home Preparations Clinical cases of leptospirosis in humans. Causes of leptospirosis in humans. Routes of infection

Clinical cases of leptospirosis in humans. Causes of leptospirosis in humans. Routes of infection

Leptospirosis

Synonym: Vasiliev-Weil disease, water fever

Leptospirosis (leptospirosis) is an acute zoonotic infection characterized by symptoms of intoxication with pronounced myalgia, predominantly affecting the kidneys, liver, nervous and vascular systems, accompanied by the development of hemorrhagic syndrome and often jaundice.

Historical information. For the first time, the clinical picture of infectious jaundice was described in 1886 by the German scientist A. Weil based on an analysis of 4 cases of the disease. In 1888, a student of S.P. Botkin, N.P. Vasiliev, published a report on 17 cases of this disease, which he had observed since 1883. The detailed information presented by him clinical description of the disease made it possible to clearly distinguish it from the so-called catarrhal jaundices (Botkin's disease) and thereby distinguish it as an independent nosological form. infectious jaundice became known as Vasiliev-Weil disease. The search for the causative agent of the disease was crowned with success in 1914-1915, when the Japanese researcher A. Inado et al. isolated from patients leptospira L. icterohaemorrhagiae and attributed it to spirochetes. In subsequent years, leptospirosis was identified in many countries of the world and its pathogens were studied - Various types leptospira.

Leptospira are hydrobionts and this is largely due to the epidemiological features of the disease.

Morphologically, they are characterized by the presence of numerous (15-20) small curls (from Latin leptos - small, spira - curl).

The length of leptospira is 6-15 microns, the thickness is 0.25 microns. Leptospira are mobile. They have translational, rotational and flexion movements. Leptospira are gram-negative, according to Romanovsky-Giemsa stained in pink color, with silvering - in brown. Cultivated under anaerobic conditions on special media at a temperature of 25-35 ° C and pH 7.2-7.4. The growth of leptospira is found only on the 8-10th day of cultivation. When microorganisms are destroyed, endotoxin is released. Leptospira pathogenicity factor is their adhesiveness to endothelial cells of capillaries and erythrocytes.

Depending on the antigenic structure, leptospira are divided into serological groups and variants. Serogroups of major importance in human pathology in our country are: L. grippothyphosa, L. pomona, L. tarassovi, L. hebdomadis, L. icterohaemorrhagiae, L. canicola.

Leptospira resistant to action low temperatures, survive for a long time in water, which ensures their persistence in natural conditions. In natural reservoirs, they can remain viable for 2-3 weeks, in the soil - up to 3 months, on food products - for several days. Leptospira are not resistant to ultraviolet radiation, acids, alkalis, disinfectants, heat. Of the laboratory animals, guinea pigs are the most susceptible to leptospira.

Epidemiology. The sources of human leptospirosis infection are sick and recovered wild and domestic animals that infect water and soil, forming natural, anthropurgic (economic) and mixed foci.

Natural foci of leptospirosis are due to the presence of infection among wild animals. They are located mainly in the forest, forest-steppe and forest-tundra zones. Natural foci can be found in lakeside basins, reed beds, marshy grassy areas of forests, and wet clearings. The main carriers in natural foci are small moisture-loving rodents and insectivores: voles, field mice, gray rats, shrews, hedgehogs.

Anthropourgical lesions may occur in countryside as well as in cities. In connection with the continuous growth of the number of farm animals, they play the most important role. In anthropurgic foci, cattle, pigs, and rats serve as reservoirs of infection. The main epidemiological significance in the spread of infection is anthropurgic foci that occur in livestock farms and in slaughter and primary processing animal raw materials. In animal carriers, leptospira persist for a long time in the convoluted tubules of the kidneys and are excreted in the urine for several months.

A sick person is not a source of infection.

The alimentary route and the contact mechanism of infection transmission are of primary importance in infection with leptospirosis.

Infection with leptospirosis occurs when bathing and drinking water from natural and artificial reservoirs, food products, through household and industrial items contaminated with infected urine. More often, leptospirosis affects people working in swampy meadows, rice and livestock farms, and meat processing plants. It is possible for leptospirosis to spread to dog kennel workers and dog owners.

Leptospirosis is characterized by summer-autumn seasonality. However, sporadic cases of leptospirosis are recorded all year round. People of all ages are susceptible to leptospirosis, but adolescents and adults are more commonly affected. Past illness causes homologous immunity, persistent, but not preventing infection with other Leptospira serovars.

Pathogenesis and pathological anatomical picture. Leptospirosis is an acute cyclic generalized infection. There are 5 phases of the infectious process.

The first phase (1st week after infection) - the introduction and reproduction of leptospira. From the area of the entrance gate (skin, mucous membranes), without causing inflammation at the site of introduction, leptospira hematogenously penetrate into the internal organs (mainly the liver, kidneys, spleen, lungs), where pathogens multiply. Penetration of leptospira through the blood-brain barrier is noted, generalized hyperplasia of the lymph nodes develops. This phase corresponds to the incubation period.

The second phase (2nd week of illness) is secondary leptospiremia and generalization of infection, which causes the accumulation of toxic metabolites, the penetration of leptospira into the intercellular spaces of organs and tissues, especially in the liver, kidneys, and nervous system. Clinically, this phase corresponds to the initial period of the disease.

The third phase (3rd week of illness) is the development of the maximum degree of toxemia, pancapillarotoxicosis and organ disorders. As a result of damage to the endothelium and increased vascular permeability, hemorrhages develop. Degenerative and necrotic changes occur in hepatocytes, epithelium renal tubules with dysfunction of organs, the appearance of jaundice, signs of renal failure of the renal type. The development of hemolysis is characteristic. Some patients have meningitis. In the severe course of the disease, shock is observed with a possible fatal outcome.

