Leptospirosis (also known as Weil's disease, canicola fever, canefield fever, nanukayami fever or 7-day fever) is a bacterial zoonotic disease caused by spirochaetes of the genus Leptospira that affects humans and a wide range of animals, including mammals, birds, amphibians, and reptiles. It was first described by Adolf Weil in 1886 when he reported an "acute infectious disease with enlargement of spleen, jaundice and nephritis". The pathogen, Leptospira-genus bacteria was isolated in 1907 from post mortem renal tissue slice. leptosirose 200x magified File links The following pages link to this file: Leptospirosis ... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The following codes are used with International Statistical Classification of Diseases and Related Health Problems. ... // A00-A79 - Bacterial infections, and other intestinal infectious diseases, and STDs (A00-A09) Intestinal infectious diseases (A00) Cholera (A01) Typhoid and paratyphoid fevers (A010) Typhoid fever (A02) Other Salmonella infections (A03) Shigellosis (A04) Other bacterial intestinal infections (A040) Enteropathogenic Escherichia coli infection (A045) Campylobacter enteritis (A046) Enteritis due to Yersinia... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. ... The Mendelian Inheritance in Man project is a database that catalogues all the known diseases with a genetic component, and - when possible - links them to the relevant genes in the human genome. ... The Disease Bold textDatabase is a free website that provides information about the relationships between medical conditions, symptoms, and medications. ... MedlinePlus (medlineplus. ... eMedicine is an online clinical medical knowledge base that was founded in 1996. ... Medical Subject Headings (MeSH) is a huge controlled vocabulary (or metadata system) for the purpose of indexing journal articles and books in the life sciences. ... This false-colored electron micrograph shows a malaria sporozoite migrating through the midgut epithelia. ... Zoonosis is any infectious disease that can be transmitted from animals, both wild and domestic, to humans. ... Families Spirochaetaceae Brachyspiraceae    Brachyspira    Serpulina Leptospiraceae    Leptospira    Leptonema The spirochaetes (or spirochetes) are a phylum of distinctive bacteria, which have long, helically coiled cells. ... For other uses of the word, please see Genus (disambiguation). ... Species Leptospira is a genus of spirochaete bacteria, including a small number of pathogenic and saprotrophic microorganisms. ... Trinomial name Homo sapiens sapiens Linnaeus, 1758 Humans, or human beings, are bipedal primates belonging to the mammalian species Homo sapiens (Latin: wise man or knowing man) under the family Hominidae (the great apes). ... Adolf Weil (February 7, 1848/1849, Heidelberg - July 23, 1916) was a German physician after whom Weils disease is named. ... Year 1886 (MDCCCLXXXVI) was a common year starting on Friday (link will display the full calendar) of the Gregorian calendar (or a common year starting on Sunday of the 12-day slower Julian calendar). ... Splenomegaly is an enlargement of the spleen, which usually lies in the left upper quadrant (LUQ) of the human abdomen. ... Jaundice, also known as icterus (attributive adjective: icteric), is a yellowing of the skin, conjunctiva (clear covering over the sclera, or whites of the eyes) and mucous membranes caused by increased levels of bilirubin in the human body (or the body of another red blooded animal). ... Nephritis is inflammation of the kidney. ... A pathogen or infectious agent is a biological agent that causes disease or illness to its host. ... Phyla Actinobacteria Aquificae Chlamydiae Bacteroidetes/Chlorobi Chloroflexi Chrysiogenetes Cyanobacteria Deferribacteres Deinococcus-Thermus Dictyoglomi Fibrobacteres/Acidobacteria Firmicutes Fusobacteria Gemmatimonadetes Lentisphaerae Nitrospirae Planctomycetes Proteobacteria Spirochaetes Thermodesulfobacteria Thermomicrobia Thermotogae Verrucomicrobia Bacteria (singular: bacterium) are unicellular microorganisms. ... 1907 (MCMVII) was a common year starting on Tuesday (link will display the full calendar) of the Gregorian calendar (or a common year starting on Wednesday of the 13-day-slower Julian calendar). ... An autopsy (also known as a post-mortem examination, necropsy or obduction) is a medical procedure that consists of a thorough examination performed on a corpse after death, to evaluate disease or injury that may be present and to determine the cause and manner of a persons death. ... It has been suggested that Renal anomalies and Renal plasma threshold be merged into this article or section. ...

