Leptospira causes. Introduction of specific serum. Specific and nonspecific laboratory diagnostics

Leptospirosis in humans is an acute zoonotic infection. The causative agents are spiral-shaped microorganisms called Leptospira. A disease that provokes disruption of the central nervous system, kidneys, skeletal muscles, the development of jaundice, intoxication, fever and severe myalgia, is also called infectious jaundice, Japanese or water fever.

Features of the development of the disease are due to the characteristics of Leptospira specific factors pathogenesis:

• Release of endotoxin, which leads to general intoxication of the body and disruption of the integrity of the vascular endothelium with the leakage of blood from them;
• The presence of flagella, which give the pathogen maximum mobility, the ability for circular, translational, sliding movements;
• Obtaining energy only as a result of oxidative processes in fatty acids;
• The presence of pathogenic enzymes destructive for parenchymal organs in the form of hemolysin, plasmacoagulase, fibrinolysin and lipase.

The causative agent of leptospirosis enters the body through the slightest damage to the skin and mucous membranes. Also, the site of penetration may be the conjunctiva of the eye. For the development of the disease, it is enough to have contact for a short period of time with water in which leptospira lives, or with an infected animal (rodents, pigs, dogs, hedgehogs and cattle are especially susceptible to leptospirosis).

Leptospires use the lymphatic system to move throughout the body without causing inflammation of the lymph nodes. Within a short period of time, the pathogen penetrates various tissues and internal organs, most often the damage affects the lungs, liver, central nervous system and spleen. Here Leptospira actively multiply and accumulate (the incubation period is 14 days), after which they begin to destructive processes, accompanied by intoxication, dysfunction of blood clotting and destruction of red blood cells.

Leptospirosis in humans is quite common due to significant susceptibility to this infection. The risk group includes the elderly, newborns and people suffering from immunodeficiency. At the same time, there is no species resistance to pathogenic pathogens.

Routes of infection

1. Contact - if a person had direct contact with a sick animal or touched contaminated household items or water.
2. Nutritional – when eating products from infected animals and infected plant waste products.
3. Aerogenic - if contaminated air enters the respiratory tract.
4. Transmissible - as a result of flea bites or infected ticks.

Symptoms

The first phase of the disease, called the incubation period, lasts about two weeks, followed by a phase of clinical manifestations. It lasts no more than a month and is divided into three alternating periods.

Generalization

Characteristic acute course and the following symptoms: general intoxication, chills and high fever. Fever lasts for 5 days, aggravated by myalgia. Especially severe pain observed in the area calf muscles, in which focal necrobiotic and necrotic changes occur. In general, the period lasts about a week.

height

The duration of this period is about 14 days, during which secondary bacteremia develops and secondary lesion internal organs.

Toxinemia

It is characterized by severe intoxication as a result of the release of endotoxin by gradually dying leptospira. Poisoning of the body results in infectious-toxic shock, multiple organ failure, disruption of the vascular endothelium, and the appearance of bruises on internal organs, mucous membranes and skin (hemorrhages develop).

Also, symptoms of leptospirosis include the development of jaundice due to destructive changes and hemolysis with aggravation of the process in the form of hepatic and renal failure. The result of such disorders in the absence of timely treatment is coma.

An objective examination reveals the following signs of the disease, called the “hood symptom”:

• Facial swelling, redness skin;
• Change in skin color of the upper chest and neck (appearance of red pigment);
• Yellowness of the scleral vessels and pronounced injection, with no signs of conjunctivitis.

When Leptospira penetrates the blood-brain barrier, purulent meningitis or meningoencephalitis develops with clear signs in the form of stiff neck and positive Brudzinski and Kering symptoms (inability to fully straighten knee-joint due to a reflex spasm of the lower leg muscles, etc.).

Features of hemorrhages (rashes) with leptospirosis

Hemorrhages and rashes can be present both on the mucous membranes and skin, and in the internal organs. Characteristic differences such manifestations are:

• Similar in appearance to rubella, measles and scarlet fever;
• Rash affects the abdomen, arms and chest;
• Disappearance of the rash after a couple of hours (in some cases), followed by pigmentation and peeling of the skin;
• Development as a result of decompensation of nasal hemorrhages, abdominal bleeding and hemorrhages (at injection sites).

It should be noted that itching may be a sign liver failure Therefore, you should pay attention to the obligatory accompanying sign in the form of yellowness of the skin.

Forms of the disease

Leptospirosis in humans can occur in mild, moderate and severe forms.

Light form

Characteristic signs are fever with an increase in temperature to 38-39 degrees with moderate general intoxication of the body and the absence of pronounced disturbances in the functioning of internal organs.

Moderate form

The fever becomes more pronounced, the picture of the disease becomes more detailed, but there are no manifestations of jaundice yet.

Severe form

Depending on the severity criteria, this form of leptospirosis is divided into types such as hemorrhagic, icteric, renal, meningeal, mixed.

A severe form of the disease is called Weil's disease, the symptoms of which appear three days after the symptoms disappear light form. Leptospirosis in humans at this stage is determined by such a specific symptom as Weil's syndrome, which is characterized by impaired consciousness in combination with jaundice, anemia and prolonged fever. This syndrome becomes most pronounced in the peak phase.

With liver damage in the area of ​​the organ, characteristic pain occurs, the liver increases in size, and characteristic changes occur in the blood serum. Renal dysfunction is accompanied by symptoms such as hematuria, azotemia, proteinuria and pyuria.

Other specific signs of severe leptospirosis include stomach and nosebleeds, hemoptysis, and the development of aseptic meningtitis. Also, there is a possibility of hemorrhagic pneumonia and hemorrhages in the adrenal glands.

Possible complications

In some cases, acute renal failure can develop in a latent form without hemorrhagic syndrome and jaundice, ending in death after 3-5 days.

In addition, in the acute phase, cerebral edema, pneumonia and myocarditis, paralysis or paresis may be observed, as well as dangerous eye complications - iridocyclitis, iritis, uveitis, which occur a month after the pathogen enters the body.

Diagnostic measures

When diagnosing leptospirosis in humans, the closest attention is paid to the presence of fever and its degree, the appearance of the patient, thrombohemorrhagic syndrome, the severity of jaundice and the degree of kidney damage. At the same time, a thorough differential diagnosis leptospirosis, taking into account the following symptoms:

1. Fever that persists for about 5 days, which is also possible with other infectious diseases, including adenovirus, Infectious mononucleosis, a typhus-like form of salmonellosis.
2. Jaundice, to exclude malaria, toxic or viral hepatitis.
3. Thrombohemorrhagic syndrome, which also develops with sepsis, rickettsiosis and hemorrhagic fever.

Diagnosis of leptospirosis involves collecting not only clinical information, but also epidemiological indications, which include the presence of contact with domestic and wild animals, type of activity, and the fact of swimming in open water. In addition, they take into account the examination data, during which the degree of its enlargement is determined by palpation of the liver, diagnosing hepatomegaly by the following signs: protrusion of the organ a couple of centimeters from under the edge of the costal arch, diffuse aching or radiating pain in the area of ​​the right hypochondrium.