In patients who died from leptospirosis, there are signs of a significant circulatory disorder with a predominant lesion of the vessels of the microcirculatory bed, a common hemorrhagic syndrome, an enlarged liver, the tissue of which is easily torn. Fatty and protein degeneration of hepatocytes, accumulation of bile pigments in them, necrosis of individual liver cells are characteristic. An increase in the spleen and lymph nodes is revealed, in which hyperplasia of lymphoid elements, an increase in the number of plasma and polymorphonuclear cells, signs of erythrophagy are noted. The most significant changes are observed in the kidneys - an increase, hemorrhages in the cortical and medulla. Characterized by dystrophy and necrosis of the epithelium of the convoluted tubules, the glomeruli are affected to a lesser extent. In the lumen of the tubules, leptospira are often found. Quite often, edema of the substance and membranes of the brain, focal hemorrhages in the brain are determined. Some patients present with signs of myocarditis, dystrophic changes in skeletal muscles (calf, lumbar, etc.).

The fourth phase (3-4 weeks of illness) - with a favorable course of the disease, during which non-sterile immunity is formed, titers of various antibodies (agglutinins, opsonins, complement-binding, etc.) increase, phagocytosis of leptospira is activated by stellate endotheliocytes in the liver, monocytes, polymorphically -nuclear cells, etc., however, leptospira can still persist in the intercellular spaces, especially in the kidneys (until the 40th day of illness). Along with this, there is a reverse development of organ and functional disorders. This phase corresponds to the period of extinction clinical manifestations.

Fifth phase (weeks 5-6 of the disease) - sterile immunity to the homologous leptospira serovar is formed, impaired functions are restored, and recovery occurs.

clinical picture. The incubation period ranges from 3 to 30 days and averages 6-14 days. The clinical manifestations of leptospirosis vary widely.

There are icteric and anicteric forms of leptospirosis occurring in the lungs, moderate and severe forms. A number of patients develop relapses of the disease and a variety of complications are observed - specific (acute renal or renal-hepatic failure, bleeding, shock, meningitis, eye damage - iritis, iridocyclitis, clouding vitreous body etc.) and non-specific (stomatitis, otitis media, pneumonia, bedsores, abscesses, etc.).

During the course of the disease, the following periods are distinguished: initial (feverish), peak (organ damage), convalescence.

The initial period lasting about 1 week (shortened in severe course of the disease) is manifested by a general toxic syndrome and signs of generalization of infection. It is characterized by an acute, often sudden onset of the disease. There are chills, a rapid increase in body temperature up to 39-40 ° C, severe headache, dizziness and weakness; common symptom are intense myalgia, especially in the calf muscles, palpation of the muscles is painful. Some patients experience muscle soreness abdominal wall, requiring differentiation from surgical pathology bodies abdominal cavity. The fever persists for 5-8 days, has a constant or remitting character and decreases critically or by the type of accelerated lysis.

During this period of the disease, patients are usually excited, restless. Puffiness of the face, hyperemia of the face and sometimes neck, vasodilation of the sclera and conjunctiva are characteristic, herpetic eruptions often appear on the lips and wings of the nose with hemorrhagic impregnation. From the 3-6th day of illness, a polymorphic rash (morbilliform, punctate, urticaria, etc.) appears on the skin of the trunk and extremities. In severe cases of the disease, hemorrhages are possible on the sclera and conjunctiva, in the axillary and groin areas, in the elbows.

Characterized by tachycardia, decreased blood pressure, deafness of heart tones. Breathing speeded up according to the level of body temperature. In severe leptospirosis, there may be signs respiratory failure followed by bloody sputum. Often there are signs of bronchitis.

From the 2-3rd day of the disease, the tongue becomes dry, covered with a brown coating. Palpation of the abdomen can be sensitive, an enlarged and slightly painful liver is determined, in 1/3 of patients - an enlarged spleen. Often revealed micropolylymphadenitis.

In most patients during this period, there are signs of kidney damage: a positive symptom of Pasternatsky, a decrease in urination, in the urine - protein, leukocytes, erythrocytes, hyaline cylinders, less often - granular; in the blood - an increase in the content of nitrogenous metabolites.

Often (in 10-20% of patients) a meningeal symptom complex develops: increased headache, dizziness, nausea and vomiting, positive symptoms Kernig, Brudzinsky and others. CSF examination reveals an increase in protein, lymphocytic and lymphocytic-neutrophilic moderately pronounced pleocytosis. Leptospira may be found in the cerebrospinal fluid.

The hemogram during this period is characterized by neutrophilic leukocytosis with a shift of the formula to the left and a significant increase in ESR.

At the end of the 1st - beginning of the 2nd week of the disease, the temperature reaction and general toxic manifestations begin to decrease, at the same time they become more pronounced and organ disorders progress. A number of patients, usually with a severe form of the disease, develop liver and kidney failure and hemorrhagic syndrome.

Jaundice, which appears in some patients already during the 1st week of the disease, progresses rapidly during the height of the disease, acquires a bright, saffron hue, and is often accompanied by hemorrhages in the mucous membranes and skin. Hemorrhages can also occur with the anicteric form of leptospirosis. As jaundice increases, the liver and spleen increase even more, which often become painful on palpation; many patients note itching of the skin.

At biochemical research Hyperbilirubinemia is detected (with an increase in the level of both bound and free bilirubin), normal or moderate increased activity ALT and AST (the values of these indicators are usually less than in viral hepatitis), increased activity alkaline phosphatase, 5-NUK. Protein-sedimentary samples usually do not change.

Kidney damage is the most characteristic manifestation of the height of leptospirosis. In patients, there is a more significant decrease in diuresis than in the initial period, up to anuria in the severe course of the disease. Proteinuria increases (2-30 g / l), in the urine sediment are detected in in large numbers leukocytes, erythrocytes, renal epithelial cells, granular and waxy casts. Characterized by a significant increase in the level of urea, residual nitrogen and creatinine in the blood serum, hyperkalemia, acidotic shifts in the acid-base state. Pathogens can be isolated from the urine.

Progressive renal and often renal and hepatic insufficiency is one of the main causes of death in patients with leptospirosis.

Signs of damage appear naturally of cardio-vascular system: frequent and sometimes arrhythmic weak filling pulse, low blood pressure (even against the background of renal failure, hypertension is rarely observed), muffled heart sounds; ECG shows signs of myocardial dystrophy and conduction disturbances.