Though being recognised among the world's most common zoonoses, leptospirosis is a relatively rare bacterial infection in humans. The infection is commonly transmitted to humans by allowing fresh water that has been contaminated by animal urine (often from rats) to come in contact with unhealed breaks in the skin, eyes or with the mucous membranes. Zoonosis (pronounced as zoo-on-no-sis) is any infectious disease that may be transmitted from animals, both wild and domestic, to humans. ... An infection is the detrimental colonization of a host organism by a foreign species. ... For the village on the Isle of Wight, see Freshwater, Isle of Wight. ... This article or section is in need of attention from an expert on the subject. ... Species 50 species; see text *Several subfamilies of Muroids include animals called rats. ... In zootomy and dermatology, skin is the largest organ of the integumentary system made up of multiple layers of epithelial tissues that guard underlying muscles and organs. ... A human eye. ... The mucous membranes (or mucosae; singular: mucosa) are linings of mostly endodermal origin, covered in epithelium, and are involved in absorption and secretion. ...

Except for tropical areas, leptospirosis cases have a relatively distinct seasonality with most of them occurring August through September (in the Northern Hemisphere).

Causes

Scanning electron microscope of a number of Leptospira sp. bacteria atop a 0.1 µm polycarbonate filter

Leptospirosis is caused by a spirochaete bacterium called Leptospira interrogans that has at least 5 different serovars of importance in the United States causing disease (icterohaemorrhagiae, canicola, pomona, grippotyphosa, and bratislava).^[1] There are other (less common) infectious strains. It should however be noted that genetically different leptospira organisms may be identical serologically and vice versa. Hence, an argument exists on the basis of strain identification. The traditional serologic system is seemingly more useful from diagnostic and epidemiologic standpoint at the moment (which may change with further development and spread of technologies like PCR). Image File history File links Leptospira_scanning_micrograph. ... Image File history File links Leptospira_scanning_micrograph. ... SEM Cambridge S150 at Geological Institute, University Kiel, 1980 SEM opened sample chamber The scanning electron microscope (SEM) is a type of electron microscope capable of producing high resolution images of a sample surface. ... Polycarbonates are a particular group of thermoplastic polyesters. ... Species Leptospira is a genus of spirochaete bacteria, including a small number of pathogenic and saprotrophic microorganisms. ... A serovar or serotype is a grouping of microorganisms or viruses based on their cell surface antigens. ... Wikipedia does not yet have an article with this exact name. ...

Leptospirosis is transmitted by the urine of an infected animal, and is contagious as long as it is still moist. Deer, cows, sheep, rats, raccoons, possums, voles, skunks, mice, specific marine mammals and even infected dogs may serve as hosts. Dogs may lick the urine of an infected animal off the grass, or drink from an infected puddle. There have even been reports of "house dogs" getting leptospirosis apparently from licking the urine of infected mice that entered the house. There is a direct correlation between the amount of rainfall and the incidence of leptospirosis, making it seasonal in temperate climates and year-round in tropical climates.

Leptospirosis is also transmitted by the semen of infected animals^[2].

Humans become infected through contact with water, food, or soil containing urine from these infected animals. This may happen by swallowing contaminated food or water or through skin contact. The disease is not known to be spread from person to person and cases of bacterial dissemination in convalescence are extremely rare in humans. Leptospirosis is common among watersport enthusiasts in specific areas as prolonged immersion in water is known to promote the entry of the bacteria. Occupational risk factors include veterinarians, slaughter house workers, farmers, and sewer workers. An outbreak in an inner city environment has been linked to contact with rat urine.^[1] Look up veterinarian in Wiktionary, the free dictionary. ...

