8/4/2019 Leptospirosis Final

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LEPTOSPIROSIS

Submitted by:

IGNACIO, Dianne Grace C.Group 3, BSN 4  – Barcelo

Submitted to:

Ms. Yolanda Borda, RNClinical Instructor 

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OVERVIEW: Leptospirosis*DEFINITION

Leptospirosis is a complex bacterial disease that affects both humans and animals. It is caused byspiral shaped bacteria called spirochetes of the genus Leptospira. Two types of leptospirosis

present: Anicteric leptospirosis and Icteric leptospirosis. People get leptospirosis when brokenskin or mucous membranes (eyes, nose, mouth) comes in contact to either infected animal urine

or water, soil, or vegetation contaminated with such urine.

The bacteria survive best in warm water — 72°F (22°C) — that is fairly stagnant. Most reportedcases have occurred from swimming, wading, or splashing in pools, streams, or puddles

contaminated with infected dog or rat urine. The animals most commonly infected are rats, dogs,

swine, and raccoons. Leptospirosis occurs worldwide and is more common in the tropics. Most

cases occur in the summer.

Leptospirosis has two phases: The first phase starts suddenly with headaches, severe musclepains in the calves and thighs, chills, and fever, and lasts 6 to 15 days. The second phase starts afew days after your temperature has returned to normal. Fever will return, and you may getmeningitis because the bacteria will have spread to the lining of the spinal cord, causing

headaches and a stiff neck. Other serious symptoms include jaundice, mental confusion,

depression, or decreased urine output. The second phase lasts another seven to ten days.

*RISK FACTORS

Leptospirosis is a zoonosis of worldwide distribution. Leptospirosis infects many species of wild

and domestic animals that have been isolated from birds, fish and reptiles. The infected animalsexcrete spirochetes in urine for an extended period of time. The majority of human cases worldwide result from occupational exposure to rat contaminated water or soil. At risk are people who

work with animals, on farms, in rice paddies or sugar cane fields, or in sewers are most at risk.

Seventy-five percent of victims are male, from teenagers to young adults.

  Water activity in endemic areas (Hawaii, Malaysia)

  Fresh-water related activities such as farming or gardening, hiking across streams andswimming

*PATHOPHYSIOLOGY

Leptospires enter the host through abrasions in skin, or through mucus membrane, conjunctivaand nasal mucosa. Followingthe penetration, leptospirosis gain rapid access and circulate in the

blood stream through the lymphatics, resulting in leptospiremia and spread to all organs of the

body. The primary lesion causes damage to the endothelial lining of small blood vessels whichresults in ischemic damage to the liver, kidney, meninges and muscles.

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During acute infection, leptospires multiply in the small blood vessel endothelium, resulting in

damage and vasculitis. The major clinical manifestations of the disease are believed to besecondary to this mechanism, which can affect nearly any organ system.

  In the kidneys, interstitial nephritis, tubular necrosis, and impaired capillary permeability,

as well as the associated hypovolemia, result in renal failure.

 Liver involvement is marked by centrilobular necrosis and Kupffer cell proliferation,with hepatocellular dysfunction.

  Pulmonary involvement is secondary to alveolar and interstitial vascular damage

resulting in hemorrhage. This complication is considered to be the major cause of leptospirosis-associated death.

  The skin is affected by epithelial vascular insult.

  Skeletal muscle involvement is secondary to edema, myofibril vacuolization, and vesseldamage.

  The damage to the vascular system as a whole can result in capillary leakage,

hypovolemia, and shock. Many patients with leptospirosis may develop disseminated

intravascular coagulation (DIC), hemolytic uremic syndrome (HUS), thrombotic

thrombocytopenic purpura (TTP), and vasculitis. Thrombocytopenia indicates severedisease and should raise suspicion for a risk of bleeding.

After an incubation period of 6-15 days, an initial septicemic phase, leptospires can be isolated

from the blood; cerebrospinal fluid and other tissues. Initial symptoms: last for 2-7 days and a

second symptomatic or immune phase begins. The immune phase is associated with theappearance of circulating antibodies, despite the presence of these antibodies still leptospires can

be found in kidney and urine.