Specific diagnostics using laboratory methods

As part of such activities, leptospirosis is analyzed through bacterioscopic, bacteriological, serological and genetic research. From the moment the first symptoms of leptospira appear in the blood, dark-field microscopy can be detected; at a later date, urine tests are taken and cerebrospinal fluid(relevant in the presence of positive meningeal signs). After taking the test, the result is expected within 8 days (this period is necessary for the growth of Leptospira).

Serological analysis for leptospirosis is based on the use of a microagglutination reaction, which involves the determination of antibodies and antigens that are related to each other and form agglomerates. If the increase in antibody titer exceeds 1:100, it is stated positive reaction. It is advisable to conduct such a study after the end of 7 days from the moment signs of the disease appear. As for genetic research, it is used to identify the DNA of the pathogen in the patient’s biological material. For this purpose, polymerase chain reaction is used.

Nonspecific diagnosis of leptospirosis

Such laboratory research involve taking tests to determine the level of ESR, residual nitrogen, bilirubin of direct and indirect fractions, protein, urobilinogen, ketone bodies, neutrophilic leukocytosis, TAM.

Medical therapy

Treatment of leptospirosis consists of etiotropic, pathogenetic and symptomatic therapy(prescribing antibiotics, preventing complications and alleviating the condition, respectively). Antibiotic therapy can be carried out with the prescription of penicillin (in the absence of an allergic reaction), drugs of the tetracycline group, gamma globulin contained in hyperimmune ox serum.

Leptospirosis in a person in mild form can be treated on an outpatient basis without the need for hospitalization. As a rule, a 5-6-day course of antibiotics (tetracycline or penicillin) is given. If adverse reactions such as vomiting, nausea or diarrhea develop, erythromycin may be used. If the patient complains of muscle pain, headaches, or fever, ibuprofen or paracetamol may be additionally prescribed. To avoid relapse of the disease, the course of treatment should not be interrupted.

Treatment of severe forms must be carried out in a hospital under the supervision of doctors. Antibiotics are administered intravenously, supplemented by IV drips containing nutrients that support the patient. The need for pathogenetic therapy arises with the development of renal failure, cerebral edema, acute cardiovascular failure or DIC syndrome. To alleviate the patient's condition, hemodialysis is performed and infusion therapy with the introduction of appropriate drugs (diuretics for impaired renal function, ascorbic acid and cardiac glycosides for cardiac dysfunction, brain metabolites for cerebral edema, detoxification drugs and protease inhibitors in the case of DIC).

The duration of treatment depends on the condition of the body, the degree of damage to internal organs and the response to therapy.

Rehabilitation period

After successful treatment of leptospirosis, patients should be registered with a dispensary for a period of about six months. During this period, rehabilitation measures are carried out, consisting of consultations with an ophthalmologist, neurologist, therapist or pediatrician (if the patient is a child). After six months, the patient must appear every month for an appointment with a therapist, who, if necessary, will prescribe an examination with a specialized specialist. During the first two months of rehabilitation, clinical and laboratory examinations are carried out regularly.

If at the end of the rehabilitation period the test for leptospirosis does not give positive results, the patient is removed from the register. Otherwise, observation with appropriate rehabilitation measures lasts for 2 years.

Preventive measures

Effective prevention of leptospirosis is possible only if the following conditions are met:

1. Timely vaccination, testing and treatment of pets. Vaccination against leptospirosis helps protect not only your pets, but also your family members from such an insidious disease.
2. Avoid visiting fresh water bodies if there are abrasions or cuts on the skin.
3. Hygienic shower after swimming in rivers and lakes.
4. High-quality hygiene of farm workers, the use of gloves and protective masks when in contact with animals.
5. Regular hand washing, especially after playing with pets and returning from the street, eating only washed fruits, vegetables and herbs.

Important nuances

Unlike animals, a person infected with leptospirosis does not pose a danger to others, since he is a biological dead end in the chain of spread of the disease.

Treated leptospirosis in humans does not guarantee lifelong immunity due to the type specificity of the disease. If the body is infected with another Leptospira serovar, infection can occur again.

As you can see, leptospirosis is easier to prevent than to treat. The main thing is to be attentive to your own body and contact specialists at the first suspicion. Only professional diagnostics, timely treatment and a responsible approach become the key to successful recovery without the development of life-threatening complications.

Leptospirosis is an infection caused by Leptospira. Other names for the disease: water (dog) 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 occurs everywhere. It is only in Antarctica that it is impossible to get sick from the disease. The disease is especially common in tropical countries.

Sources of infection are 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 excretions. Leptospirosis can be contracted through contact with wet soil, when cutting meat, and also through consumption of infected products (milk). The disease is often found 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. The pathogen also easily enters through the conjunctiva of the eyes and mucous membranes. No changes are observed at the site of Leptospira penetration.

Pathogens move throughout the body lymphatic system. However inflammatory processes does not occur in lymph nodes. Leptospira easily enters tissues and organs. They affect the central nervous system, kidneys, lungs, liver and spleen. Leptospira multiply and accumulate in internal organs. This period of the disease is called incubation. It lasts up to 2 weeks.

The onset of the disease is acute. Leptospires release their toxins into the blood. This leads to pronounced intoxication of the body. Pathogens destroy red blood cells. Their toxic substances impair blood clotting function.

Infection appears acute fever. There are no warning signs of the disease.

The patient has general intoxication of the body. Chills occur, 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 cerebrospinal fluid and the pathogen can be detected in the blood. The above phenomena are observed within 4-9 days. Repeated chills. Myalgia and increased body temperature - characteristic symptoms diseases.

A clear sign is severe muscle pain. Palpation of the calf muscles, lumbar region and thigh muscles causes pain. Sometimes facial hyperemia occurs, upper sections chest and neck. Some patients develop a rash. The most common occurrence is erythematous exanthema. Diarrhea, cough and hemoptysis may occur. The examination reveals bradycardia. Sometimes there may be ischemia and sensory disturbances.

The second phase is toxemia of internal organs. The disease affects the nervous system, liver and kidneys. In severe cases, the following are possible: jaundice, meningitis, acute renal failure and hemorrhagic syndrome.

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

If the liver is affected, the patient suffers from pain in the area of ​​this organ. At the same time, the liver increases in size. Tests detect changes in blood serum. With kidney damage, hematuria, proteinuria, azotemia and pyuria are observed. A man suffers from nasal 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 a patient has fever, nephritis, hepatitis, meningitis, shock toxic syndrome. During the first phase, leptospira can be detected in the blood or cerebrospinal fluid. In the second phase they are determined in the urine. Leptospira can be detected in the patient's urine within 11 months after the onset of the disease. In addition, they can be periodically detected despite treatment with antibiotics.

Reference signals for diagnosis: acute onset diseases, jaundice, muscle pain, rash, kidney damage, scleritis, increased ESR, leukocytosis. Epidemiological data are also important.

In many cases, the disease requires resuscitation measures. The prognosis depends on the virulence of Leptospira and the condition of the patient’s body. The prognosis is always serious, since 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. So that the drugs provide healing effect, they should be started no later than the 4th day from the onset of the disease. In addition, the patient needs drinking plenty of fluids And bed rest. At acute failure a person's kidneys undergo hemodialysis.

In the 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 complications and icteric form are absent, 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 involve identifying and treating sick animals. The leptospirosis vaccine helps prevent the spread of the pathogen. It is given to 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 - acute zoonotic natural focal infectious disease with predominantly water transmission of the pathogen, characterized by general intoxication, fever, damage to the kidneys, liver, central nervous system, hemorrhagic diathesis and high mortality.