Symptoms

In animals, the incubation period (time of exposure to first symptoms) is anywhere from 2 to 20 days. In dogs, the liver and kidney are most commonly damaged by leptospirosis. Vasculitis can occur, causing edema and potentially disseminated intravascular coagulation (DIC). Myocarditis, pericarditis, meningitis, and uveitis are also possible sequelae. ^[1] One should strongly suspect leptospirosis and include it as part of a differential diagnosis if the whites of the dog's eyes appear jaundiced (even slightly yellow), though the absence of jaundice does not eliminate the possibility of leptospirosis, and its presence could indicate hepatitis or other liver pathology rather than leptospirosis. Vomiting, fever, failure to eat, reduced urine output, unusually dark or brown urine, and lethargy are also indications of the disease. Incubation period is the time elapsed between exposure to a pathogenic organism and when symptoms and signs are first apparent. ... The term symptom (from the Greek meaning chance, mishap or casualty, itself derived from συμπιπτω meaning to fall upon or to happen to) has two similar meanings in the context of physical and mental health: Strictly, a symptom is a sensation or change in health function experienced by a patient. ... In medicine, vasculitis (plural: vasculitides) is a group of diseases featuring inflammation of the wall of blood vessels due to leukocyte migration and resultant damage. ... Edema (American English) or oedema (British English), formerly known as dropsy or hydropsy, is swelling of any organ or tissue due to accumulation of excess lymph fluid, without an increase of the number of cells in the affected tissue. ... Disseminated intravascular coagulation (DIC) is a pathological process in the body where the blood starts to coagulate throughout the whole body. ... In medicine (cardiology), myocarditis is inflammation of the myocardium, the muscular part of the heart. ... Pericarditis is inflammation of the sac surrounding the heart, the pericardium. ... Meningitis is the inflammation of the protective membranes covering the central nervous system, known collectively as the meninges. ... Uveitis specifically refers to inflammation of the middle layer of the eye, termed the uvea but in common usage may refer to any inflammatory process involving the interior of the eye. ... In medicine, differential diagnosis (sometimes abbreviated DDx or ΔΔ) is the systematic method physicians use to identify the disease causing a patients symptoms. ... Jaundice, also known as icterus (attributive adjective: icteric), is a yellowing of the skin, conjunctiva (clear covering over the sclera, or whites of the eyes) and mucous membranes caused by increased levels of bilirubin in the human body (or the body of another red blooded animal). ... Hepatitis is inflammation of the liver. ... Vomiting (or emesis) is the forceful expulsion of the contents of ones stomach through the mouth. ... Fatigue is a feeling of excessive tiredness or lethargy, with a desire to rest, perhaps to sleep. ...

In humans, leptospiral infection causes a wide range of symptoms, and some infected persons may have no symptoms at all. Leptospirosis is a biphasic disease that begins with flu-like symptoms (fever, chills, myalgias, intense headache). The first phase resolves and the patient is asymptomatic briefly before the second phase begins that is characterized by meningitis, liver damage (causing jaundice), and renal failure. Because of the wide range of symptoms the infection is often wrongly diagnosed. This leads to a lower registered number of cases than there really are. Symptoms of leptospirosis include high fever, severe headache, chills, muscle aches, and vomiting, and may include jaundice, red eyes, abdominal pain, diarrhea, and/or a rash. The symptoms in humans appear after 4-14 day incubation period. The term symptom (from the Greek meaning chance, mishap or casualty, itself derived from συμπιπτω meaning to fall upon or to happen to) has two similar meanings in the context of physical and mental health: Strictly, a symptom is a sensation or change in health function experienced by a patient. ... In the United States medical error is estimated to result in 44,000 to 98,000 unnecessary deaths each year and 1,000,000 excess injuries[1]. It is estimated that in a typical 100 to 300 bed hospital in the United States that excess costs of $1,000,000... An analogue medical thermometer showing the temperature of 38. ... A headache is a condition of pain in the head; sometimes neck or upper back pain may also be interpreted as a headache. ... Vomiting (or emesis) is the forceful expulsion of the contents of ones stomach through the mouth. ... Jaundice, also known as icterus (attributive adjective: icteric), is a yellowing of the skin, conjunctiva (clear covering over the sclera, or whites of the eyes) and mucous membranes caused by increased levels of bilirubin in the human body (or the body of another red blooded animal). ... Abdominal pain can be one of the symptoms associated with transient disorders or serious disease. ... Types 5-7 on the Bristol Stool Chart are often associated with diarrhea Diarrhea (in American English) or diarrhoea (in British English) is a generally unpleasant condition in which the sufferer has frequent watery, loose bowel movements (from the ancient Greek word διαρροή = leakage; literally meaning to run through). Acute infectious... A typical rash A rash is a change in the skin which affects its appearance or texture. ...