Along with symptoms of damage internal organs manifestations of hemorrhagic syndrome are intensified both in the form of hemorrhages in the skin and mucous membranes, and in the form of gastric, intestinal and uterine bleeding. In some patients, hemoptysis is detected, signs of respiratory failure progress as a result of hemorrhages in the lungs. Often there are hemorrhages in the muscles, especially the lumbar, muscles of the abdominal wall, simulating the picture " acute abdomen”, hemorrhages in the adrenal glands. Increased signs of anemia are characteristic.

The hemogram during this period is characterized by a noticeable decrease in the number of erythrocytes, reticulocytes and platelets, a decrease in hemoglobin levels, moderately pronounced neutrophilic leukocytosis (usually less than 20.0 * 10^9 / l) with a shift in the formula to the left, lymphopenia, aneosinophilia and a significant increase in ESR (40- 60 mm/h).

Against the backdrop of timely and adequate therapy with a favorable course of the disease, from the 3rd week of the disease, signs of organ disorders begin to regress. The intensity of jaundice decreases, oligoanuria is replaced by polyuria, indicators of azotemia decrease and indicators of the acid-base and electrolyte state are restored, the well-being of patients improves.

However, a number of them have complications that manifest as eye damage (iritis, uveitis, iridocyclitis, vitreous opacity) and persist for the next few weeks. There may be signs of an associated infection - pneumonia, otitis media, stomatitis, abscesses at the site of bedsores, etc. long time anemia is noted.

In some patients (about 1/3 of cases) there are relapses of the disease (from one to two or three, rarely more), occurring with less significant toxic and organ manifestations. In the event of a recurrence of the disease, there is a repeated, usually less significant increase in temperature within 3-6 days. In some, due to repeated relapses, the fever becomes undulating.

The duration of the disease averages 3-4 weeks, in the presence of relapses it can be extended up to 2-3 months.

There may be cases of the disease with mild manifestations of the disease, without significant impairment of kidney and liver function.

Forecast. With adequate therapy, it is favorable, lethal outcomes are 1-3%, however, epidemic outbreaks with high mortality (up to 20-30% or more) are known.

Diagnostics. Recognition of leptospirosis is based on a thorough analysis of epidemiological history data, a correct assessment of the results of clinical and laboratory examinations (cyclic course of the disease with signs of generalization of infection, hepatic and renal disorders, neutrophilic leukocytosis and increased ESR, etc.).

Specific diagnostics include various methods and serological tests.

In the initial period of the disease, leptospira can be detected in the blood or sometimes in the cerebrospinal fluid when examining the “crushed drop” method in a dark-field microscope or by inoculating 0.2-0.5 ml of blood per 5-10 ml of a nutrient medium (phosphate-serum and other environment) at a temperature of 30 "C, as well as by infecting laboratory animals, in the organs of which pathogens are found when stained with silver nitrate.

During the height of the disease, leptospira can be isolated from the blood, cerebrospinal fluid and urine, in more late dates- from urine. In the organs of patients who died from leptospirosis, pathogens are most often found in the kidneys.

For serological diagnosis predominantly use the reaction of microagglutination and lysis (PMA), diagnostic titers of which (1:100 or more) are detected in paired blood sera taken during the peak and later stages of the disease (a diagnostic sign is an increase in titer by 4 times or more). RSK and RIGA can be used.

Differential diagnosis. Leptospirosis should be differentiated from a large group of infectious and non-infectious diseases. During the initial period, differential diagnosis with influenza, typhoid-paratyphoid diseases, hemorrhagic fevers, meningitis. During the peak period, with icteric forms of viral hepatitis, malaria, yellow fever, yersiniosis.

Treatment. Patients with leptospirosis are subject to mandatory hospitalization in infectious hospitals, where they undergo a complex etiotropic, pathogenetic and symptomatic therapy, prescribe a sparing diet and a motor regimen corresponding to the period of the disease.

Etiotropic treatment is carried out with penicillin, which is administered intramuscularly 6 times a day at a dose of 6-12 million units, depending on the severity of the disease, for 7-10 days. An effective appointment for mild forms of the disease is tetracycline 0.8-1.2 g per day or doxycycline - 0.1 g 2 times a day for 7 days.

Along with antibiotic therapy, usually with severe forms apply antileptospiral gamma globulin containing antibodies to the most common serovars of leptospira. Gamma globulin is administered intramuscularly on the first day, 10-15 ml, on the next 2 days, 5-10 ml. Early use of gamma globulin in the initial period of the disease reduces the frequency and severity of organ lesions, contributes to a more favorable course of the disease.

Etiotropic therapy is carried out in combination with pathogenetic agents, including detoxification solutions, diuretics, agents that increase vascular resistance and blood coagulation, antihistamines and analgesics. In severe cases of the disease, glucocorticoids are prescribed (usually prednisolone from 40-60 to 120 mg per day or more).

With the progression of acute renal failure, electrolyte and acidotic disorders are corrected, higher doses of osmo- and saluretics are prescribed, and with significant azotemia and prolonged anuria, hemodialysis is used, hyperbaric oxygenation, hemosorption and other methods of intensive care.

Careful patient care and prevention of associated infection are important. With significantly severe anemia, hemotherapy is performed.

Leptospirosis convalescents are subject to medical examination within 6 months with the participation of an infectious disease specialist, nephrologist, ophthalmologist and neuropathologist.

Prevention. The prevention of leptospirosis in humans involves a complex of hygienic and veterinary measures.

It is forbidden to use raw water from open reservoirs, swimming in slow-flowing reservoirs accessible to farm animals. It is necessary to use protective clothing and footwear during land reclamation and hydraulic engineering works.

In anthropurgic foci, water bodies are protected from rodents and farm animals, veterinarians and livestock breeders must use overalls. It is necessary to constantly carry out deratization measures. Carry out isolation and treatment of sick animals.

From the book Dog Treatment: A Veterinarian's Handbook author Nika Germanovna Arkadieva-Berlin

From the book Seasonal Diseases. Summer author Lev Vadimovich Shilnikov

LEPTOSPIROSIS

From book Home Directory diseases author Ya. V. Vasilyeva (ed.)