Etiology of leptospirosis

Leptospires are thin, mobile spiral-shaped microorganisms with a length from several to 40 nm or more and a diameter from 0.3 to 0.5 nm. Both ends of leptospira are, as a rule, bent in the form of hooks, but hookless forms are also found. Leptospires have three main structural elements: an outer shell, an axial filament and a cytoplasmic cylinder, which is helically twisted around the longitudinal axis. They reproduce by transverse division.

Leptospira are gram-negative. They are strict aerobes; they are grown on nutrient media containing blood serum. Optimum growth is 27–30 °C, however, even in such conditions they grow extremely slowly. The pathogenicity factors of Leptospira are exotoxin-like substances, endotoxin, enzymes (fibrinolysin, coagulase, lipase, etc.), as well as invasive and adhesive ability.

Leptospira are sensitive to high temperatures: boiling kills them instantly, heating to 56–60 °C kills them within 20 minutes. Leptospira are more resistant to low temperatures. Thus, at –30–70 °C and in frozen organs, they remain viable and virulent for many months. Bile, gastric juice and acidic human urine have a detrimental effect on leptospira, and in the slightly alkaline urine of herbivores they remain viable for several days. In the water of open reservoirs with a slightly alkaline or neutral reaction, leptospires persist for 1 month, and in damp and waterlogged soil they do not lose pathogenicity for up to 9 months. Leptospira survives on food products for up to 1–2 days, and when exposed to ultraviolet light and when dried, they die within 2 hours. Leptospira is sensitive to penicillin, chloramphenicol, tetracycline and is extremely sensitive to the action of conventional disinfectants, boiling, salting and pickling. At the same time, low temperatures do not have a detrimental effect on Leptospira. This explains their ability to overwinter in open reservoirs and moist soil, fully maintaining virulence.

Epidemiology of leptospirosis

Leptospirosis is one of the most common natural focal infectious diseases. The source of the infectious agent is wild, farm and domestic animals. Role individual species animals as a source

leptospirosis infection is far from the same due to varying degrees their sensitivity to these microorganisms and the nature of the response to infection. Animals in which, as a result of infection, a chronic and, in some cases, asymptomatic process occurs, accompanied by prolonged excretion of leptospira in the urine, have the greatest epidemiological and epizootological significance. It is these animals that ensure the preservation of Leptospira as a biological species. The greatest importance in natural foci of leptospirosis is assigned to representatives of the order of rodents, as well as insectivores (hedgehogs, shrews). Carriage of Leptospira has been proven in almost 60 species of rodents, of which 53 belong to the family Mouse-like and Hamster-like.

The biological plasticity of Leptospires makes it possible to adapt them to agricultural and domestic animals (cattle, pigs, horses, dogs), as well as to synanthropic rodents (gray rats, mice),

which form anthropurgic foci of infection, representing the main danger to humans (Fig. 17-3).

From an epidemiological point of view, the incidence of large and small cattle, as well as pigs. Animals of any age are affected, but in adults leptospirosis occurs more often in a latent form, and in young animals - in a more pronounced form.

new symptoms.

Humans are not important as a source of infection.

The main factor in the transmission of the causative agent of leptospirosis is water contaminated with secretions (urine) of infected animals. The immediate causes of human infection are the use of raw water for drinking, washing from open reservoirs, swimming in small low-flow ponds or wading them.

They also play some role in the transmission of infection. food products, contaminated with rodent secretions. Transmission of the infection most often occurs through contact, but the food route is also possible. Transmission factors include

wet soil, pasture grass, contaminated with excretions of sick animals. Infection can occur during the slaughter of livestock, cutting up carcasses, as well as through consumption of milk and unheated meat. Leptospirosis often affects people who have professional contact with sick animals: veterinarians, pest control specialists and agricultural workers.

For Leptospira to penetrate, the slightest violation of the integrity of the skin is sufficient.

Epidemic outbreaks of leptospirosis are usually confined to the summer-autumn period. The peak incidence occurs in August. There are three main types of outbreaks: aquatic, agricultural and livestock.

Leptospirosis also occurs in sporadic cases, which can be recorded throughout the year.

Leptospira are hydrophilic, therefore leptospirosis is characterized by high prevalence in areas where there are many swampy and highly humid lowlands.

In the Russian Federation, leptospirosis is considered one of the most common zoonoses, the incidence is 0.9–1.5 per 100 thousand population. The incidence is highest in the North-West, Central and, especially, North Caucasus

regions. In recent years, a clear trend towards urbanization of morbidity has been noted - distribution in megacities (Moscow, St. Petersburg).

The natural susceptibility of humans to leptospirosis infection is significant. Post-infectious immunity is strong, but type-specific, so recurrent diseases caused by other serovars of the pathogen are possible.

Measures to prevent leptospirosis

Nonspecific

Prevention is carried out jointly by the bodies of Rospotrebnadzor and the veterinary service. They identify and treat valuable animals, carry out regular rodent control of populated areas, protect water bodies from contamination by animal excretions, prohibit swimming in stagnant bodies of water, disinfect water from open water sources, and fight stray dogs.

Specific

Vaccination of farm animals and dogs is carried out, as well as routine vaccination of persons whose work is associated with the risk of contracting leptospirosis: workers of livestock farms, zoos, pet stores, dog kennels,

fur farms, enterprises for processing livestock raw materials, laboratory employees working with Leptospira crops. The vaccine for the prevention of leptospirosis is administered from the age of 7 years at a dose of 0.5 ml subcutaneously once, revaccination after a year.

Pathogenesis of leptospirosis

The pathogen penetrates the human body due to its mobility.

The entrance gates are microdamages to the skin and mucous membranes of the oral cavity, esophagus, conjunctiva of the eyes, etc. There are known cases of laboratory infection through damaged skin. With intradermal penetration in an experiment on laboratory animals, leptospira penetrates the blood within 5–60 minutes, apparently bypassing The lymph nodes, which do not perform a barrier function in leptospirosis. At the site of introduction of the pathogen, no primary affect occurs. Further spread of Leptospira occurs through the hematogenous route, while the lymphatic vessels and regional lymph nodes also remain intact. With the blood stream, leptospira enters various organs and tissues: liver, spleen, kidneys, lungs, central nervous system, where their reproduction and accumulation occur. Developing first phase infections lasting from 3 to 8 days, which corresponds to the incubation period.

Second phase The pathogenesis of leptospirosis is secondary bacteremia, when the number of leptospira in the blood reaches a maximum and they still continue to multiply in the liver and spleen, adrenal glands, causing the clinical onset of the disease. With the blood flow, leptospira are again distributed throughout the body, even breaking the BBB. During this period, along with the reproduction of leptospira, their destruction begins as a result of the appearance of antibodies that agglutinate by the fourth day of the disease and lyse the leptospira. The accumulation of metabolic products and breakdown of leptospira in the body is accompanied by fever and intoxication, which increases the sensitization of the body and causes hyperergic reactions.

This phase lasts for 1 week, but can be shortened to several days. The maximum concentration of leptospira towards the end of the leptospiremia phase is observed in the liver. Leptospira produces hemolysin, which, influencing the membrane of red blood cells, causes their hemolysis and the release of free bilirubin. In addition, destructive changes develop in the liver with the formation of inflammation and tissue edema. In severe cases of the disease, the main factor pathological process in the liver - damage to the membranes of blood capillaries, which explains the presence of hemorrhages and serous edema.