Complications

Complications include meningitis, respiratory distress and renal interstitial tubular necrosis, which results in renal failure and often liver failure (the severe form of this disease is known as Weil's disease). Cardiovascular problems are also possible. Approximately 5-50% of severe leptospirosis cases are fatal, however, such cases only constitute about 10% of all registered incidents. Meningitis is the inflammation of the protective membranes covering the central nervous system, known collectively as the meninges. ... Renal failure is the condition in which the kidneys fail to function properly. ... Liver failure is the final stage of liver disease. ...

Diagnostics

On infection the microorganism can be found in blood for the first 7 to 10 days (invoking serologically identifiable reactions) and then moving to the kidneys. After 7 to 10 days the microorganism can be found in fresh urine. Hence, early diagnostic efforts include testing a serum or blood sample serologically with a panel of different strains. It is also possible to culture the microorganism from blood, serum, fresh urine and possibly fresh kidney biopsy. Kidney function tests (Blood Urea Nitrogen and creatinine) as well as blood tests for liver functions are performed. The later reveal a moderate elevation of transaminases. Brief elevations of aspartate aminotransferase (AST), alanine aminotransferase (ALT), and gamma-glutamyltransferase (GGT) levels are relatively mild. These levels may be normal, even in children with jaundice. Diagnosis of leptospirosis is confirmed with tests such as Enzyme-Linked Immunosorbent Assay (ELISA) and PCR. Serological testing, the MAT (microscopic agglutination test), is considered the gold standard in diagnosing leptospirosis. As a large panel of different leptospira need to be subcultured frequently, which is both laborious and expensive, it is underused, mainly in developing countries. A cluster of Escherichia coli bacteria magnified 10,000 times. ... Human blood smear: a - erythrocytes; b - neutrophil; c - eosinophil; d - lymphocyte. ... A microbiological culture is a way to determine the cause of infectious disease by letting the agent multiply (reproduce) in predetermined media. ... The blood urea nitrogen (BUN) test is a measure of the amount of nitrogen in the blood that comes from urea. ... Chemical structure of creatinine. ... In general, a diagnosis (plural diagnoses) covers a broad spectrum, or spectra, of testing in some form of analysis; such tests based on some collective reasoning is called the method of diagnostics, leading then to the results of those tests by ideal (ethics) would then be considered a diagnosis, but... The Enzyme-Linked Immunosorbent Assay (ELISA or EIA for short) is a biochemical technique used in immunology to detect the presence of an antibody or an antigen in a sample. ... PCR tubes in a stand after a colony PCR The polymerase chain reaction (PCR) is a biochemistry and molecular biology technique[1] for exponentially amplifying DNA, via enzymatic replication, without using a living organism (such as E. coli or yeast). ... In medicine, a gold standard test is the diagnostic test that is regarded as definitive in determining whether an individual has a disease process. ...

