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What is leptospirosis: features of the pathology and methods of treatment

We live in close contact with the animal world and can no longer imagine our diet without meat products. Unfortunately, it is fraught with many dangers, including various pathologies, the carriers of which are all sorts of rodents and livestock. One of these diseases is leptospirosis, an acute infectious disease that leads to serious complications and even death.

Content

Description of the disease and pathogen leptospirosis

Leptospirosis is a very dangerous infectious disease that occurs in an acute form. The causative agent of the disease are the bacteria Leptospira interrogans (leptospira). Patients in the shortest time from the moment of infection begin to feel a strong deterioration in health, characteristic rash appears on the skin surface, the liver and kidneys are disturbed.

Currently, leptospirosis is considered by the World Health Organization to be one of the most common and serious diseases that can be infected from animals, but its outbreaks have been significantly reduced due to vaccination and the destruction of rodents. Before the introduction of these measures, the level of infection reached in some regions of the Russian Federation up to 7% of the total population. The main bursts occurred with the increase in the number of dogs in the cities and the development of agriculture and animal husbandry. Currently, up to 3,000 cases are registered in the Russian Federation per year, especially in the North Caucasus region.

Leptospira

Leptospira is a bacterium that can cause outbreaks of a disease with many deaths.

Most often, men from 18 to 40 years old suffer from leptospirosis. It is not associated with any features and differences in the structure of the organism. The main reasons are lifestyle and professional activities.

Leptospirosis is an extremely life-threatening disease. In addition, it causes serious economic damage in those countries in which epidemics are developing. The state suffers heavy losses, as agricultural animals suffer, milk production decreases, many livestock heads die. These factors stimulate scientists of all countries to improve methods of dealing with this disease and come up with new effective vaccines.

There are several synonyms for leptospirosis: Vasiliev-Weil disease, infectious jaundice, meadow-meadow fever, Japanese 7-day fever, Bush-Gzell disease. The first name is formed from the names of its discoverers, who described the disease in 1886 in Germany and 1888 in Russia independently of each other.

Pathogenesis of Vasiliev-Weil disease: causes and modes of transmission of infection to humans

Bacteria Leptospira belong to the class of spirochetes. There are a large number of its varieties, but Leptospira Interrogans are dangerous for humans.

Outwardly, this microorganism is a spiral thin ribbon, hence the name: leptos - small, spira - curl.

They are very mobile and move quickly in liquid and viscous media. They reproduce exclusively in conditions of high humidity (favorable environment - swamps, water bodies, forests and fields), and die in dry climates. These bacteria are fairly resistant to low temperatures, but they do not tolerate heat much more than 30 ° C. Thanks to a special enzyme - fibrinolysin - leptospirae dilute human blood, which contributes to the rapid penetration of the infection into the bloodstream.

Rodent

Rodents are frequent carriers of leptospirosis.

You can become infected from various rodents that live at home or on the street. Sometimes foxes and foxes become carriers.

Among domestic animals, leptospirosis can develop in cows, sheep, dogs, cats, pigs.

With the urine and animal excrement, leptospira penetrate the soil, from which they can get into various water bodies. In the human body, pathogenic bacteria are introduced mainly with food and water. First of all, they are on the mucous membranes and skin, then through the flow of blood or lymph are spread throughout the body, where they multiply in various organs, and then again enter the blood. This moment is considered to be the beginning of the disease, after which the first symptoms appear.

There are several ways of infecting a person:

  1. Contact path is the most common and is recorded in most patients. In this case, leptospira enters the human body through small wounds and cuts on the skin and mucous membranes. In particular, workers in the field of agriculture and any other animal-related professions (toksidermisty, shepherds, livestock specialists, veterinarians) are often infected in this way. Also, the infection can penetrate through the damaged skin and during bathing.
  2. The alimentary path consists of ingress of leptospira into the human body through the mouth and the gastrointestinal tract. You can become infected by drinking water or eating contaminated foods.

