Leptospirosis

Leptospirosis is an acute infectious disease caused by various serotypes of leptospira. It is characterized by general intoxication, fever, kidney damage, liver, nervous system and muscles. In severe forms, acute renal failure, jaundice and hemorrhagic syndrome are observed. Refers to zoonoses with natural foci. Human infection occurs through contaminated water bodies, less often through food or in contact with infected animals (pigs, etc.).

Etiology, pathogenesis. In the pathogenic form of leptospira, there are more than 120 serological types and subtypes. Leptospira in reservoirs persist for up to 25 days, quickly die with heating, drying, with the addition of salt, sugar. On food products are stored up to 1-2 days. Leptospira are sensitive to penicillin, tetracyclines, levomycetin. The gate of infection is often the skin. Leptospira penetrate through microtrauma when in contact with infected water. Can penetrate and through the mucous membranes of the digestive tract. The severity of the disease depends on the reactivity of the microorganisms, and not on the serotype of the leptospira. During the first week of illness, leptospires are found in the blood.

Symptoms, course. The incubation period lasts from 4 to 14 days (usually 7-9 days). The disease begins acutely without any prodromal symptoms. There is a strong chill, body temperature already in the first day reaches 39-40 grams. C. Patients complain of severe headache, insomnia, lack of appetite, muscle pain, especially in the calf muscles. The pain in the muscles is so strong that patients can hardly walk. When palpation there is pronounced tenderness of the muscles. The skin of the face and neck is hyperemic, the vessels of the sclera are injected. Fever lasts 5-10 days, in some patients (without antibiotic therapy) there is a second wave of fever. With severe forms of the disease from the 3rd-5th day, icteric sclera and skin integument appears. At the same time, 20-50% of patients have polymorphic exanthema (korepodobnaya, rubella-like, less scarlet-like). Heavy forms are characterized by hemorrhagic syndrome (petechial rash, bleeding in the sclera, bruising at the injection site, nosebleeds, etc.). However, severe forms with fatal outcome from uremia occur, in which there is no jaundice and manifestations of hemorrhagic syndrome. From the A-5-th day, there is an increase in the liver and spleen. There may be meningeal syndrome (mostly due to serous meningitis). In the blood - neutrophilic leukocytosis, increased ESR. Light forms can occur with a 2-3-day fever, with mild symptoms of general intoxication.

Complications: meningitis, encephalitis, myelitis, irites, iridocyclitis, acute renal failure (the main cause of death of patients), pneumonia, otitis, etc. It is necessary to differentiate from influenza, hemorrhagic fever with renal syndrome, pseudotuberculosis, infectious mononucleosis, typhoparathyphoid diseases. Proof of the disease is the detection of the pathogen or the growth of the titer of specific antibodies. After recovery, long-term immunity is formed with respect to the homologous type.

Treatment. Prescribe penicillin at 2 000 000-4 000 000 units / day, with severe forms, signs of meningitis, daily doses of penicillin are increased to 12 000 000-16 000 000 units / day. You can appoint tetracyclines in a dose of 0.8-1.2 g / day. Antibiotics are used for 8-10 days. At the expressed intoxication and a hemorrhagic syndrome appoint prednisolone on 30-40 mg / sut. A special anti-leptospirosis gamma globulin is produced, which is administered 10 ml IM after preliminary desensitization. When developing acute renal failure, it is necessary to resort to extracorporeal hemodialysis.

The prognosis for severe forms of the disease is serious.

Prevention. Prohibition of bathing in water bodies located in an endemic area, and drinking water from open water bodies. Use of rubber boots when working on wet meadows and overalls when caring for sick animals. According to the indications - vaccination. Sick people do not pose a danger to others.