From the book Complete Medical Diagnostic Handbook author P. Vyatkin

Leptospira is a gram-negative rod from the spirochete family. There are more than 200 serotypes in nature. Well adapted to external factors. In freshwater reservoirs it lasts up to thirty days, in the soil it is active for about nine months with sufficient moisture. Boiling does not tolerate, it dies instantly. The bacterium is sufficiently resistant to low temperatures with the preservation of virulence. Leptospira are freshwater hydrobionts, development occurs in conditions of dampness and humidity. The optimal growth of the causative agent of leptospirosis is observed in the warm season. The peak incidence occurs at the end of summer - the beginning of autumn.

Leptospirosis is common on all continents except Antarctica. Susceptibility to the disease in humans is high. Leptospirosis is often characterized by a severe course, according to the Ministry of Health, the mortality rate is about 25-30%. Leptospirosis is classified as dangerous infections. It is impossible to get infected from a sick person.

After introduction into the human body, the pathogen spreads throughout the body through the lymphogenous route. The bacterium is able to secrete endo and exotoxins. Actively moving and multiplying, causes multiple lesions human organs and systems. Leptospirosis is characterized by the cyclic nature of the course of the disease.

CAUSES

The reservoir of leptospirosis are mammals from different groups: rodents, insectivores, dogs, pigs, foxes and cattle (oxen, cows, bulls). They can both suffer from leptospirosis and be carriers of the disease. into the environment the pathogen enters with the natural secretions of a diseased animal. The person is a dead end in the spread of leptospirosis and does not excrete the pathogen.

Routes of infection:

Alimentary. When eating foods that have been contaminated with the waste products of sick animals, in particular rodents. Cases of leptospira entering the human body during the use of dairy products and meat with insufficient heat treatment are described. The causative agent is introduced through the mucous membranes of the digestive organs.
Contact. Occurs while swimming in contaminated waters of open reservoirs. Short-term human contact allows the pathogen to penetrate through the mucous membrane of the eye or nasopharynx. Transmission factors can also be wet soil or pasture grass. Cases of infection of laboratory personnel during the study of biomaterial are isolated.

CLASSIFICATION

There is no generally accepted classification of leptospirosis. Leptospirosis can be conditionally divided according to the severity of the course and the presence of a symptom of jaundice.

According to the severity of the flow:

Lung. Limited to minor fever.
Moderate. High temperature and extended clinic.
Heavy. Intense febrile state with great jaundice. The thrombohemorrhagic syndrome joins, develops.
Erased form. It is expressed by short-term fever with the absence of a typical clinical picture.

For jaundice:

Icteric form (Vassiliev-Weil disease).
Anicteric form (water fever).

SYMPTOMS

The severity of leptospirosis depends on two factors: the degree of virulence of leptospira and the state of immunity of the human body.

Symptoms of the disease have the following development:

The incubation period for leptospirosis lasts from three days to two weeks. The onset of the disease is sudden. On the background full health noted increase in body temperature up to 39-40⁰С. In the absence of antibiotics, fever is undulating.
The symptoms of general intoxication of the body join: severe headaches, lethargy, chills, weakness, loss of appetite. The specific symptoms are pronounced myalgia in the muscles. Synapse damage nerve endings causes pain with characteristic localization in the calf and femoral muscles. Painful sensations with leptospirosis, it prevents free movement, forcing the patient to take a forced position.
The appearance of the patient acquires character traits, there is a "symptom of the hood": face becomes puffy, pronounced redness of the neck and upper part chest, redness of the sclera.
Ephemeral maculopapular rash appears on the 3-4 day from the beginning of the temperature increase. Localization on the chest, abdomen and arms. The rash may disappear within a few hours of onset, leaving behind pigmentation and flaking. In some cases, there are herpetic eruptions on the lips and wings of the nose. During this period, reddening of the tonsils and soft palate throat, coughing, enlargement of regional lymph nodes.
The phenomena of jaundice are observed on the 4th-5th day of leptospirosis. Icteric sclera and yellowness of the skin indicates a severe course of leptospirosis. When leptospira enters the biliary system, the gallbladder ducts become blocked. Yellowing skin and mucous membranes occurs due to hemolysis and destructive changes. Liver damage leads to liver failure.

The severe course of leptospirosis suggests a generalization of the process. On the part of the heart, there is a decrease in heart rate, a slight decrease in blood pressure, signs of myocardial destruction may be observed on the ECG. The liver enlarges, becomes painful on palpation. From the urinary system signs of acute renal failure: oliganuria, protein and traces of renal epithelium in the urine. With damage to the central nervous system, meningeal signs appear. In some cases, bleeding from the nose, hemoptysis, bleeding gums are observed.

Improvement occurs from the end of the third week of the disease. For a long time, symptoms of impaired liver and kidney function persist.

DIAGNOSTICS

At the primary stage of leptospirosis, it is difficult to make a correct diagnosis due to the non-specificity of symptoms. The polymorphism of the symptom complex of the onset of the disease makes it difficult to differentiate the first two days of the disease. On the third day, in laboratory studies, leptospira are isolated from bacteriological material taken from a sick person.

Diagnosis methods:

Collection of epidemiological data.
The study of the clinical picture of the disease.
laboratory specific diagnosis includes serological, bacteriological, bacterioscopic methods. At the beginning of the disease, bacteria are found in the blood, later - in the urine.
Culture of blood, urine, or cerebrospinal fluid on nutrient media to confirm the diagnosis.

TREATMENT

The choice of tactics for the treatment of leptospirosis depends on the stage of the disease, the course of the process. Hospitalization of patients in infectious diseases hospitals is mandatory. Recommended bed rest throughout the fever. With signs of renal or hepatic insufficiency, bed rest is maintained even in the absence of fever. diet therapy prescribed to all patients with leptospirosis. The choice of dietstol depends on the prevalence of the process.

