LEPTOSPIROSIS

Lepthosporiosis is an acute infectious disease characterized by fever, renal, hepatic, and nervous system damage.

Pathogen - leptospira - have the appearance of thin moving spirals; For a long time they are retained in water and in soil; Dying at boiling and the impact of disinfectants.

There are two types of foci of leptospirosis - natural and anthropurgic. In natural foci, the source of the causative agent of infection are rodents, insectivores, artiodactyls, predatory animals of many species, to a lesser extent birds. The most important are mice, voles, muskrats. In anthropurgical foci, the sources of infectious agents are large and small cattle, pigs, horses, dogs, as well as house mice and rats. In animals, the disease occurs in mild or latent form and is often accompanied by a prolonged release of leptospira with urine and feces, and in cattle also with milk. This leads to widespread contamination with environmental pathogens and infection of animals. The person is infected mainly through the water of standing water bodies during bathing, as well as when using it for drinking and household needs without first boiling. Infestation is also possible during mowing on wetlands, when harvesting rice, vegetables, caring for diseased animals, slaughtering and carcassing of these animals, processing raw materials (removing and dressing skins, etc.), using uninfected milk from sick animals, and Also contaminated by the excrement of rodents (mice, rats) food products not subjected to heat treatment (bread, breadcrumbs, confectionery, sugar, etc.). In the form of epidemic outbreaks, leptospirosis is more common in summer and autumn, sporadic cases are recorded throughout the year.

Clinical picture . The duration of the incubation period is 3 - 30 days, usually 6-14 days. The disease begins sharply with chills, raising the body temperature to 39 - 40 ° C. There is severe headache , weakness, general malaise, nausea , vomiting , inhibition, sleep is broken, sometimes nonsense , loss of consciousness. Muscular pains are characteristic. Meningism can develop, and in severe course - serous meningitis. Psychoses are possible. There are bright hyperemia and puffiness of the face, injection of vessels of the sclera, small hemorrhages under the conjunctiva. From the first days of the disease, it is possible to have a rose-papular, papular, and in severe cases a petechial rash, nosebleeds are frequent, bloody vomiting , hematuria , extensive hemorrhages at the injection sites. Tones of the heart are muffled, tachycardia , a systolic murmur at the apex of the heart is heard, collapse can develop. A common but not an obligatory sign is jaundice , which develops on the 3rd - 4th day of the disease. The liver and spleen increase, possibly kidney damage (low back pain, decreased diuresis, down to oligoanuria). High body temperature lasts 5 to 8 days, then decreases critically or accelerated lysis. In a number of cases, relapses of the disease occur, usually proceeding more easily. The disease lasts about 4 weeks. When recovering, asthenia persists for a long time.

Complications . It is possible to develop acute renal failure, myocarditis, meningitis, polyneuritis, iridocyclitis, as well as complications caused by secondary microflora (pneumonia, otitis, pielitis).

The diagnosis is made on the basis of a clinical picture, an epidemiological history (being in conditions of possible contact with the pathogen of the disease) and laboratory data.

This takes into account the characteristic changes in the blood: leukocytosis (up to 20 -30x109 / l) with neutrophilia and a shift of the leukocyte formula to the left, increasing the ESR up to 40-60 mm / h. Urine examination reveals urobilinuria, decreased density, proteinuria, cylindruria, elevated white blood cells and red blood cells. To detect leptospira during the first week of the disease, bacteriological examination of the blood is carried out, and in the 2nd -3rd week - urine. The reaction of microagglutination and smear of leptospira is also used.

Treatment is carried out in a hospital. Assign a milky-vegetable diet and a plentiful drink. Intramuscular injection of a specific anti-leptospirosis gamma globulin was shown. Antibiotics are effective for early administration. In the period of intoxication, infusion therapy is performed (intravenous drip isotonic sodium chloride solution, hemodez, reopolyglucin). When hemorrhagic syndrome prescribed asorutin, vikasol , transfusion of fresh frozen plasma.

Forecast . In severe cases, death from acute renal or renal-hepatic insufficiency is possible.

Prevention. In natural foci, where people's diseases are mainly associated with work in contaminated water bodies and the use of water from these reservoirs for household needs, it is necessary to provide workers with waterproof footwear and gloves and prohibit bathing in water bodies.

For drinking and domestic needs only use disinfected water. According to epidemic indications, people are vaccinated with leptospiroznoy vaccine. In anthropurgical outbreaks, the main measures to combat leptospirosis are deratization and protection of food and water from contamination by rodents. It is necessary to provide working clothes for slaughterhouses, meat processing plants, sewerage facilities, as well as caring for sick animals.