*CLINICAL MANIFESTATIONS

The course of the disease is a 6-15 days asymptomatic incubation period followed by roughly a

7-day period of flue-like symptoms where the patient is febrile and experiences chills, severeheadache, chills, muscle aches, and vomiting, and may include jaundice (yellow skin and eyes),

red eyes, abdominal pain, diarrhea, or a rash. If the disease is not treated, the patient could

develop kidney damage, meningitis (inflammation of the membrane around the brain and spinalcord), liver failure, and respiratory distress. There is a brief asymptomatic period as the first

phase resolves, and then the second, more dangerous phase commences. During this phase, the

disease mounts an attack on vascular linings, liver, generates a high fever, and can complicateinto meningitis.

Anicteric Leptospirosis (90% of cases)

Phase 1: Initial septicemic phase (lasts 3-7 days)

  Headache

  High fever

  Myalgia

  Conjunctivitis

  Maculopapular rash

  Hepatomegaly

  Splenomegaly

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Phase 2 (follows brief improvement from phase 1)

  Meningitis

  Uveitis

  Chorioretinitis

Icteric Leptospirosis (Weil's Syndrome, 10% of cases)

  Much more severe than anicteric form  Fever

  Jaundice

  Azotemia

  Hypotension

  Hemorrhagic Vasculitis

*LABORATORY AND DIAGNOSTIC TESTS

Samples of blood, urine, or fluid from around the spinal cord will grow bacteria on special

culture plates. The blood can also be sent to state laboratories for antibody testing.

Some people with leptospirosis have no symptoms at all, others have a mild illness, and still

others have a severe illness with meningitis and liver failure. It depends upon what type of 

leptospire infects you.

Culture (Growth may require 16 weeks)

  Blood Culture

  Urine Culture

  Cerebrospinal Fluid Culture

*NURSING MANAGEMENT 

  Monitor vital signs

  Monitor fluid intake and output strictly Advise patient to rest

  Treat the fever with acetaminophen (antipyretic) as prescribed

  Inform the doctor if the following signs and symptoms occur:

 Headache

 Stiff neck 

 Changes in amount or color of urine

 Jaundice Nausea

 Bruising or hemorrhage

 Rashes

 Dyspnea

 Oliguria Change in consciousness

  Advise client to avoid swimming or wading in warm waters that may be contaminated by

animal urine (such as dog or rats)

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  Daily weight and abdominal girth should be taken for the patients with ascites

  Severely ill patients should be nursed in propped-up position to lessen the risk of secondary pulmonary complications. 

  Patients with vomiting should be managed by I/V fluids and electrolyte replacement.

*NURSING DIAGNOSIS

Impaired nutritional needs related to anorexia

Give small, frequent mealsAssess eating patterns

Give warm meal

Measure patients body weight dailyHyperthermia related to increased metabolic diseases

Give warm compress, avoid alcohol use

Instruct patient to drink plenty of fluids

Administer antipyretic as ordered

Knowledge DeficitActivity Intolerance

Risk for fluid volume imbalance

*MEDICAL MANAGEMENT

Leptospira are sensitive to Penicillin given through IV; Tetracycline and Erythromycin, and

Doxycycline given by mouth for 5 to 7 days

  Treatment within first few days of illness may reduce the severity of disease but has littleeffect if started later on.

 These antibiotics are usually given for 10 days.

  Symptomatic and supportive care is initiated particularly for renal and hepatic failure.

*COMPLICATIONS

Weil’s syndrome is a severe form of leptospirosis that affects the liver and kidneys, causing jaundice, decreased urine (Oliguria), azotemia, jugular vein distention, orthostatic hypotension,

change in consciousness, fever, internal bleeding (GI bleeding), and anemia due to hemolysis,and thrombocytopenia.

*PREVENTION  Avoid the use of contaminated water and soil,

  Use rodent control measures.

  Immunization of dogs and other domestic animals and birds.

  Good environmental sanitation

  Immunization/antimicrobial prophylaxis with doxycycline.may be,of value to certain

high risk occupational groups