Drug therapy includes:

Etiotropic drugs. Broad-spectrum antibiotics in various combinations. The recommended duration of the course of treatment is 7-10 days.
The use of specific antileptospiral immunoglobulin obtained from the blood serum of oxen. Appointed by an infectious disease specialist in the first days of the disease. Applicable to patients from the age of eight. Prevents the frequency and severity of organ lesions.
Detoxification therapy. It is carried out with solutions of preparations of a cleansing action in the initial period of leptospirosis.
Drugs that improve renal blood flow. If necessary, diuretics.
Symptomatically used analgesic and anti-inflammatory therapy.
Enzymatic preparations and hepatoprotectors.
Severe course is an indication for hemodialysis and the use of hyperbaric oxygen therapy.

COMPLICATIONS

The appearance of complications is possible at any stage of leptospirosis. Elderly patients are more likely to develop conditions life threatening. With late detection of leptospirosis in patients, depending on age, there are combined complications.

Against the background of the main symptoms, lesions are observed:

On the part of the organs of vision, uveitis, iridocycline, conjunctivitis are possible.
As the infection spreads and the blood-brain barrier is overcome, the central nervous system is affected in the form of serous or purulent, less often meningoencephalitis.
The infection causes pneumonia,.
Complications from the side of the heart in the form of.
Liver damage different intensity up to acute liver failure.
Variety of forms of kidney disease. The extreme phase is acute.

PREVENTION

Measures to prevent leptospirosis should be based on identifying groups of people increased risk infection and knowledge of the epidemiological situation in the region. The purpose of control is to control the likely sources of infection.

Preventive measures include:

Vaccination of farm animals and dogs.
Rodent control, derat control agriculture, city objects.
Veterinary control of food storage and sale conditions.
Scheduled vaccinations for employees of risk groups according to their professional characteristics.
The use of overalls by workers at risk (employees of meat processing plants, slaughterhouses, milkmaids, shepherds).
Control of the sanitary condition of water bodies. Regular checks by the relevant intake services drinking water for the population and places of recreation on the water.
Educational work among the population about the dangers of swimming in stagnant water bodies.

PROGNOSIS FOR RECOVERY

With timely access to a specialized specialist and early diagnosis of the presence of bacteria in the body the prognosis for recovery is favorable. Employability is restored slowly. After recovery, the patient is placed on a mandatory dispensary record for 6 months with an examination by specialized specialists.

With the development of jaundice, involvement in the process of the liver and kidneys, accession, the prognosis is unfavorable. After suffering leptospirosis, a stable immunity is formed. It is possible reinfection leptospira of another serotype.

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Conventionally, all liver diseases can be divided into two types: caused by malnutrition and the use of alcoholic beverages, and the second group - infectious diseases. The latter are of both viral and bacterial origin. The difficulties of the first diagnosis in the similarity of symptoms, which often misleads doctors and makes it difficult to set correct diagnosis. Leptospirosis belongs to the category of severe conditions, one of the important diagnostic features of which is liver damage.

What is leptospirosis and what is the causative agent of this infection? For what reasons can a person get sick? What are the stages of the development of the disease and what symptoms accompany them? Are complications and serious consequences for the body possible? How is diagnosis and treatment carried out? Does it exist effective prevention? Who is vaccinated against leptospirosis and how is it tolerated? Below are the answers to all these questions.

What is leptospirosis

This disease resembles the flow of viral hepatitis, although it belongs to the category of "slow killers", that is, it affects all organs gradually, over several years.

Leptospirosis has always existed in nature, but the first recorded descriptions of the disease appeared at the end of the 19th century. Independently of each other, the German scientist A. Weil and the student of S. P. Botkin, N. P. Vasiliev, published studies on patients with liver damage in 1886. After the publication of their work, it was possible to completely isolate the disease in separate group. After 28 years, already in Japan, the scientist A. Inada discovered the causative agent of leptospirosis and attributed it to spirochetes.

Since the beginning of the 20th century, several bacteria responsible for the occurrence of infection have been identified, their properties and the types of disease they lead to have been studied.

The causative agent of the disease

Leptospirosis is an acute zoonotic infectious disease, that is, the pathogen can multiply in the body of certain animals. Foci of infection at different times of the year are found almost everywhere, except for eternally cold places.

The causative agent of leptospirosis is a bacterium belonging to the Leptospira family of the spirochete class. A feature of this microorganism is its love for aquatic habitats, which contributes to the infection of humans and animals. Spirochete is a long coiled bacterium with big amount small curls.

What is known about leptospira?

Bacteria grow very slowly in artificial conditions, so it is sometimes difficult to make a diagnosis, because they can be detected only a week after cultivation.
The causative agent of leptospirosis after destruction releases endotoxin, which damages the cells of all body systems.
Leptospira, after entering the human body, attaches to the inner layer of blood vessels and blood cells, damaging them.
Bacteria are resistant to low temperatures, they are weakly affected by ultraviolet, acids and alkalis, disinfectants available to everyone do not always have an effect on microorganisms desired result.
The causative agent of leptospirosis is perfectly preserved in water for up to three weeks. They live in the soil for at least three months.

Causes of human infection with leptospirosis

The source of infection in leptospirosis are wild and domestic animals that have had the disease or during the active development of the infection. During this period, they infect the soil, water.

The main carriers of the infection in nature are small rodents, but other animals can also transmit leptospirosis:

rats;
voles;
shrews;
of laboratory animals, guinea pigs are the most susceptible to leptospirosis;
marmots;
pets are also at risk - pigs, horses, even dogs often get sick;
cattle can also be a source of infection for humans.

The transmission route of leptospirosis is alimentary (fecal-oral). The transmission mechanism is contact.

How does a person become infected?

Through water during bathing or when using it from natural sources.
By eating food contaminated by infected animals.
How else is leptospirosis transmitted to humans? - during contact with objects environment contaminated with diseased animals.

A person does not get infected from other people, the main source of infection is animals. Absolutely everyone can get sick, but more often it is teenagers and adults.

Leptospirosis is characterized by seasonality - the incidence is more common mainly in the summer-autumn period. After the infection, a strong immunity is formed, which does not prevent a person from contracting another type of disease from another causative agent of leptospirosis, of which more than 19 species are known.

