you need
- Did you ever catch fish or crayfish in the freshwater during this period?
(more likely to get sick if you walk on the bottom of the reservoir barefoot, with
bare feet, and engage in their own fishing barehanded);
- could you clean the basement or cellar without
- Did you go hunting?
- Did you move to a private house?
- Have you bought a new animal (and a domestic rat, including
- could you drink water directly from the reservoir, without
- have you not eaten steak with blood or half-baked meat?
If at least one question made you think or answer
�“Yes”, contact your infectious diseases doctor as soon as possible. Like us
already said, the disease is very dangerous, accompanied by a rather
Leptospirosis usually manifests itself in one of 2 forms:
- icteric, characterized by marked lesion
- anicteric, having more favorable projections.
The disease usually proceeds in 2 phases:
The first phase of the disease is considered the period from the appearance of the first
symptoms up to 7 days – while leptospira that have entered the bloodstream are spread
through the bloodstream.
Manifestations of this phase are non-specific (i.e.
it is difficult to make any definite diagnosis) symptoms:
- temperature increase – up to 38-39 ° C, accompanied by chills.
It lasts 4-9 days, then decreases. The second “wave” of increase
temperature (between 6 and 12 days) usually indicates that
infection of the meninges has occurred – meningitis has developed;
- muscle pain, especially in the calf and abdominal;
- from 3-4 days conjunctivitis develops (eyes become more
red, scant mucous discharge comes from them);
- lack of appetite;
- on the body and limbs for 2-4 days may appear red
rash, very reminiscent of measles. She can hold on to everything
several hours, but most often observed several days;
- a sign of severe course – the appearance of a disease on the skin after 1-2 days
not a core-like rash, but hemorrhages that do not fade when
pressing on them with glass or stretching the skin under them;
- rashes may appear on the lips, similar to herpes,
but with bloody content.
After 5-7 days, the symptoms may disappear spontaneously, and then
no longer return (even without treatment). In some cases
the disease begins to show minor symptoms: mild
yellowing of the skin and sclera (or even the absence of this feature),
darker urine color, which also becomes less.
Most often after 1-3 days, during which a person feels
healthy, the second phase of the disease begins, at which
Leptospira spread through the internal organs.
In this phase, leptospirosis can be referred either jaundice or
- From 3-6 days there is a slight yellowing of the sclera, which
- blood may also appear in the urine;
- sudden “menstruation” in women (in fact, this is the uterine
bleeding caused by liver damage which is responsible for
- from 4-5 days, kidney damage may develop, which
manifested by a decrease in the amount of urine. 1-2 days after that
urination usually stops completely;
- broken heart work. For those people whose heart was on
moment of infection cool, most often just quickens the pulse, can
to be rare extraordinary reductions (extrasystoles). In the elderly
people, people with heart disease, smokers and “professionals”
serious alcohol-induced rhythm disturbances can occur in alcohol intake, and their
the danger is that a person does not always feel them;
- signs of meningitis may appear: headache, nausea,
inability to bow your head to the chest;
- With this form of the disease, various forms can develop.
lung damage. Subjectively, they can not be distinguished: for all
characteristic cough, increased respiration, and in severe cases – a feeling
lack of air.
Anicteric form встречается чаще (примерно в 90% случаев).
It develops after a short and not very pronounced first phase.
diseases. It is characterized by symptoms of meningitis:
- re-raising the temperature;
- re-emerging headache;
- the inability to tilt the head so that the chin reached up
- depression of consciousness;
- face asymmetry;
- swallowing disorder;
- blurred speech;
- difficulty moving in limbs
You can talk about encephalitis. It occurs when leptospirosis
Some patients may develop uveitis (inflammation
choroid, dangerous blindness), which is detected
a few weeks or even years after the start
An anicteric form of leptospirosis may also occur.
decrease in the amount of urine (up to the disappearance of urine),
bleeding gums, uterine and gastrointestinal bleeding.
A person may also feel discomfort and heaviness in the area of the right
hypochondrium, indicating an enlarged liver.
Symptoms of the disease can vary from combinations
minor signs (for example, headaches, muscle aches,
to fever) to severe course (for example, heavy bleeding or
If the disease is accompanied by a combination of renal and hepatic
insufficiency complicated by bleeding (external or
internal), it is called Weyl’s disease and with a large share
probabilities caused by such leptospira as leptospira
Recovery from mild to moderate disease,
If assistance began to be rendered on time, it occurs after 3-4 weeks.
Every 3-5 people who have recovered from leptospirosis can
recur, and even several times over the next year.
Complications and prognosis of the disease
The effects of leptospirosis are always very serious. It:
- acute renal failure which may result
- chronic kidney damage that lasts for many months and
- acute liver failure;
- infectious myocarditis (inflammation of the heart muscle);
- prerenal azotemia;
- acute respiratory distress syndrome (pulmonary edema that occurs
not due to heart disease), caused mainly by
soaking the lung tissue with blood;
- interstitial pneumonitis;
- decompensation of chronic heart failure;
- thrombosis of the veins of the cranial cavity;
- necrotizing pancreatitis;
- hearing loss
The mild form of leptospirosis rarely ends deadly. But y
those patients whose disease was severe (this is 5-10% of all
patients with leptospirosis), mortality can reach 5-40%.
