Leptospirosis in humans
What is leptospirosis?
Leptospirosis is an acute zoonotic disease of infectious origin caused by specific pathogens by a Leptospira occurring with toxic lesion of the internal organs, high fever and jaundice.
The cause of leptospirosis are Leptospira. They represent a helical shaped gram-negative rod-shaped microorganisms from the group of spirochaetes. They are very small and due to its structure practically does not linger in the lymphatic system of the person, quickly spreading in the blood system. Pathogens circulating in the natural foci habitat of small rodents. People not included in the scope of their natural cycle and infection occurs by chance. This is only possible by direct contact of the infection lesions on the skin or mucous membranes of a person.
In practice was the two way distribution of Leptospira from rodents to man:
Via infected water bodies of standing type. In their coastal areas there is a concentration of pathogens that can get into the water with feces of rodents;
Through infected food. Such cases of leptospirosis have been occurring repeatedly, when feces of infected rodents got into the food. People become infected when they eat and direct contact of the mucosa and Leptospira.
The transmission is exclusively contact. Although the disease itself is included into the group of dangerous infections, the infected person is not dangerous for other people because it does not emit of Leptospira in the environment.
In the patient with leptospirosis causative agents of minor skin injuries and microtraumas fall into a capillary channel, where they post all the tissues of the body. Reproduction of Leptospira occur in parenchymal organs with a rich mikrotsirkulyatsii (liver, kidney, muscle, heart). The main target of the causative agents of leptospirosis are the endothelial cells of the capillary network of these bodies. When this occurs, severe microcirculatory disorders, what is the basis of their lesion and clinical picture of leptospirosis. The immune system reacts violently to the introduction of Leptospira and in a short time triggers the protective mechanisms that are responsible for the destruction of pathogens. This process is the basis of the expressed intoxication and fever at leptospirosis.
Symptoms of leptospirosis
The clinical picture of leptospirosis is sometimes not specific and leaves the disease under the guise of other diseases. It is important to consider historical data. In most cases of leptospirosis patients had history of contact with water of stagnant water or stay in the wild.
The symptoms of leptospirosis are following:
Incubation period. Lasts from one to two weeks after the initial contact with the pathogen. At this time, the symptoms are not marked;
Fever. Occurs with the first release of young of Leptospira from affected organs. Each subsequent cycle of reproduction is accompanied by an increase in temperature. So leptospirosa fever is intermittirutaya the nature of the temperature jumps up to 39-40%;
Muscle pain. Intense, is more pronounced in those groups of muscles that are subjected to high loads (calves, thighs);
Yellowness of the skin and sclera. Appears in almost all cases of leptospirosis in the early stages of the disease. This feature leads to frequent diagnostic errors when leptospirosis is perceived for hepatitis. Do not forget about the existence of Busselton forms of the disease;
Skin rashes. Presents hemorrhagic elements and hemorrhages across the entire surface of the skin, sclera and conjunctiva, oropharyngeal cavity;
Damage to the kidneys. Manifested in the form of oligo-anuria (decrease in the number of daily urine with sufficient water consumption).
Oligoanuria the occurrence of leptospirosis is a critical symptom of the disease. Its existence for more than 5 days in almost all cases are fatal.
Treatment of leptospirosis in humans
Correct diagnosis of leptospirosis in early stages of the disease is one of the main criteria of success of the treatment. It includes:
The introduction of specific protivomoroznyh sera (hyperimmune Gama-globulin). It is desirable that it was a donor human drugs, not animal origin;
Antibacterial therapy. Carried drugs, which Leptospira are sensitive most (Augmentin, Ceftriaxone, tetracycline, amikacin);
The detoxication therapy. Reduce the symptoms of intoxication could be achieved by infusion of colloids and crystalloids, vitamins (ascorbic acid, cocarboxylase, vitamins B2 and B12, menadione);
Struggle with kidney failure. Require massive fluid therapy: saline solution, Trisol, ringer's solution, sodium bicarbonate, reosorbilakt, refortan. It is obligatory to fill diuretics in high dosage (lasix, furosemide, tripas), calcium chloride or gluconate, aminophylline;
Struggle with hemorrhagic syndrome and microcirculation disorders introduction kontrikala, low doses of glucocorticoid hormones (prednisone, dexamethasone), etamzilata and menadione.
Prevention of leptospirosis
Leptospirosis refers to dangerous diseases with high mortality, but specific preventive measures have not yet been developed. This is due to the fact that different strains of Leptospira different antigenic components. Therefore, to create a vaccine that would significantly protected from infection, is not possible.
To prevent the disease in this way:
The fight against small rodents. Necessarily held in houses, and particularly the objects of public catering, food warehouses and shops. Each representative of the number of animals can be a carrier leptospirosis infection;
To exclude or to limit bathing in ponds to natural conditions;
Use protective rubber suits if necessary, contact with infested water;
Emergency antibiotic prophylaxis with doxycycline after possible infection or the emergence of any manifestations of the symptoms of the prodromal period.