Stages of disease development

Infection most often occurs during human contact with water. Leptospira are introduced into damaged skin, while inflammation or visible tissue disorders cannot be detected at the site of their entry into the body. The main changes occur in the organs and in the vascular network.

There are 5 phases in the development of leptospirosis.

The entry of the pathogen into the body and its penetration through the bloodstream into the liver, spleen, lungs.
The appearance of the first clinical signs corresponds to the penetration of leptospira into the bloodstream and mass distribution throughout all organs and systems.
The third week of the disease is a period of pronounced manifestations or peak. Small vessels are maximally permeable to damaging factors.
At the fourth stage of the disease, with a successful combination of circumstances, the symptoms gradually subside.
Leptospirosis in humans ends well and sterile immunity is formed at the fifth week, which corresponds to the last period of infection. Sometimes there are complications or relapses of the disease.

Almost all stages of the disease correspond to pathogenesis. In the phase of infection or the incubation period of leptospirosis, the disease practically does not manifest itself, but the changes are already gaining momentum. It lasts from 3 to 30 days, but the average is one to two weeks. At this time, the person is not yet aware of the presence of the disease.

There are several more stages of infection.

The initial or febrile course lasts about a week or less in severe cases.
The time of heat or the period of damage to internal organs.
Remission of symptoms of leptospirosis or recovery.

Each period lasts at least a week for mild to moderate infections. What forms is the severe course of leptospirosis divided into? - this is icteric, when all the above periods run faster, and anicteric.

Cases of a mild course of the disease are described, without typical clinical manifestations or with mild symptoms, but without impaired liver and kidney function.

Symptoms of the disease

The first week of the course of leptospirosis is characterized by the development of general symptoms, the suspicion of this infection can only be caused by contact with a sick animal or bathing at the site of the outbreak.

What are the symptoms of leptospirosis in humans in the initial period?

Characterized by an acute sudden onset with sharp rise temperatures up to 39–40 ºC. The fever lasts at least a week.
Severe severe headache and weakness.
One of the typical symptoms of this period is the appearance of myalgia or severe pain in the area of the abdominal wall of the abdomen, painful when touched and examined.
A person at this time of the course of leptospirosis is often excited, worried about something.
A typical appearance of the patient is puffiness, redness (hyperemia) of the face and neck, the sclera of the eyes are injected (the vascular pattern is enhanced).
Perhaps the appearance of other infections against the background of a decrease in immunity - leptospirosis in children manifests itself in the form of herpetic eruptions on the lips and on other mucous membranes.
After only two days, a polymorphic rash appears. Its elements are different in appearance and do not have common features. Hemorrhages or bruises occur on the elbow and knee bends.
Diagnosis of leptospirosis in humans in the initial period is based on the detection of leptospira in the cerebrospinal fluid, on changes in the parameters of a general blood and urine test.
Against the background of the main symptoms, patients often develop bronchitis, sputum with streaks of blood is secreted, and upon examination, the liver and spleen enlarge.

The course of leptospirosis during the height of the disease

Approximately in the second week of the course of infection from the moment of the first obvious manifestations in a person, another stage begins, when in inflammatory process almost all organs and systems are involved. The first blow falls on the liver, kidneys, nervous system.

What is known about the development of the second period of leptospirosis?

The next period is the resolution of the disease with a gradual restoration of the functioning of the organs. But about a third of patients have a relapse, when the symptoms, even if not so strong, but return. Jaundice in recurrent leptospirosis is rare, organ damage is less pronounced.

On average, the disease lasts at least four weeks, but with relapses it drags on for up to two, and sometimes even three months.

What symptom is not typical for leptospirosis in all periods of the disease? - despite the inflammation of the liver tissue, there is no repeated loosening of the stool.

Complications

The consequences of leptospirosis are difficult to predict even with timely assistance. Complications are most often observed in severe infections.

How can leptospirosis end?

Recurrence of the infection is possible.
Deaths occur in 1-3% of cases.
Liver failure.
Complications of leptospirosis include impaired renal function or acute renal failure.
Meningitis, muscle paralysis.
Acute bleeding and shock.
Damage to the eyes and organ of hearing: iridocyclitis, otitis media.
Pneumonia.
Stomatitis, bedsores.

Diagnosis of leptospirosis

What tests are taken for leptospirosis in humans? To begin with, they are examined by standard general clinical methods. Do general analysis blood and urine. But with their help, it is only possible to establish the inflammatory process in the body and damage to the kidneys.

At the beginning of the disease, leptospira bacteria can be detected in the blood and cerebrospinal fluid by a special “crushed drop” method. During the height of the disease, the pathogen is detected in almost all biological fluids.

Serological research methods are more indicative in the second period of leptospirosis. The antibody titer in paired sera, taken at the height of the disease and when it subsides, is examined. Apply RSK, RMA and other methods.

Differential diagnosis leptospirosis is carried out with viral hepatitis influenza, meningitis, malaria and hemorrhagic fever.

Treatment of leptospirosis

Therapy is carried out in the infectious diseases department of the hospital. This is a serious infection, so it is impossible to cope with it at home on your own.

How is leptospirosis treated in humans?

Prevention of leptospirosis

TO non-specific methods protection of the population against the causative agent of leptospirosis includes:

identification and treatment of sick animals or carriers of infection;
health education in areas with frequent outbreaks;
animals with a high risk of developing leptospirosis are administered anti-infection serum and regularly revaccinated;
the prevention of leptospirosis in humans also includes wearing individual means protection when working with farm and wild animals.

Leptospirosis vaccine for humans

by the most effective method preventing the development of the disease in humans is the vaccination of humans against leptospirosis. But the vaccine is not administered to everyone without exception, protection is provided only to certain categories of citizens.

Who is vaccinated?

Animal breeders and veterinarians, as they regularly encounter a source of infection and may be infected.
Meatpacking workers.
Deratizers, vacuum cleaners.
People working in the foci of infection, laboratory workers.

How is Leptospirosis Vaccinated?

Vaccinations against leptospirosis are given to a person based on indications starting from the age of seven. If animals have many options for protection against the pathogen, then humans have little choice. An inactivated leptospirosis vaccine is used, that is, killed strains of a microorganism that can no longer cause an infection, but are able to protect a person.