    Pathogens for a long time are able to exist on vegetables and fruits, which were sprayed with water from open reservoirs. In addition, leptospira can be in the meat and milk of infected animals. Bacteria die after heat treatment.

  3. The aspiration route of infection consists in aspiration (the penetration of water into the respiratory tract during inhalation) through the nasopharynx or the oral cavity. The fact is that open water bodies, especially with stagnant water, are often infected with leptospira due to urine and faeces of animals.
  4. The transmissible path is the rarest. In this case, the infection enters the body due to the bite of ticks or lice, which act as a carrier. At the same time leptospira penetrate immediately into the bloodstream.

During illness, a person is not dangerous to others, he is not infectious.

transmission routes of leptospirosis

There are several ways of transmission of infection: contact, nutritional, aspiration, transmissible

The characteristic symptoms of meadow-meadow fever in adults and children: rash, kidney damage, etc.

The main symptoms in patients arise from the substances that the bacterium secretes in the course of its vital activity. They greatly affect the health and human health, leading to extremely serious consequences.

After the collapse of the leptospira emit a special endotoxin, which affects the epithelium of the vascular walls, which provokes the destruction of capillaries. It is for this reason that small bruises appear on the skin surface of the infected. Also, small hemorrhages can occur throughout the body, apparently it is noticeable on the whites of the eyes, which take on a red hue.

In addition to disrupting the integrity of blood vessels, endotoxin leads to a strong increase in body temperature. This is the first symptom of the disease, which is found on the second day of the disease.

The more bacteria in the body, the higher the temperature will rise, reaching 40 0 C.

After ten days, the temperature may drop sharply to normal values, which does not indicate an improvement. Very often there is pain in the muscles. Also, toxins cause fatty dystrophy in the liver, cell necrosis in the kidneys and hemorrhage in the spleen.

Vascular damage

When leptospirosis occurs vascular damage, which leads to numerous hemorrhages

Hemolysin leptospira destroys the walls of red blood cells, which leads to hemolysis, in which a large amount of hemoglobin is released. This is evident when taking blood tests. In humans, pallor of the skin is observed, and blood pressure can be greatly reduced. Patients become very weak, quickly tired, they feel dizzy, there is a lack of air.
Hemolysis

Leptospira emit substances that destroy red blood cells

Due to the release of plasma coagulase leptospira able to liquefy blood due to the processes of coagulation, folding of proteins. It affects patients in the most disastrous way, since the clots that form form interfere with the full flow of blood: blood clots begin to form that clog the walls of blood vessels. In patients with leptospirosis, ischemia develops, in which blood circulation is disturbed in all internal organs. In turn, this can provoke a stroke, a heart attack and various other acute conditions of the body that can be fatal.
Ischemia

Clogged vessels and blood clots that result in ischemia of the internal organs.

The leptospirosis rash spreads to the whole body. It appears about 3–5 days after the onset of the disease and occurs in more than half of all patients. First of all, the trunk is affected, and after a while - the limbs. The rash can be of a different type: sometimes small reddish specks form several millimeters, and in some cases large bruises, which then merge into one plaque. Rarely, herpes sores appear in the upper lip and nostrils.
Subcutaneous hemorrhage

Many hemorrhages form on the skin surface of patients with leptospirosis.

The organs of the urinary system are often affected. The kidneys are the first to suffer, oliguria develops in patients: less than 300–500 ml of urine is excreted per day.

Oliguria - reducing the amount of urine separated by the kidneys.

In case of severe disease, anuria may begin in a patient, in which the daily volume of urine is less than 100 ml, which is a critical value. In the shortest possible time, acute renal failure forms, edema builds up, and a high content of proteins and erythrocytes is found in urine tests.

With the defeat of the patient's heart, blood pressure sharply decreases and arrhythmia develops. When carrying out an electrocardiogram, doctors often find signs of degeneration of the heart muscle, rhythm and conduction disturbances. People complain of shortness of breath and fatigue.