The pathogenesis of jaundice in leptospirosis is twofold: on the one hand, the breakdown of red blood cells due to the toxic effect on the membranes of hemolysin and hemolytic antigen, as well as as a result of erythrophagy by the cells of the reticuloendothelial system in the spleen, liver and other organs, on the other hand, due to developing parenchymal inflammation with disruption of bile formation and excretory function of the liver.

Third phase pathogenesis of leptospirosis - toxic. Leptospira die due to the bactericidal effect of the blood and the accumulation of antibodies, disappear from the blood and accumulate in the convoluted tubules of the kidneys. The toxin accumulated due to the death of Leptospira has a toxic effect on various organs and systems. In some patients, Leptospira multiply in convoluted tubules and are excreted from the body in the urine. In this case, kidney damage comes to the fore. Most characteristic lesion kidneys with leptospirosis is a degenerative process in the epithelium of the tubular apparatus, so it is more correct to consider them as diffuse distal tubular nephrosis. Patients develop signs of acute renal failure with oligoanuria and uremic coma. Heavy defeat kidneys are one of the most common reasons death due to leptospirosis.

In the toxemia phase, damage to organs and tissues is caused by the action of not only the toxin and waste products of Leptospires, but also autoantibodies formed as a result of the breakdown of affected tissues and cells of the macroorganism. This period coincides with the second week of illness, but may be somewhat delayed. The toxin has a damaging effect on the endothelium of capillaries, which increases their permeability with the formation of blood clots and the development of disseminated intravascular coagulation syndrome.

The central nervous system is affected due to the penetration of the BBB by leptospira. Some patients develop serous or purulent meningitis, less commonly meningoencephalitis.

In some cases, specific leptospirosis myocarditis occurs.

The pathognomonic symptom of leptospirosis is the development of myositis with damage to the skeletal, especially the calf muscles. The lungs (leptospirosis pneumonia), eyes (iritis, iridocyclitis), and less often other organs are often affected.

Clinical picture of leptospirosis

The incubation period lasts from 3 to 30 (usually 7–10) days.

Classification

There is no generally accepted classification of leptospirosis.

According to the clinical course, there are mild, moderate and severe forms of leptospirosis. Light form may occur with fever, but without significant damage to internal organs. Moderate form characterized by severe fever and widespread clinical picture leptospirosis, and the severe form is characterized by the development of jaundice, the appearance of signs of thrombohemorrhagic syndrome, meningitis and acute renal failure. By clinical manifestations There are icteric, hemorrhagic, renal, meningeal and mixed forms. Leptospirosis can be complicated or uncomplicated.

Main symptoms and dynamics of their development

The disease begins acutely, without a prodromal period, with severe chills and an increase in body temperature within 1–2 days to high numbers (39–40 °C).

The temperature remains high for 6–10 days, then it decreases either critically or by shortened lysis. In patients who have not received antibiotics, a second febrile wave can be observed. Other symptoms of intoxication also occur, such as severe headache, lower back pain, weakness, lack of appetite, thirst, nausea, and sometimes vomiting. Conjunctivitis may also develop during this period.

A characteristic sign of leptospirosis is pain in the muscles, mainly the calf muscles, but pain in the muscles of the thigh and lumbar region may occur. In severe forms, the pain is so severe that it makes it difficult for the patient to move. On palpation, sharp muscle soreness is noted. The intensity of myalgia often corresponds to the severity of the disease. Myolysis leads to the development of myoglobinemia, which is one of the causes of acute renal failure. In some patients, myalgia is accompanied by skin hyperesthesia. Noteworthy are the hyperemia of the skin of the face and neck and the injection of scleral vessels. Upon examination, a “hood symptom” is revealed - puffiness of the face and hyperemia of the skin of the face, neck and upper half of the chest, injection of scleral vessels.__

In severe cases of leptospirosis, from the 4th–5th day of illness, icterus of the sclera and jaundice of the skin occur. Clinical course can be schematically divided into three periods:

• elementary;
• height;
• recovery.

In 30% of patients, exanthema occurs in the initial and sometimes at the height of the disease. The rash consists of polymorphic elements located on the skin of the trunk and limbs. The nature of the rash can be measles-like, rubella-like, or less often scarlet-like. Urticarial elements may also occur.

Macular rash tends to merge individual elements. In these cases, erythematous fields are formed. Erythematous exanthema is the most common; the rash disappears after 1–2 days. After the rash disappears, pityriasis-like peeling of the skin is possible. Herpetic rashes often appear (on the lips, wings of the nose). Thrombohemorrhagic syndrome is manifested, in addition to petechial rash, by hemorrhages in the skin at injection sites, nosebleeds,

hemorrhages in the sclera.

During this period, a slight sore throat and cough are possible. At objective research moderate hyperemia of the arches, tonsils, soft palate, on which you can see enanthema, hemorrhages.

In some patients, the submandibular and posterior cervical lymph nodes are enlarged.

From the outside of cardio-vascular system Relative bradycardia and decreased blood pressure are noteworthy. Heart sounds are muffled, and ECG can detect signs of diffuse myocardial damage. The development of specific leptospirosis pneumonia or bronchitis is possible. When it occurs, dullness of pulmonary sound and pain in the chest. The liver is enlarged, moderately painful on palpation, and in almost half of the patients the spleen is palpable.

Signs of central nervous system damage in leptospirosis are meningeal syndrome: dizziness, delirium, insomnia, headache and positive meningeal symptoms (stiff neck; Kernig's sign; upper, middle and lower symptoms Brudzinsky). When examining the cerebrospinal fluid, signs are noted serous meningitis: cytosis with a predominance of neutrophils.

From the urinary system, signs of acute renal failure can be observed: decreased diuresis up to the development of oligoanuria, the appearance of protein, hyaline and granular casts in the urine, renal epithelium. The blood content of potassium, urea, and creatinine is increased. When examining peripheral blood, an increase in ESR and neutrophilic leukocytosis with a shift of the formula to the left, often to myelocytes, and aneosinophilia are determined.

At the height of the disease, from the 5th–6th day in severe cases, intoxication increases, headache intensifies, muscle weakness, aversion to food appears, vomiting becomes more frequent, although the body temperature decreases. Some patients experience jaundice, the intensity of which corresponds to the severity of the disease and lasts from several days to several weeks. During this period, the most severe manifestations of hemorrhagic syndrome are observed: hemorrhages in the skin and mucous membranes, bleeding from the gums, gastrointestinal bleeding, hemoptysis, hemorrhages in the membranes and substance of the brain. More often, hemorrhagic syndrome is observed in the icteric form of the disease. Clinical and ECG signs of damage to the heart and meninges appear. Kidney damage deserves special attention: increasing azotemia, proteinuria.

As a result of hemolysis and impaired erythropoiesis, hyporegenerative anemia, thrombocytopenia, leukocytosis, lymphopenia increase, platelet aggregation ability is impaired, ESR reaches 40–60 mm/h. At biochemical research blood reveals moderate hyperbilirubinemia with increased content both bound and free bilirubin at slight increase transferase activity. At the same time, due to muscle damage, the activity of creatine phosphokinase sharply increases, the protein synthetic function of the liver is disrupted, and the level of albumin decreases.