The vaccine is injected subcutaneously in 0.5 ml under the shoulder blade or in the region of its lower angle. Immunization is one-time, but revaccination for workers at risk is carried out annually.

Side effects from the vaccine are rare and occur more often with individual intolerance to the drug. Sometimes there is swelling and soreness at the injection site.

Vaccination is contraindicated for children under 7 years of age, pregnant women, breastfeeding women and people with progressive diseases of the nervous system.

What is the likelihood of getting leptospirosis? It is high, since the causative agent of the infection is found in the nature around us, in domestic and wild animals with which a person comes into contact daily. It is impossible to make a diagnosis on your own, but in order to protect yourself from the onset of the disease, you need to know about it and take timely preventive measures if necessary.

Leptospirosis is an infection caused by leptospira. Other names for the disease: water (canine) fever, Japanese fever, infectious jaundice.

The causative agent is Leptospira. Leptospira are hydrophiles. Therefore, high humidity and heat are considered a favorable environment for them. Leptospirosis is ubiquitous. Only in the conditions of Antarctica it is impossible to get sick with an illness. The disease is especially common in tropical countries.

Sources of infection - animals. These can be rats, shrews, dogs, cattle, pigs, etc. A person with leptospirosis is not a source of infection. Among animals, it is transmitted through food and water. A person becomes infected by contact with water. Pathogens can be picked up through the skin if the water is contaminated with animal secretions. Leptospirosis can be contracted by contact with moist soil, by cutting meat, and by eating infected products (milk). The disease is common among workers livestock farms and veterinarians. Leptospirosis is seasonal. Most cases are detected in August.

For leptospira to enter the body, the slightest damage to the skin is enough. Therefore, infection occurs even with fleeting contact with water, where there are microbes. Through the conjunctiva of the eyes and mucous membranes, the pathogen also easily enters. No changes are observed at the site of penetration of leptospira.

In the body, pathogens move through the lymphatic system. However, there are no inflammatory processes in the lymph nodes. Leptospira easily enters tissues and organs. They affect the central nervous system, kidneys, lungs, liver and spleen. Leptospira multiply and accumulate in the internal organs. This period of the disease is called the incubation period. It lasts up to 2 weeks.

The onset of the disease is acute. Leptospira release their toxins into the blood. This leads to a pronounced intoxication of the body. Pathogens destroy red blood cells. Their toxic substances worsen the coagulation function of the blood.

Infection manifests itself acute fever. There are no signs of the disease.

The patient has a general intoxication of the body. Chills, severe headache, heat. The person loses appetite and sleep. He suffers from constant thirst.

Most often, the incubation period lasts about a week. Leptospirosis has 2 phases. The first phase is leptospiremia. In the cerebrospinal fluid and in the blood, the pathogen can be detected. The above phenomena are observed within 4-9 days. Repeated chills. Myalgia and fever characteristic symptoms diseases.

A striking sign is severe muscle pain. Palpation of the calf muscles, lumbar region and thigh muscles hurts. Sometimes there is flushing of the face, upper chest and neck. Some patients develop a rash. The most common is erythematous exanthema. Diarrhea, cough, and hemoptysis may occur. Examination reveals bradycardia. Sometimes there may be ischemia and sensory disturbances.

The second phase is toxemia of internal organs. Ailment strikes nervous system, liver and kidneys. IN severe cases possible: jaundice, meningitis, acute renal failure and hemorrhagic syndrome.

Weil's syndrome is a specific sign of leptospirosis. It is characterized by anemia, jaundice, prolonged fever, and impaired consciousness. The syndrome reaches its maximum expression at the second stage of the disease. In this case, symptoms of damage to the kidneys or liver appear.

If the liver is affected, then the patient suffers from pain in the region of this organ. In this case, the liver increases in size. Analyzes reveal changes in blood serum. With kidney damage, hematuria, proteinuria, azotemia and pyuria are observed. A person suffers from nose and stomach bleeding and hemoptysis. Hemorrhages in the adrenal glands and hemorrhagic pneumonia are possible.

Sometimes aseptic meningitis becomes a sign of leptospirosis.

For diagnosis, data obtained as a result of bacteriological examination are used. Doctors may suspect fever, nephritis, hepatitis, meningitis, shock toxic syndrome. During the first phase, leptospira can be detected in the blood or in the cerebrospinal fluid. In the second phase, they are determined in the urine. Leptospira can be detected in the patient's urine for up to 11 months after the onset of the disease. In addition, they can be periodically determined, despite antibiotic treatment.

Reference signals for diagnosis: acute onset of the disease, jaundice, muscle pain, rash, kidney damage, scleritis, increased ESR, leukocytosis. Epidemiological analysis data is also important.

In many cases, the disease requires resuscitation. The prognosis depends on the virulence of leptospira and on the state of the patient's body. The prognosis is always serious, as the mortality rate from leptospirosis reaches 10%.

Antimicrobial agents are used for treatment. These are penicillin, chloramphenicol, erythromycin, streptomycin, tetracycline derivatives. Doxycycline is often used. Sometimes doctors prescribe gamma globulin. In order for the drugs to have a therapeutic effect, they must be taken no later than the 4th day from the onset of the disease. In addition, the patient needs plenty of fluids and bed rest. In acute kidney failure, a person is given hemodialysis.

IN acute phase the disease is complicated by liver or kidney failure, bleeding, cerebral edema, myocarditis or pneumonia. Dangerous complications are eye lesions (iritis, uveitis, iridocyclitis). They occur a month after the onset of the disease.

If there are no complications and icteric form, then the prognosis is favorable. Death occurs due to liver or kidney failure, meningoencephalitis or pneumonia.

Consequences of leptospirosis

Acute kidney and liver failure, eye diseases. Paresis or paralysis may also occur.

Veterinary and sanitary measures are important preventive methods. They provide for the identification and treatment of sick animals. The leptospirosis vaccine helps prevent the spread of the pathogen. It is made for people and animals. Do not use water from contaminated sources.

Compliance with sanitary and hygienic standards reduces the likelihood of infection with leptospirosis to a minimum.

