a review on the clinical outlook of leptospirosis

International Research Journal of Emerging Trends in Multidisciplinary
ISSN 2395 - 4434
Volume 1, Issue 10 December 2015
www.irjetm.com
A REVIEW ON THE CLINICAL OUTLOOK OF
LEPTOSPIROSIS
*
ÖZGÜR ASLAN
*Lecturer, ArtvinCoruh University, Faculty of Health Sciences, Artvin /TURKEY
spirals hooked at one or both ends, and it
ABSTRACT
Leptospirosis is an infectious
moves by spinning or with lateral
disease, which is frequent in several
movements. It could be observed using
countries, generally characterized by
dark field microscopy or other special
symptoms
stains (İkiz and Özgür, 2004; Saltoğlu,
such
as
hemoglobinemia,
icterohemoglobinuria, icterus, sepsis, and
2003;Şahin et al., 2002; ).
anemia induced by leptospira genus
species in all domestic animals and
CLINICAL FINDINGS
humans.
Keywords:
Leptospirozis,
clinical
Leptospirosis is characteristically a twophased disease: the septicemic phase
outlook of leptospirosis
(lasting 4 – 9 days) and immunogenic
phase (lasting 4 – 30 days). In the initial
INTRODUCTION
period
Leptospirosis
is
a
prevalent
and
(septicemic
phase)
leptospira
could be existent in the blood and BOS.
significant zoonotic infections in the
Leptospiromia
world, induced by Leptospira genus
Symptoms start to disappear with the
spirochetes. Leptospirosis is an infection
formation of IgM-type anti bodies and the
indicated by over 240 serotypes in
fever goes down. During the second, and
rodents, mammals, certain birds and
sometimes the third week, a relapse with
reptiles caused by Leptospirainterrogans.
fever that lasts a short period of time is
Leptospirainterrogans is a strict aerobe,
observed. The symptoms reappear. It was
helicoid, slender mobile microorganism
concluded that this second phase is
with two periplasmic flagella. It is
induced by the immune mechanism due
usually 6 – 20μm long and with a
to
diameter of .01μm. It has thick and fixed
(immune phase), neurological system
lasts
hypersensitivity.
for
In
a
this
week.
period
50
International Research Journal of Emerging Trends in Multidisciplinary
ISSN 2395 - 4434
Volume 1, Issue 10 December 2015
www.irjetm.com
symptoms such as meningeal irritation
disease and observed in approximately
symptoms, iridocyclitis, optic neuritis, or
25%
encephalomyelitis
patients suffer from bitemporal and
and
peripheral
of
the
patients.
intense
Symptomatic
neuropathy and miscarriages could be
frontal
observed. In this period called immune
confusion could be observed. In several
phase, leptospira could be observed in
cases, cough and chest pain; hemoptysis
urea, kidneys and humor aqueous, but not
and pulmonary involvement in few
in factor blood and BOS (Turhan et al.,
patients
2012).
(Sünbül, 2003).
are
headache.
significant
Mental
symptoms
Important clinical symptoms are bleeding
or non-bleeding conjunctival hyperemia,
1. Anicteric Leptospirosis
eye pain, increase in muscular tonus,
Many patients start with subclinical or
mild symptoms. In few patients, it is
sudden onset accompanied with fever.
Other symptoms are tremors, headache,
myalgia, abdominal pain and rarely skin
rashes. The most frequent symptom
observed in physical examination is high
fever. Fever recedes after 1 -3 days.
Fever could be biphasic and could repeat
3 – 4 days after recession (Sünbül, 2003;
Sargın et al., 2012). The myalgia that
holds on to back, abdomen and calf
muscles is a significant symptom for
hepato-splenomegaly
lymphadenopathy.
and
Less
frequent
symptoms are macular, maculopapular,
erythematous, urticarial or hemorrhagic
rash. Serious neurological disorders such
as coma, hemiplegia and transverse
myelitis could rarely develop.Leptospira
could be isolated from the urine 5 – 7
days after the onset of the disease.
Routine urine analysis would reflect mild
proteinuria,leukocyturia and/or hematuria
and hyaline, granular cylinders (Sünbül,
2003).
leptospira infection. Sore throat and skin
rash
are
less
frequent
symptoms.
2. IctericLeptospirosis (Weil Disease)
Sometimes photophobia might develop.
This anicteric symptom usually lasts for
A serious form of leptospirosis, Weil
one week and recedes with the formation
disease is characterized by jaundice, renal
of
or
dysfunction, hemorrhagic diathesis and
asymptomatic aseptic meningitis is an
high mortality. It is generally observed
immune phase characteristic of the
with
anti
bodies.
Symptomatic
51
International Research Journal of Emerging Trends in Multidisciplinary
ISSN 2395 - 4434
Volume 1, Issue 10 December 2015
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Leptosipiraicterohaemorrhagiae/copenha
serum creatinine is around 2 -8 mg/dl
geni serotypes, but it could also occur
during the acute phase of the disease, but
with other serotypes. Patients might
in some cases these values could exceed
develop
300
liver,
kidney
failures,
and
18
mg/dl,
respectively.
hemorrhagic pneumonia and circulation
Concurrent development of dehydration
disorders (Sargın et al., 2012). It varies
and hypotension causing hypovolemia
between the disease with a mild fever to
aggravates renal damage. Development
the icteric-hemorrhagic form and to
of anuria is a sign of bad prognosis.
severe liver and kidney involvement
Certain cases recover without the need
(Gün et al., 2005).Kidney and liver
for dialysis, while others require dialysis.
symptoms are predominant in patients.