The condition begins to improve from the end of the second week, the period of convalescence is from the 20–25th day of illness. During this period, a relapse of the disease is possible, which usually proceeds more easily than the main wave. In other cases, body temperature

persistently normalizes, but persists for a long time asthenic syndrome, polyuric crisis is possible. The functions of the liver and especially the kidneys are restored slowly; insufficiency of tubular function persists for a long time, which is manifested by isohyposthenuria and proteinuria; Trophic disorders and an increase in anemia are possible.

In different regions, the course may differ in the frequency of icteric forms, damage to the central nervous system, and the development of acute renal failure. The most severe form of leptospirosis is caused by L. interrogans icterohaemorragiae. Abortive and erased forms of the disease are common, occurring with short-term (2-3 days) fever without typical organ pathology.

Complications of leptospirosis

ITS, acute renal failure, acute hepatic renal failure, acute renal failure (RDS), massive bleeding, hemorrhage, myocarditis, pneumonia, in late dates-uveitis, iritis, iridocyclitis.

Mortality and causes of death

Mortality varies from 1 to 3%. The causes of death are the complications mentioned above, most often acute renal failure.

Diagnosis of leptospirosis

Clinical

Epidemiological anamnesis plays an important role in the diagnosis of leptospirosis. The patient’s profession should be taken into account (agricultural worker, hunter, veterinarian, pest control), as well as contact with wild and domestic animals. Attention should be paid to whether the patient swam in open water, since the contamination of water with leptospira in some regions is extremely high.

The diagnosis of leptospirosis is established on the basis of characteristic clinical symptoms: acute onset, hyperthermia, myalgia, facial flushing, combined liver and kidney damage, hemorrhagic syndrome, acute inflammatory changes in the blood.

Specific and nonspecific laboratory diagnostics

Laboratory confirmation of the diagnosis is obtained through bacterioscopic, bacteriological, biological and serological studies. In the first days of the disease, leptospires are detected in the blood using dark-field microscopy, and later in urine sediment or CSF.

When culturing blood, urine or CSF on culture media containing blood serum, it is possible to obtain more reliable results, although this method takes time, since, as already mentioned, leptospira grows rather slowly.

Primary cultures of blood, urine, organ tissues suspected of containing leptospira are recommended to be kept for the first 5–6 days at a temperature of 37 ° C, and then at 28–30 ° C.__ The biological method consists of infecting animals: mice, hamsters and guinea pigs, however, recently this method has had many opponents who consider it inhumane.

The most informative are serological methods, in particular the microagglutination test recommended by WHO. An increase in antibody titer of 1:100 or higher is considered positive. RAL Leptospira in the Dutch modification is also used. Antibodies appear late, no earlier than the 8th–10th day of illness, so it is advisable to examine paired sera taken at intervals of 7–10 days.

Treatment of leptospirosis

Mode. Diet

Treatment is carried out in a hospital setting. Hospitalization is carried out according to epidemiological indications. Mode in acute period bed. Diet is determined clinical features diseases. If renal syndrome is dominant - table No. 7, hepatic - table No. 5, with combined lesions - table No. 5 with salt restriction or table No. 7 with fat restriction.

Drug therapy

The main method of treatment is antibacterial therapy, which is most often carried out with penicillin at a dose of 4–6 million units/day or ampicillin at a dose of 4 g/day. If penicillin is intolerant, doxycycline is prescribed at a dose of 0.1 g twice a day, chloramphenicol at a dose of 50 mg/kg per day. If the central nervous system is affected, the dose of penicillin is increased to 12–18 million units/day, the dose of ampicillin is increased to 12 g/day, and chloramphenicol is increased to 80–100 mg/kg per day.

The duration of antibiotic therapy is 5–10 days.

With acute renal failure in initial stage when the daily amount of urine decreases, osmotic diuretics are administered intravenously (300 ml of 15% mannitol solution, 500 ml of 20% glucose solution), 200 ml of 4% sodium bicarbonate solution per day in two doses. In the anuric stage, large doses of saluretics (up to 800–1000 mg/day of furosemide), anabolic steroids (methandienone 0.005 g 2–3 times a day), 0.1 g/day of testosterone are administered.

For ITS, the patient is administered intravenously prednisolone at a dose of up to 10 mg/kg per day, dopamine according to an individual regimen, then sequentially intravenously 2–2.5 l of a solution such as Trisol♠ or Quintasol♠, 1–1.5 l of a polarizing mixture (5% solution glucose, 12–15 g of potassium chloride, 10–12 units of insulin). Saline solutions are first injected in a stream, then moving to drip administration(when pulse and blood pressure appear). When DIC develops, fresh frozen plasma, pentoxifylline, sodium heparin, and protease inhibitors are used.

Indications for hemodialysis

• Two- or three-day anuria.
• Azotemia
  Use hyperbaric oxygen therapy. With pronounced hemorrhagic syndrome prescribe 40–60 mg/day prednisolone orally or intravenously 180–240 mg/day. Symptomatic treatment and a complex of vitamins are also prescribed.

LEPTOSPIROSIS

Leptospirosis is an acute infectious disease from the zoonotic group, caused by Leptospira, with predominant damage to the kidneys and liver, cardiovascular and nervous systems. Diseases previously identified in isolation depending on the Leptospira serotype are considered as clinical variants of one nosological form

Etiology. Leptospira is an elongated, corkscrew-shaped cell that is not very resistant to unfavorable environmental conditions. The pathogen has a variety of forms. Most outbreaks are associated with leptospira icterohemorrhagica, canicola, pomona, influenpotyphos, hebdomadis, and less often with other numerous forms of leptospira. The most common sources of infection in humans are livestock, rodents, dogs and water. The main reservoir of the pathogen, especially in cities, are rats, which pollute the environment and water bodies with their secretions. Circulation of the pathogen among rats is possible when sewage or water sources are contaminated. Food products can become a factor in the transmission of infectious agents only when they are intensively infested with rats.

Over the past decades, changes in the etiological structure of leptospirosis have been observed. If in the post-war years in the Ukrainian SSR pathogens such as influenpotyphoid and pomona prevailed, associated with water outbreaks caused by infection from agricultural and wild animals, then in recent years the leading factor has become icterohemorrhagic leptospirosis, which has led to a noticeable increase in severe clinical forms with high mortality.

Epidemiology. Leptospirosis is common on all continents. The majority of diseases are associated with the water factor - swimming in rivers, ponds, lakes, and fishing. This explains the summer seasonality, especially pronounced during hot days. But even in winter, there are cases of human infection as a result of contact with rodents on livestock farms, food factories, grocery stores, and homes inhabited by rodents. Infection can occur when hunting for muskrats or caring for nutria in home breeding conditions. The incidence remains elevated among certain groups associated with caring for sick animals (veterinarians, livestock specialists, milkmaids, pig farmers), slaughtering livestock in meat processing plants, and working in mines where rodents are present.

Particularly convincing are cases of the disease in people in whom, in the presence of skin abrasions, scratches, cuts, abrasions, the first symptoms of leptospirosis appeared a few days after swimming in a river or a reservoir with stagnant water. The water factor of infection, which can be considered the main one, allows us to consider leptospirosis as a disease of dirty water. Group diseases, especially anicteric forms, are often associated with field agricultural work. Hence the names of such fevers - “meadow”, “water”, “mowing”.