Leptospirosis is an ailment of an infectious nature, which is caused by specific pathogens from the genus Leptospira. The pathological process primarily affects the capillaries, as well as the liver, kidneys and muscles.

The causative agent of this disease enters the body through wounds on the skin and mucous membranes. After some time, it penetrates the bloodstream and spreads throughout the body, affecting large organs. But on this life cycle leptospira does not end. In the affected organs, they begin to grow and multiply rapidly, and after a while they enter the bloodstream again. Gradually, the level of leptospira in the blood will begin to rise. This will be accompanied severe intoxication. The patient will have a fever, nausea, headache. The symptoms become more and more pronounced. Without proper treatment, it can develop hemorrhagic diathesis or death will come.

Causes

In the process of spreading this disease among people, animals play a priority role. Leptospirosis in humans can occur after close contact with them. Therefore, it is important to take preventive measures in a timely manner in order to prevent the development of pathology. An effective remedy is the leptospirosis vaccine.

The disease is transmitted:

by contact, if there are damages on the skin - when swimming in reservoirs, cutting carcasses;
alimentary way. Anyone can become infected if they eat water from open water natural origin, unprocessed foods such as milk or meat.

Often the disease affects people whose prof. activity is associated with constant contact with animals.

Outbreaks often occur in summer period. The disease most often affects people living in places with high humidity.

Forms

Except known form pathology, accompanied by a febrile period, in the presence of organ lesions, the disease can proceed in an erased or in an abortive form. It is characterized by a short-term and slight increase in temperature, as well as the absence of organ damage.

The incubation period for leptospirosis is from 3 to 30 days. On average, the first symptoms in infected people appear on the 7-10th day.

Pathogenesis

The causative agent of the disease freely enters the human body through injured skin or through the mucous membranes. Further, getting into the bloodstream, it moves to the parenchymal organs, where it multiplies for almost two weeks (the average duration of the incubation period). After that, the pathogen returns to the bloodstream again and releases a huge amount of toxins that destroy the capillary endothelium. Also, toxins "attack" the links of hemostasis.

Leptospira begin to leave the human body a week after infection. This process can take several months or weeks. It all depends on the form of the disease and the severity of its course.

Symptoms

in the acute period, there is an increase in body temperature up to 39–40 degrees. The course of the disease is accompanied by chills. A person's temperature can last for a very long time - for 6-10 days;
the person is very thirsty;
symptoms of intoxication of the body are expressed (visible even in incubation period) due to poisoning with toxins secreted by leptospira;
pain in the lumbar region;
puffiness of the face;
. Pain in the muscles appear even in the initial period of the development of the disease. The calf muscles hurt the most;
the skin of the neck and face is hyperemic. The whites of the eyes also turn red;
in some clinical situations, redness of the soft palate and pharynx is noted;
the posterior cervical lymph nodes increase in size (a characteristic symptom).

In some cases, with the progression of leptospirosis, a rash appears. The place of its primary localization is the trunk, as well as the limbs. Its elements can be quite diverse:

red spots;
papules;
rubella-like rash;
herpetic eruptions (on the nose and lips).

with liver damage in the acute period, people have hepatomegaly, yellowness of the skin and whites of the eyes;
with damage to the CCC in a patient, the heartbeat becomes much less frequent, blood pressure drops;
if a person develops a hemorrhagic syndrome, then petechial rashes appear on the body. Nosebleeds and hemorrhages in the eye proteins are possible;
signs of CNS damage - dizziness, impaired consciousness.

Diagnostics

Diagnosis of leptospirosis is quite specific. It is important to immediately seek medical help when the first symptoms of the disease appear. The sooner such a disease is detected, the easier it will be to cure. Clinicians consider:

the fact of a close relationship with wild or domestic animals;
whether the sick person bathed in open natural reservoirs;
the patient's profession.

For an accurate diagnosis, several studies will be required:

in blood smears using a dark-field microscope, leptospira can be detected (the most exact method diagnosis of leptospirosis);
bacteriological method;
detection in the patient's blood of antibodies to a specific pathogen.

Treatment

At the first symptoms of the disease, people are immediately sent to a medical institution, since leptospirosis is a complex disease and can only be treated in stationary conditions. Treatment of leptospirosis is a very long and complex process.

Antibiotic therapy is prescribed taking into account the infectious agent, as well as its sensitivity to certain drugs.

If the disease progresses and the patient has developed an infectious-toxic shock, then he should immediately begin to provide the first medical care. In / in enter saline solutions, fresh frozen plasma. In more severe clinical situations, hemodialysis is prescribed.

Diet plays an important role in the treatment of leptospirosis. The patient is given a diet in which fats and salts are limited.

Complications

uremic coma;
purulent encephalitis;
DIC;
iritis;
hemorrhagic syndrome;
death.

Prevention

You can protect yourself from infection by limiting contacts with possible carriers of the disease - rodents, wild and agricultural animals. All existing preventive measures can be conditionally divided into 2 groups. The first includes measures that people themselves must take in order not to become infected. The second group includes activities, the responsibility for which lies with the epidemiological control authorities.

Basic rules for personal prevention:

vaccination against leptospirosis. An effective prophylactic. The leptospirosis vaccine is administered intramuscularly and for a long time protects a person from infection;
animal vaccination. All domestic and farm animals must be vaccinated. They are also given the leptospirosis vaccine;
extermination of rodents in the house;
refusal to swim in unverified places;
Strict observance of safety rules during outdoor recreation.

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Diseases with similar symptoms:

Jaundice is a pathological process, the formation of which is affected by a high concentration of bilirubin in the blood. The disease can be diagnosed in both adults and children. Any disease can cause such a pathological condition, and they are all completely different.

Inflammation of the lungs (officially pneumonia) is an inflammatory process in one or both respiratory organs, which usually has infectious nature and is caused by various viruses, bacteria and fungi. In ancient times, this disease was considered one of the most dangerous, and although modern treatments allow you to quickly and without consequences get rid of the infection, the disease has not lost its relevance. According to official figures, in our country every year about a million people suffer from pneumonia in one form or another.