Renal functions recover without leaving
Jaundice is obvious. Transaminases are
sequela. In cases accompanied with acute
generally high, but frequently remain
kidney failure, serum amylase levels are
within the range of 4 – 5 times the normal
significantly
(Beğendik et al., 2011).
pancreatitis symptoms are not frequent
It displays two clinical pictures of
(Levett, 2001; Aydemir et al., 2004).
high,
but
clinical
biphasic disease (anicteric form) and
fulminant
disease
(icterohemorrhagic
4. Lung involvement
form). In the biphasic disease picture,
primordium is the acute or septicemic
phase. It lasts for one week and indicated
by sudden onset fever, retro-orbital pain,
paraspinal and abdominal muscle pain,
throwing up, purpuric or maculopapular
rash and conjunctival rash (Okur et al.,
2010).
3. Renal involvement
Picture 1: (A) Pneumonemia in a swine
infected with
Leptospirainterrogansserovarcopenhage
Acute renal failure is characterized by
ni in Brasil. (B) Healthy Guinea Pig lung
sudden onset of uremia and oliguria in
for comparison (Bharti et al., 2003).
the second week of the disease often
accompanied with jaundice. Blood urea
nitrogen levels are below 100 mg/dl and
52
International Research Journal of Emerging Trends in Multidisciplinary
ISSN 2395 - 4434
Volume 1, Issue 10 December 2015
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Lung
involvement
is
frequent
in
leptospirosis. Coughing, dyspnea, and
chest pain is present. Severe hemorrhagic
pneumonia and acute pulmonary distress
is observed rarely (Furuncuoğlu et al.,
2006; Sünbül, 2003).
6. Hematologic System Involvement
syndrome could be among the significant
Hemorrhagic symptoms such as petechia,
symptoms of the infection and could
purpura, ecchymosis, and nasal bleeding
develop without hepatic and renal failure.
could be observed in Weil disease.
During the course of the acute disease,
Furthermore, gastrointestinal bleeding,
hemoptysis emerges concurrent with the
pancreatic, adrenal and subarachnoid
cough.
bleeding are also reported rarely (Levett,
With
progressive
lung
involvement, crumb-like small nodular
2001).
Thrombocytopenia
densities, consolidations are observed
observed in many cases, however it is
frequently in the lower lobes. Wen
temporal
radiological involvement is dense, bibasic
disseminated intravascular coagulation
crackles could be heard (Levett, 2001).
(Sünbül, 2003).
and
does
not
is
result
also
in
7. Eye Involvement
5. Heart involvement
Eye symptoms are reported in critical
Heart involvement is observed in the
leptospirosis.In
majority
several
conjunctival hyperemia in certain series
are
was reported. Existence of conjunctival
identified in icteric and non-icteric
hyperemia accompanied with icterus in
patients. Atrial fibrillation, atrial flatter,
sclera is pathognomonic for Weil disease.
tachycardia, and ventricular tachycardia
In a few cases, after recovery from the
including premature ventricular pulses
acute disease, unilateral or bilateral
were observed in one fifth of the patients
anterior uveitis could develop. Uveitis
who had cardiac monetization. In patients
could persevere months or years after the
without
acute disease (Levett, 2001).
of
patients
electrocardiographic
critical
and
variations
supportive
care,
cardiovascular collapse could develop
with
the
Postmortem
shock,
causing
examination
most
patients,
8. Other complications
fatalities.
frequently
reveals acute coronary arteritis and
aortitis, whereas congestive heart failure
Acute infection in pregnancy is reported
to cause abortus and stillbirth. Leptospira
are
isolated
in
breast
milk.
Rare
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International Research Journal of Emerging Trends in Multidisciplinary
ISSN 2395 - 4434
Volume 1, Issue 10 December 2015
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Beğendik H, Oral YU, Baran Aİ,
complications are cerebrovascular events,
2.
rhabdomyolysis,
Karahocagil MK, Erkoç R (2011) Weil
thrombocytopenic
thrombotic
purpura,
acute
hastalığı, Bir olgu sunumu, Van Tıp
cholecystitis, erythema nodosum, aortic
Dergisi. 8(1):33-35.
stenosis, Kawasaki syndrome, reactive
3.
arthritis, epididymitis, nerve paralyses,
Matthias MA, Diaz MM, Lovett MA,
hypogonadism in males, and Guillain-
Levett PN, Gilman RH, Willig MR,
Barre syndrome. Cerebral arteritis is
Gotuzzo E, Vinetz JM. 2003. On behalf
reported. Weil disease has a high
of
mortality rate that varies between 5 –
StatesLeptospirosisConsortium.
15% (Sünbül, 2003).
Lancetİnfect. Dis. Rev. 3: 757- 771.
4.
Bharti AR, Nanlly JE, Ricaldi JN,
the
Peru-
United
Furuncuoğlu Y, Yıldız A, Polat E,
CONCLUSION
Öztürk R. 2006. Leptospira’ya bağlı
As a result, although leptospirosis is
miyokardit olgusu, İst. Tıp Fak. Derg. 69:
defined as a zoonotic infection in humans
87-89.
and animals, characterized with jaundice,
5.
high fever and hemoglobinuria, induced
leptospirainsidansı
by Leptospirainterrogans serotypes, the
Üniversitesi Sağlık Bilimleri Enstitüsü
disease displays a complex clinical
Doktora Tezi, Diyarbakır.
picture and is difficult to diagnose only
6.
using clinical pictures (Gül, 1985; Takçı,
Biberoğlu K. 2005. Weil Hastalığı:
2004).
Aseptik Menenjit, akut böbrek yetmezliği
Gül
K.
1985.
ve
Bölgemizde
tipleri.
Dicle
Gün İT, Sağlam F, Demir U,
ve şiddetli üst gastrointestinal sistem
kanaması ile seyreden bir olgu sunumu.
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