Pathogenesis. Leptospira penetrates the human body through the mucous membranes of the digestive system, conjunctiva, and skin, without leaving inflammatory changes at the site of penetration. Even invisible damage. scratches and abrasions can become gateways to infection. Once in the body, leptospires are carried by the blood and lymph into organs rich in reticuloendothelial tissue, mainly the liver, kidneys, and spleen. Here they multiply quickly. Leptospiremia reaches its full development by the 3-5th day of the disease. During this period of generalization of clinical symptoms, leptospira can be detected in the blood, as well as in the cerebrospinal fluid, where they enter after breaking the blood-brain barrier. The accumulation of Leptospira breakdown products in the blood leads to sensitization of the body and the occurrence of hyperergic reactions. The most important pathogenetic factor is damage to the blood capillaries. An increase in their permeability is clinically manifested by hemorrhagic syndrome. It comes to the fore in the picture of pathological changes in internal organs in the form of extensive hemorrhages in the kidneys, liver, spleen, adrenal glands, and digestive system. Thrombocytopenia and decreased blood clotting are of great importance in the origin of hemorrhages. The inflammatory process in hepatocytes is often accompanied by jaundice. Autoimmune processes take part in the development of the disease.

Under the influence of specific antibodies, leptospira disappear from the blood by the end of the 1st week of illness. Their further intensive accumulation occurs in the kidneys. Damage to the convoluted tubules leads to impaired urination, including uremia - the main cause of death. After an illness, strong and long-lasting active immunity is formed.

Clinic differs in significant diversity - from a short-term febrile state to extremely severe forms that end in death. The duration of the incubation period is from 3 to 14 days. In some cases, this period can be reduced to 2 days. Sometimes, for example, when swimming in a pond once, the incubation period can be determined with maximum accuracy. Only rarely is there a gradual development in the form of malaise and weakness. In most cases, the disease begins acutely with chills and fever. The temperature rises to 39-40 ° C, is remitting in nature, lasts 5-8 days, and then decreases critically or as an accelerated lysis. Subsequently, second, shorter wave of fever - the disease recurs. As leptospiremia develops, intoxication increases: appetite disappears, nausea, vomiting, headache, sometimes delirium, and loss of consciousness appear. Patients may remain immobile. The slightest effort is associated with widespread myalgaia. Particularly troubling is the pain in the calf muscles, sometimes expressed to such an extent that patients have difficulty moving and have difficulty staying on their feet. Sometimes there may be no pain Possible abdominal syndrome associated with damage to the abdominal muscles.

The patient's appearance is characteristic: hyperemia and puffiness of the face, pronounced injection of scleral vessels, up to hemorrhages under the conjunctiva. An early roseolous-papular ephemeral rash may appear. In severe cases, it becomes petechial in nature. Herpetic rashes on the lips, at the wings of the nose, and enanthema of the mucous membrane of the pharynx are not uncommon. Hemorrhagic manifestations are typical - nosebleeds, vomiting in the form of coffee grounds, hematuria. Extensive bruising remains at the sites of intravenous injections. Changes in the lungs range from mild catarrhal symptoms to hemorrhagic pneumonia. Muffled and dull heart sounds and systolic murmur at the apex are noted. The pulse is slow, tachycardia and arrhythmia are possible. A tendency towards hypotension is determined due to a decrease mainly in diastolic pressure. Protracted collapses, infectious-toxic shock, and dyspnea are possible. Electrocardiographically, changes in the heart muscle, a decrease in functional contractility, the phenomenon of acute toxic-infectious myocarditis, rhythm and conduction disturbances are noted. The ECG determines changes in the final part of the ventricular complex: downward displacement and deformation of the S - T segments, flattening and inversion of the wave T. On the 3-5th day, rapidly increasing jaundice appears. The size of the liver increases. The spleen usually cannot be palpated. From the first days of the illness, symptoms of damage to the central nervous system appear - severe headache, insomnia, lethargy or increased excitability. Often, neurological symptoms are limited to meningitis; in severe cases, serous meningitis can develop. Cerebrospinal fluid comes out in frequent drops, transparent, sometimes xanthochromic, opalescent. The disease proceeds as a lymphocytic meningitis with protein-cell dissociation.

As the disease develops, symptoms of kidney damage come to the fore. Diuresis noticeably decreases, protein and casts appear in the urine, azotemia increases. Violation of glomerular filtration and tubular reabsorption leads to anuria. A gradual increase in diuresis indicates the attenuation of the process. Oliguria is replaced by polyuria, the daily amount of urine excreted can reach 3-4 l, while high levels of residual nitrogen remain for a long time, which can be explained by the increased flow of nitrogen products from tissues into the bloodstream under conditions of a cyclical infectious process. The total duration of the disease is 3-4 weeks.

According to the leading sign of damage to individual organs and systems, the following clinical forms of leptospirosis can be distinguished: hepatorenal, cardiovascular, pulmonary, meningeal, abdominal

Hepatorenal - one of the most common typical forms. Jaundice with symptoms of hepatargia and symptoms of acute renal failure come to the fore.

Cardiovascular the form is manifested by tachycardia, arrhythmia. Hypotension often develops, caused by a decrease mainly in diastolic blood pressure until the development of collapse. sudden cardiac arrest, muffled heart sounds, systolic murmur in the heart area and expansion of its boundaries, pulse lability, rhythm disturbances characteristic of myocarditis, conduction disturbances are noted

Pulmonary the form is characterized by catarrhal symptoms of respiratory pain, sometimes hemorrhagic pneumonia, chest pain, tachypnea, bloody sputum, drop in blood pressure. This option, which is usually extremely severe, has a particularly high mortality rate

Meningeal the form is accompanied by a sharp headache, stiffness of the neck muscles, positive Kernig and Brudzinsky symptoms. When performing a spinal puncture, moderate cytosis is noted, positive Pandi and Nonne-Apelt reactions

Leptospirosis may be masked by symptoms of an acute abdomen Abdominal the form is characterized by sharp pain in the upper abdomen. The pain syndrome resembles the picture of cholecystitis, cholecystopancreatitis. The appearance of jaundice and hyperleukocytosis in these cases can lead to unnecessary laparotomy

The given clinical classification is conditional, since individual options cannot be considered in isolation, there are no clear boundaries between them. The same clinical signs (hyperthermia, headache, jaundice, hemorrhages, renal failure) can be repeated in separate forms, but the main, leading sign allows you to navigate the differential diagnosis of the disease

A laboratory study reveals hyperleukocytosis with a neutrophilic shift, sometimes to young and myelocytes. The number of eosinophilic granulocytes almost always decreases, plasma cells appear. ESR within a short time increases to 40-60 mm/h and even exceeds these indicators Develops hypochromic anemia The hemoglobin content noticeably decreases, blood clotting slows down, which is confirmed by a coagulogram. As jaundice develops, the bilirubin content in the blood reaches high level due to the direct and, to a lesser extent, indirect fraction. The activity of enzymes, in particular aminotransferases, is moderately increased or remains within normal limits, which indicates the presence of an inflammatory rather than a necrotic process in the liver. Diagnostic important sign- a significant increase in the level of residual nitrogen, urea, creatinine. Protein is detected in the urine, red blood cells, renal epithelial cells, and casts appear.