Symptoms of icteric form: hemorrhagic syndrome, liver failure, and others

As the name implies, with this type of leptospirosis jaundice develops. It appears due to serious liver damage due to hepatocyte necrosis, which is accompanied by the release of bile. The blood level increases bilirubin, which affects the color of the skin and mucous membranes. Their color can vary from light yellow to dark orange. Jaundice is detected already in the first week of the disease and the patient’s condition is deteriorating dramatically. At the same time, hemorrhagic syndrome often occurs, with bruising on the skin.

Jaundice

In most patients, liver damage occurs, which leads to the appearance of a yellow tinge of skin and mucous membranes.

From 10 to 15 days, the tenderness of the liver begins to increase, it is greatly increased in size due to fatty degeneration and stretching of the liver capsule. Due to hemolysis, bilirubin precursors, heme molecules, which also affect the color of the patient's skin, enter the bloodstream. Very often liver failure develops.

Clinical picture with anicteric form

In this form of leptospirosis, liver damage does not occur. The disease proceeds without bile excretion and increasing the level of bilirubin in the patient's blood. You should not think that in this case a person is not threatened with any complications. Patients also suffer from the violation of the integrity of blood vessels and other internal organs.

What is jaundice - video

Incubation period and stages of the disease

The incubation period is from 2 to 20 days. Doctors distinguish several stages through which patients with leptospirosis pass.

  1. The first is the febrile period, during which the temperature starts to rise, there is a headache and muscle aches. Patients are very sick, chills. This stage lasts about four days.
  2. During the height of the main lesions occur internal organs. The cells of the liver, kidneys, heart, and even the brain begin to break down. It is at this stage that the largest number of deaths is recorded.
  3. The recovery period is characterized by the restoration of the work of the internal organs. Gradually normalized respiratory and excretory functions.

Diagnosis and differential diagnosis: blood tests, PCR and other studies

At the first signs of leptospirosis, it is necessary to consult an infectious diseases specialist. First of all, an examination and a survey of the patient is carried out - the doctor takes a history. Be sure to study the condition of the skin and mucous membranes. On the basis of the data obtained, a conclusion is made about which diagnostic measures should be taken.

  1. Complete blood count will not indicate the presence of leptospirosis. However, it can be used to establish that there is an infectious pathogen in the body. Patients showed an increase in the content of leukocytes and erythrocyte sedimentation rate.
  2. Biochemical analysis of blood is also not able to detect the presence of bacteria. It is necessary to assess the condition of the internal organs. Increased levels of hepatic transaminase ALAT and ASAT are often diagnosed. These are characteristic signs of liver damage. In the icteric form, the level of bilirubin is significantly overestimated.
  3. The microscopic method is the most informative, it allows you to detect a harmful microorganism. For analysis, use the blood, urine or cerebrospinal fluid of the patient. Leptospira can be detected already in the first days of the disease. The downside of this study are considered frequent false-negative results.
  4. Serological diagnosis is the main method of examination for leptospirosis. It consists in the detection of special antibodies that are characteristic of this particular disease.
  5. PCR (polymerase chain reaction) is a very accurate and modern way to diagnose various infectious diseases. Its accuracy reaches 99%.

Video about laboratory and instrumental diagnosis of leptospirosis

Treatment of infectious disease

Therapy of leptospirosis must begin in the very initial stages of the disease. In no case can not self-medicate, because recovery without the necessary drugs is almost impossible and there is a high risk of death. Medicines prescribed to patients are divided according to the purpose.

Much attention is paid to the detoxification of the body, since the main complications occur precisely because of poisoning by toxins.

  1. Hemodesis is needed to restore plasma volume and normalize acid-base and water-electrolyte balances.
  2. Enterodesis due to a special substance - povidone - attaches to itself toxins and removes them from the body.
  3. Mannitol is necessary for disorders of the kidneys. It has a diuretic effect, accelerating the elimination of harmful substances. The osmotic pressure of the plasma increases and the blood volume in the body is normalized.
  4. A solution of glucose with furosemide also contributes to increased urine excretion.
  5. Polysorb, Enterosgel and other similar drugs absorb harmful substances and bacteria from the gastrointestinal tract and remove them from the body along with feces. Most often used in icteric form.