The possibility of chronic infection, that is, the existence of
leptospira in tissues is refuted by foreign scientists: very few
objective evidence to support or refute this
Leptospirosis in pregnant women can lead to developmental defects.
fetus, but more often – to their death. But there is a chance (his numbers are hard
name) that with the timely introduction of antibiotics a child
born alive and healthy.
Diagnosis of leptospirosis
Diagnosis in humans is:
- blood culture on Wednesday Tersky or Wednesday
- determination of antibodies to leptospira in serum. This analysis
performed at least 3 times: when leptospirosis antibody titer should
to grow (that is, initially antibodies were found only in serum,
divorced 125 times (then they write “titer 1: 125″), and then, to
the height of the disease, the patient’s body has already developed a lot of antibodies, and
they are already found in serum diluted 1125 times (they write
�”Title 1: 1125”. Antibody titer type 1:25 or 1:50 with very weak
increasing the diagnosis of leptospirosis in doubt;
- DNA isolation of bacteria from the blood, cerebrospinal fluid and urine
using PCR diagnostic method.
In this case, pass and other tests, to exclude diseases,
leptospirosis-like symptoms. This is hepatitis, sepsis, rickettsiosis,
brucellosis, malaria, hantavirus infections.
In this disease necessarily perform:
- urine tests, glomerular filtration rate, determination in
blood potassium, urea and creatinine – to determine the function
- definition of bilirubin, ALT, AST, coagulation, proteinogram
– для выяснения работы the liver;
- fecal occult blood – for early diagnosis
- complete blood count – to determine the level of inflammation and
- radiography of the lungs;
- Ultrasound abdominal organs, especially the kidneys, liver and
When leptospirosis is suspected, a person is treated
necessarily in an infectious diseases hospital, due to
the need to control the work of its vital organs.
Therapy at home is not carried out. Moreover, at the slightest suspicion
on renal insufficiency (decrease in the amount of urine, increase
creatinine, potassium, decreased glomerular filtration) of the patient
transferred to the intensive care unit of the infectious diseases hospital. Here also
put patients with liver failure, decompensation
heart failure, lung damage.
If the kidney performance indicators are in critical
condition (looking at the level of potassium, at high concentrations
which – above 6 mmol / l – creates a serious threat to the heart),
The patient is transferred to the department of an artificial kidney.
2 weeks of treatment strict bed rest. This is due to
the need to create benign conditions for the heart (may
develop myocarditis), and for the liver (the blood flow in this organ
depends on the position of the body; in a sitting position it decreases
more than 3 times).
Diet – table number 7, used in the treatment of renal diseases
plus a restriction (or complete abolition) of potassium-containing products.
With a high sodium level, all dishes and tea are made without salt, only
on distilled water.
For the destruction of the bacteria leptospira used
antibiotics, usually penicillin. This is “Benzylpenicillin”
or Ceftriaxone. Antibiotics also work abroad
�”Doxycycline” and “Erythromycin”. To help human immunity
prescribe specific protivoleptospirozny immunoglobulin.
In addition, performed:
- Infusion therapy – to the extent that the kidneys allow.
With a decrease in glomerular filtration volumes administered intravenously
liquids are very limited and can only be those
drugs, without the introduction of which is impossible;
- suppression of the secretion of gastric juice – drugs “Omeprazole”
�”Contralock”, “Rabeprazol”, “Nolpaz”;
- with extremely low platelet count transfusions
- prevention or treatment of bleeding – through the introduction
drugs “Gordoks”, “Contrykal”, blood plasma transfusions of the same
the group that the patient has;
- in case of kidney failure, diuretic drugs are administered,
hormonal drugs, the patient can perform several sessions
- with the defeat of the lungs – oxygen therapy is carried out, including
number and with the help of artificial ventilation;
- with damage to the heart – antiarrhythmic drugs are introduced and
Leptospirosis can be prevented by nonspecific
- working in protective gloves and goggles;
- walking on the bottom of fresh (especially standing) water in fishing grounds
- harassing domestic rodents;
- washing laundry after contact with domestic and agricultural
- use only boiled milk and boiled water;
- good roast meat before eating
Use of antibiotic doxycycline or any other in
as a preventive measure (for example, for travelers)
Human vaccination is performed using killed leptospirosis.
vaccines. It is performed by people at risk, those who live in
leptospirosis, as well as travelers to tropical countries
Dogs and other animals, as potential carriers of leptospira,
also vaccinated. The immunity created by standard vaccinations
is effective only on those types of bacteria whose antigens are introduced into
vaccine. Dogs vaccinated with inappropriate vaccines represent
particular danger to people.
Автор: Кривега Мария Салаватовна врач-реаниматолог