Severe leptospirosis is characterized by 3 main signs: anuria, hepatargia and hemorrhage. However, these symptoms are not always expressed. The disease can be of moderate severity and mild form with short-term fever, moderate intoxication, slight muscle pain. In these cases, liver enlargement is not accompanied by jaundice, changes kidneys are reduced to quickly passing albuminuria and cylindruria, functional tests of the liver and kidneys are slightly disturbed, diuresis remains normal. Complications are possible: myocarditis, endocarditis, acute pancreatitis, polyneuritis, iritis, iridocyclitis, uveitis, generalized muscle damage such as long-term polymyositis

Differential diagnosis In recognizing leptospirosis, an epidemiological history is important. Particularly convincing are cases of the disease of people in whom, in the presence of abrasions, scratches, cuts, the first symptoms of leptospirosis appear 7-12 days after swimming in a river or a reservoir with stagnant water. Group diseases are often associated with professional conditions, agricultural work. In recent years, there has been a noticeable increase in the incidence of leptospirosis not only in the summer, but also in the autumn-winter period, which requires in-depth environmental research and the necessary preventive measures.

Sometimes, in the presence of a typical clinical picture, a positive Leptospira lysis reaction, the most thorough questioning of the sick does not reveal the source of infection. In such cases, the thought arises about the possibility of food contamination by rodents.

Differential diagnostic list, numbering dozens of nosological forms - viral hepatitis, sepsis, influenza, pneumonia, meningitis, cholecystopancreatitis, hemorrhagic fever with renal syndrome, trichinosis, malaria, hepatic and renal colic, secondary infectious jaundice and other diseases and conditions, indicates the variety of symptoms that a practitioner may encounter when recognizing leptospirosis.

Despite the typical clinical picture of this disease, its diagnosis, especially in the first stages, can present significant difficulties due to the polymorphism of the infection. Frequent “masks” of it are the severity of the onset with a steep rise in temperature, as in sepsis or influenza, rapidly increasing jaundice, abdominal syndrome, making one think about cholecystopancreatitis, appendicitis, meningeal symptoms - signs that are equally inherent in many infectious and non-infectious diseases.

The relatively rare occurrence of leptospirosis may be misinterpreted as viral hepatitis. Acute onset, hyperthermia, and early-onset jaundice bring leptospirosis closer to viral hepatitis A. But the subsequent dynamics of clinical and laboratory data, epidemiological history (autumn-winter seasonality of hepatitis A) make it relatively easy to distinguish between them.

Icterohemorrhagic leptospirosis is similar in symptoms to viral hepatitis B, which also has jaundice and hemorrhagic syndrome. In contrast to rapidly developing leptospirosis with increasing renal failure, albuminuria, azotemia, hyperleukocytosis, increased. ESR viral hepatitis B in most cases develops gradually, gradually, accompanied by pain in the joints, an increase in the size of the liver and spleen, mild changes in the kidneys, leukopenia, pronounced activity of serum enzymes, especially aminotransferases, and a sharply slowed ESR. To this we must add epidemiological data: parenteral manipulations and blood transfusions in the premorbid period, which is completely not typical for leptospirosis.

The main differential diagnostic features are given in table. 10.

With a sudden onset high temperature, headache, general fatigue, weakness, photophobia, injection of scleral vessels, malaise can be suspected flu or ORZ. Great importance acquires an epidemiological history, use of water from questionable sources in the field. It is also necessary to take into account the seasonality of acute respiratory infections; they are relatively rarely observed in the summer and are not limited to affecting individual groups. With influenza, there is no severe pain in the calf muscles, there is usually no rash, there is no jaundice, hemorrhagic manifestations, or obvious signs of renal failure. Leukocytosis is not typical, ESR remains normal

It is necessary to remember serous meningitis, not so rarely occurring in infectious diseases of various etiologies. Severe headache, dizziness, neck stiffness, positive Kernig sign, increased cerebrospinal fluid cytosis All these signs can be observed in leptospirosis, the final diagnosis of which is established on the basis of anamnesis, dynamics of clinical laboratory data and the results of a serological study

There are cases where leptospirosis, accompanied by abdominal syndrome, jaundice, and diarrhea, was mistakenly taken for cholecystitis, cholecystopancreatitis, salmonellosis

Table 10 Differential diagnostic criteria for leptospirosis and viral hepatitis

	Leptospiroe	Viral hepatitis
Onset of the disease	Acute is often sudden, without	Acute, especially with hepatitis A,
	pronounced prodromal ne	slow in hepatitis B
Temperature	High in the initial period,	Initial hyperthermia with hepa
	sometimes two-wave	Titis A, normal with hepatitis
Facial hyperemia scleral injection	Clearly expressed	None
Myalgia, pain in the necrosis	The signs are typical, but not necessarily	Absent, joint pain during
	interesting	hepatitis B
Hemorrhagic	Often found	Occurs in severe cases of hepatitis B
	Early sign	Appears after prodromal
Hepatolienal syndrome	Moderate enlargement of the liver, the spleen is rarely palpable	period In most cases it is clearly determined
Kidney damage Cardiac activity ESR	Oliguria anuria Tachycardia, collapses Increases rapidly from the first	Less typical Bradycardia, hypotension Normal or slow
	sick days
Leukocytosis	Expressed with neutrophilic	Leukopenia neutropenia
Residual blood nitrogen Aminotransferase activity	Increased Normal or slightly weaker	Normal indicators Noticeably increased from the first days
Albuminuria, qi	Typically observed	Usually absent
Lindruria
Microagglut reaction	Positive on the rise	Negative
nations with leptospira
Antigenemia	Absent	Detected in hepatitis B

A febrile state as one of the manifestations of leptospirosis may be mistaken for typhoid-paratyphoid disease. Leptospirosis begins acutely, typhoid fever and paratyphoid fever gradually. Patients with typhus are apathetic, drowsy, have a pale face, a roseate rash, and an enlarged spleen are characteristic. Patients with leptospirosis are usually excited, the face is hyperemic, puffy, the injection of scleral vessels is pronounced, symptoms of kidney damage, azotemia, albuminuria predominate. Serological tests (hemoculture, Widal test, microagglutination reaction) help in recognition. Acute onset, hyperthermia can become a reason for the differential diagnosis of leptospirosis in bulk typhus, in which patients complain of a sharp headache and insomnia; hyperemia and puffiness of the face are observed, the injection erased hand tremors, a roseola rash appears, gradually turning into a petechial one. Epidemiological anamnesis and the results of serological studies are of great importance.

Leptospirosis has been repeatedly diagnosed hemorrhagic fever with renal syndrome due to such similarities as sudden onset with chills and hyperthermia, widespread myalgia, kidney damage, hemorrhagic manifestations, injection of scleral vessels, hemorrhages under the conjunctiva. But with leptospirosis there is no sharp pain in the lower back, Pasternatsky’s symptom is negative, the relative density of urine is normal, and with hemorrhagic nephrosonephritis it sharply decreases to 1002-1003, and sometimes to the relative density of water.