Differential diagnosis list for leptospirosis is very large due to diverse symptomatics. For forms with middle to high severity, the list includes dengue fever and other hemorrhagic fevers, hepatitis of various etiologies, viral meningitis, malaria and typhoid fever. Light forms should be distinguished from influenza and other related viral diseases. Specific tests are a must for proper diagnosis of leptospirosis. Under circumstances of limited access (e.g., developing countries) to specific diagnostic means, close attention must be paid to anamnesis of the patient. Factors like certain dwelling areas, seasonality, contact with stagnant water (swimming, working on flooded meadows, etc) and/or rodents in the medical history support the leptospirosis hypothesis and serve as indications for specific tests (if available). In medicine, differential diagnosis (sometimes abbreviated DDx or ΔΔ) is the systematic method physicians use to identify the disease causing a patients symptoms. ... Dengue fever (IPA: ) and dengue hemorrhagic fever (DHF) are acute febrile diseases, found in the tropics, with a geographical spread similar to malaria. ... An analogue medical thermometer showing the temperature of 38. ... Hepatitis is inflammation of the liver. ... Etiology (alternately aetiology, aitiology) is the study of causation. ... Meningitis is the inflammation of the protective membranes covering the central nervous system, known collectively as the meninges. ... Malaria is a vector-borne infectious disease that is widespread in tropical and subtropical regions, including parts of the Americas, Asia, and Africa. ... For a related disease which is caused by a different bacterium, see Paratyphoid fever. ... Influenza, commonly known as flu, is an infectious disease of birds and mammals caused by an RNA virus of the family Orthomyxoviridae (the influenza viruses). ... The medical history of a patient (sometimes called anamnesis [1][2] ) is information gained by a physician by asking specific questions, either of the patient or of other people who know the person and can give suitable information (in this case, it is sometimes called heteroanamnesis). ... Water stagnation occurs when water stops flowing. ...

Treatment

Leptospirosis treatment is a relatively complicated process comprising two main components - suppressing the causative agent and fighting possible complications. Aetiotropic drugs are antibiotics, such as doxycycline, penicillin, ampicillin, and amoxicillin (doxycycline can also be used as a prophylaxis). There are no human vaccines; animal vaccines are only for a few strains, and are only effective for a few months. Human therapeutic dosage of drugs is as follows: doxycycline 100 mg orally every 12 hours for 1 week or penicillin 1-1.5 MU every 4 hours for 1 week. Doxycycline 200-250 mg once a week is administered as a prophylaxis. In dogs, penicillin is most commonly used to end the leptospiremic phase (infection of the blood), and doxycycline is used to eliminate the carrier state. Aetiotropic drugs are antibiotics, such as doxycycline, penicillin, ampicillin, and amoxicillin. ... An antibiotic is a drug that kills or slows the growth of bacteria. ... Doxycycline (INN) (IPA: ) is a member of the tetracycline antibiotics group and is commonly used to treat a variety of infections. ... Penicillin nucleus Penicillin (sometimes abbreviated PCN) refers to a group of β-lactam antibiotics used in the treatment of bacterial infections caused by susceptible, usually Gram-positive, organisms. ... Ampicillin is a beta-lactam antibiotic that has been used extensively to treat bacterial infections since 1961. ... Amoxicillin (INN) or amoxycillin (former BAN) is a moderate-spectrum β-lactam antibiotic used to treat bacterial infections caused by susceptible microorganisms. ... Prophylaxis refers to any medical or public health procedure whose purpose is to prevent, rather than treat or cure, disease. ... A vaccine is an antigenic preparation used to establish immunity to a disease. ... Prophylaxis refers to any medical or public health procedure whose purpose is to prevent, rather than treat or cure, disease. ... An asymptomatic carrier (or just carrier), is a person who is infected with an infectious disease or carries the abnormal gene of a recessive genetic disorder, but displays no symptoms. ...