The correct selection of antibiotics, which are necessary for the destruction of the infectious pathogen of leptospirosis, is very important. As a rule, drugs of the penicillin group are prescribed, if they are not allergic.

  1. Penicillin destroys the cell wall of leptospira, which leads to their destruction.
  2. Erythromycin prevents bacteria from producing the proteins necessary for normal vital activity.
  3. Doxycycline also interferes with the processes of protein synthesis, stopping the reproduction and growth of leptospira.

Patients can be assigned to conduct plasmapheresis, in which the blood from the patient’s bloodstream is brought out, cleaned with special devices and injected back. In this case, the plasma is removed and replaced with special physiological solutions. This allows you to cleanse the body of toxins and significantly improve human well-being. A specialist can also make a choice in favor of carrying out similar procedures - hemodialysis, hemosorption, hemofiltration and some others.

Plazmoforez

Plasmophoresis allows you to clear human blood from harmful toxins

In acute and severe forms of the disease, special sera and globulins are prescribed. This allows you to raise the immune system of the person and accelerates recovery. All patients are shown bed rest.

Drugs prescribed for the treatment of patients with leptospirosis, pictured

The forecast of therapy and possible complications

Currently, mortality from leptospirosis is very high and in some countries it reaches 35% during periods of epidemics. Often patients die from renal or hepatic insufficiency, which develops due to poisoning by toxic waste products of leptospir.

In some patients, meningitis develops due to the penetration of pathogens across the blood-brain barrier. Terrible headaches and constant vomiting exhaust patients greatly. This complication is diagnosed in about 20% of all infected. Consciousness can become confused, often people fall into a coma.

In addition, the accession of a secondary infection is possible, which leads to:

  • pneumonia;
  • abscesses;
  • bedsores.

Vaccination and other preventive measures

Some groups of people working with animals or living in contaminated areas may be given anti-leptospira vaccine. It contains a large amount of antibodies, which forms a passive immunity in humans. The disadvantage of this serum is its short-term effect, it is effective for no more than six weeks, after which re-vaccination is required.

There is a very exotic method for the prevention of leptospirosis in Thailand. Locals believe that eating rat meat helps to reduce the risk of infection with leptospirae. Currently this method is unproven and dangerous.

Leptospirosis vaccine

It is important to vaccinate pets to reduce the risk of infection with leptospirosis.

You must comply with various preventive measures that can significantly reduce the risk of infection with leptospirosis. It is worth adhering to the following tips:

  • vaccinate all pets;
  • destroy rodents, disinfect the premises;
  • take precautions at work;
  • Do not drink water from unchecked sources;
  • wash fruits and vegetables;
  • thoroughly heat-treat meat products;
  • wear rubber shoes while fishing;
  • exclude contact with stray animals, street rodents.

It is very important to explain to children what danger stray homeless animals, which sometimes you want to touch so much. You also need to tell them about the possibility of infection when bathing and explain why you should never drink water from outdoor reservoirs.

washing vegetables

Wash fruits and vegetables thoroughly.

The main burden in the prevention of leptospirosis falls on specialized state bodies, in particular sanitary-epidemiological services. They are responsible for timely vaccination of livestock and people at risk. It is important to bury animals in accordance with established rules in order not to provoke outbreaks of epidemics and the spread of infection.

Leptospirosis: source of infection, developmental factors and treatment - video

Leptospirosis is a very dangerous infectious disease that requires timely treatment to the doctor and follow all the recommendations of a specialist. In no case can not self-medicate. Be careful and take precautions to reduce the risk of infection. Pay special attention to children: they often do not even know about the dangers posed by stray animals and open water bodies.

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