Leptospirosis must be differentiated from sepsis, which is characterized by an acute onset, hyperthermia, hemorrhages, hepatorenal syndrome, secondary jaundice, hyperleukocytosis, and increased ESR. All these signs are possible with leptospirosis. The final diagnosis is established taking into account environmental factors, epidemiological prerequisites, the source of possible endogenous infection (thrombophlebitis, pneumonia, endocarditis, staphyloderma), the dynamics of clinical symptoms and laboratory results.

A number of clinical and laboratory signs bring leptospirosis closer to meningococcemia, in the fulminant form, a sudden onset and rapid development of the disease, widespread myalgia, acute kidney failure, hemorrhagic syndrome, hyperleukocytosis, and increased ESR are observed. But unlike leptospirosis, meningococcemia is characterized by a profuse star-shaped rash with superficial necrosis of the epithelium, meningeal manifestations, sometimes memory loss, loss of consciousness, and no jaundice; microscopy of a smear and a thick drop of blood reveals meningococcus. Timely and immediate delivery correct diagnosis largely determines the outcome of the disease.

Leptospirosis is an infectious disease, the source of which is sick animals. The disease can most often be contracted through open bodies of water contaminated with the pathogen. The disease is characterized by the development of fever, nausea, body aches, impaired formation of secondary urine, pathology of liver function, central nervous system and hemorrhages on the skin.

If not provided in a timely manner medical care The outcome of the disease is most often death.

Leptospirosis in humans, causes of the disease, treatment

Leptospirosis is the most common disease transmitted from animals to humans in the world. It is recorded everywhere except in deserts and permafrost areas. In the Russian Federation, about 1,500–2,000 cases are registered every year, which is a high figure due to the great danger of this disease for humans.

Leptospirosis is caused by a bacterium of the Spirochaetaceae family, genus Leptospira. This pathogen has several types of Leptospira, which can be divided into groups:

1. Pathogenic
2. Non-pathogenic saprophytes
3. With unknown pathogenicity

Leptospira have good survival in water (more than 200 days), in wastewater (up to 10 days), and can survive in moist soil from 43 to 280 days. Leptospira die in a dry environment, temperature 80-100°C, while low temperatures, on the contrary, contribute to the preservation and preservation of the bacterium. Almost all disinfectants have a detrimental effect on the viability of Leptospira.

The main natural reservoir of the pathogen is rodents, mammals, foxes, arctic foxes, and nutria. Penetration of the pathogen into the human body occurs most often through the fecal-oral route, through contaminated food, and dirty hands. People's susceptibility to the pathogen is high, because it can enter the human body through damaged skin or mucous membranes at any time of the year.

When Leptospira enters the body through the skin, pinpoint necrotic areas are quickly detected in the skeletal muscles. The same thing happens in the kidneys, and the tubular system is affected, which causes swelling of the tissues, decreased diuresis, as a result of a violation of the structure of the kidneys.

In the liver, swelling of parenchymal tissue and cell destruction occurs. This leads to retention of bile in the liver, changes in skin color and damage to the nervous system organs by metabolic products of the body that accumulate due to liver pathology. Hemorrhages occur in the brain and lungs, which leads to severe pathology of the organ and disruption of its performance.

Treatment of the disease consists of prescribing specific antibacterial treatment, detoxification therapy and prevention of disease complications.

Leptospirosis in humans: symptoms and treatment

Water is the main source of leptospirosis both among people and among animals that come to drink and contaminate the water, then through this water other individuals, including humans, become infected.

The first symptoms of the disease appear after 2-26 days, on average 7-13 days. The duration of the incubation period depends on the microbial load on the body. Moreover, the more bacteria that enter the body, the faster the disease develops.

Leptospirosis is characterized by a two-phase course:

1. Leptospiremia - in this phase, leptospira can be detected in the blood and cerebral fluid during the first 4-9 days of the disease. The disease “Leptospirosis” in humans, symptoms and treatment (video and photo research reports) of this period of the disease were studied in detail only in the 80-90s of the last century. According to these studies, we can say that the disease begins suddenly, acutely. The first symptoms are most often a headache located in the frontal lobe or temples. After joining It's a dull pain in the muscles lower limbs, lower back. Very often, the onset of the disease is accompanied by chills and a rapid rise in body temperature to hectic levels (39.9 - 41°C). In this case, the duration of fever can last from 6 to 10 days. If during this period the patient does not receive antibiotic therapy, a second wave of fever may recur with severe damage to the muscular system of the human body and severe headache. 30% of patients experience jaundice of the skin and various rashes all over the body, which most often disappear within 24-48 hours. Already on the 4th-5th day of the disease, the “rabbit eye” symptom is noted, which is described as hemorrhage in the sclera and conjunctiva of the eye, which makes it bright red. It has been noted that prescribing antibiotics after 4-5 days of illness has virtually no therapeutic effect.
2. The height of the disease - this period is observed from the 14th to the 30th day of illness. This is characterized by the progression of organ damage, increased symptoms of intoxication (nausea, weakness, headache, elevated body temperature). Almost always there are hemorrhages in the skin and mucous membranes. In this case, there is a violation of the formation of secondary urine. Diuresis is less than 500 ml per day. Progressive renal failure is noted.

When examining the cardiovascular system, tachycardia and arrhythmia are noted. Severe forms diseases are always accompanied by bleeding various localizations(uterine, intestinal, pulmonary). The most interesting thing is that last stage Leptospirosis disease in humans, symptoms and treatment (video and photo research reports) have been studied in detail much earlier than first period of illness.

This is due to the fact that clinical symptoms the second phase is more pronounced and visible to the naked eye, while the first stage is in good condition immune system can only be diagnosed in a laboratory.

According to studies, Benzylpenicillin at a dosage of 500 thousand units 6 times a day or Doxycycline 100 mg IM 2 times a day for 7-10 days had a good therapeutic effect.

Leptospirosis in humans: symptoms and treatment, consequences of the disease

If medical care is not provided, everyone pathological symptom The disease can cause complications that threaten the quality and course of life:

• A decrease in the amount of urine excretion can lead to intoxication of the body with metabolic products, which will cause painful death or disability of the patient. In 80% of cases, patients undergo lifelong hemodialysis due to irreversible kidney damage.
• Yellowness of the skin leads to chronic liver damage, which over the next 5-6 years ends in cirrhosis and death within 10 years.
• Fever, nausea, muscle pain and other symptoms of intoxication if medical care is not provided can lead to organic damage brain with subsequent irreversible changes in its functioning.

In order to prevent serious complications disease requires thorough detoxification therapy with drug prevention complications at all stages of the disease.

If symptoms of brain damage develop, it is necessary to increase the dose of Benzylpenicillin to 20 thousand units/kg body weight or replace the antibiotic with Chloramphinicol at 80-100 mg/kg body weight.

At allergic reactions Ceftriaxone at a dose of 2-4 g per day IV is very effective against the penicillin series.

Leptospirosis in humans: symptoms and treatment for children

In childhood, leptospirosis has a very heavy treatment due to instability of the immune system. Therefore, at the first symptoms of the disease, children are immediately hospitalized in the intensive care unit, Ceftriaxone is prescribed in the maximum dose allowed for their age, powerful detoxification therapy is prescribed, and possible complications are prevented.

Leptospirosis is very dangerous, transient infectious disease, which is difficult to treat. Therefore, treatment at home can lead to a large number complications and even death.

At the first symptoms of leptospirosis, you must immediately contact the nearest infectious diseases department to confirm or remove the diagnosis.