Supportive therapy measures (esp. in severe cases) include detoxication and normalization of the hydro-electrolytic balance. Glucose and salt solution infusions may be administered; dialysis is used in serious cases. Elevations of serum potassium are common and if the potassium level gets too high special measures must be taken. Serum phosphorus levels may likewise increase to unacceptable levels due to renal failure. Treatment for hyperphosphatemia consists of treating the underlying disease, dialysis where appropriate, or oral administration of calcium carbonate, but not without first checking the serum calcium levels (these two levels are related). Corticosteroids administration in gradually reduced doses (e.g., prednisolone starting from 30-60 mg) during 7-10 days is recommended by some specialists in cases of severe haemorrhagic effects. The major metabolites formed from most drug metabolism are detoxication products. ... An electrolyte is a substance containing free ions which behaves as an electrically conductive medium. ... In medicine, dialysis is a type of renal replacement therapy which is used to provide an artificial replacement for lost kidney function due to renal failure. ... In medicine, dialysis is a type of renal replacement therapy which is used to provide an artificial replacement for lost kidney function due to renal failure. ... Calcium carbonate is a chemical compound, with chemical formula CaCO3. ... In physiology, corticosteroids are a class of steroid hormones that are produced in the adrenal cortex. ... Prednisolone is the active metabolite of prednisone. ...

Improper treatment greatly reduces the survival rate. A patient with leptospirosis SHOULD be treated at a specialized medical institution and MUST remain hospitalized until proper resolution of organ(s) failure and clinical infection.

Research

Leptospirosis: a zoonotic disease of global importance. Lancet Infect Dis. 2003 Dec;3(12):757-71 Bharti AR, Nally JE, Ricaldi JN, Matthias MA, Diaz MM, Lovett MA, Levett PN, Gilman RH, Willig MR, Gotuzzo E, Vinetz JM; Peru-United States Leptospirosis Consortium.

In the past decade, leptospirosis has emerged as a globally important infectious disease. It occurs in urban environments of industrialised and developing countries, as well as in rural regions worldwide. Mortality remains significant, related both to delays in diagnosis due to lack of infrastructure and adequate clinical suspicion, and to other poorly understood reasons that may include inherent pathogenicity of some leptospiral strains or genetically determined host immunopathological responses. Pulmonary haemorrhage is recognised increasingly as a major, often lethal, manifestation of leptospirosis, the pathogenesis of which remains unclear. The completion of the genome sequence of Leptospira interrogans serovar lai, and other continuing leptospiral genome sequencing projects, promise to guide future work on the disease. Mainstays of treatment are still tetracyclines and beta-lactam/cephalosporins. No vaccine is available. Prevention is largely dependent on sanitation measures that may be difficult to implement, especially in developing countries.

In a study of 38 dogs diagnosed and properly treated for leptospirosis published in the February 2000 issue of the Journal of the American Veterinary Association, the survival rate for the dialysis patients was slightly higher than the ones not put on dialysis, but both were in the 85% range (plus or minus). Of the dogs in this study that did not die, most recovered adequate kidney function, although one had chronic renal problems.

See also

• Marine Mammal Center

Release of rehabilitated pinnipeds into the Pacific Ocean The Marine Mammal Center is a private non-profit organization centered on rescue, rehabilitation, environmental research and education pertaining to certain species within the pinnipedia, carnivora and cetacea biological orders. ...

References

1. ^ ^{a b c} Heuter, Kerry J.,Langston, Cathy E. (2003). "Leptospirosis: A re-emerging zoonotic disease". The Veterinary Clinics of North America 33: 791-807. 
2. ^ Kiktenko VS (1976). "Leptospirosis infection through insemination of animals.". J Hyg Epidemiol Microbiol Immunol. 21 (2). 

External links

• U.S. Disease Control and Prevention Center page on Leptospirosis
• www.leptonet.net - the Leptospirosis information portal
• International Leptospirosis Society page
• A Symposium on Leptospirosis: Collection of peer-reviewed articles from J Postgrad Med