Leptospirosis+2010 (1)

8/12/2019 Leptospirosis+2010 (1)

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TAKING A CLOSER

LOOK AT

LEPTOSPIROSIS

Lilen C. Sarol PhDCollege of Public Health

University of the Philippines Manila


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Leptospirosis in the worldIncidence of severe cases 300,000-500,000 per year


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NUMBER OF LEPTOSPIROSIS CASES AND

DEATHS ACCORDING TO REGION


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NUMBER OF CLINICALLY CONFIRMED

LEPTO CASES ACCORDING TO REGION

(Jan. 1 Aug. 14, 2010)


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Ryoukichi Inada1874-1950

Discovery of Pathogen

in 1915


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Causative Agent

highly motile

flexiblehelical or coiled

aerobic bacteria

with bent orhooked ends

Yasuda et al. Deoxiribonucleic acid relatedness between

seogroups and serovars in the family Leptospiraceae. Int J

Sys Bacteriol 1987; 407-415

Spirochaeta icterohaemorrhagiae


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killed at 500C in 10 mins or 600C in 10

seconds susceptible to dessication,

hypochlorite disinfectants and pH

outside of 6.2 to 8.0 acid urine, non-aerated sewage and

polluted water

Sensitivity


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PHENOTYPIC CLASSIFICATION OF LEPTOSPIRES


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GENOTYPIC CLASSIFICATION OF LEPTOSPIRES


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TRANSMISSION CYCLE OF LEPTOSPIROSIS

INDIRECT CONTACT

DIRECT CONTACT

contact with moist

soil or vegetation

contaminated with

urine of infected animals

swimming or wading in

floodwaters

accidental immersion

occupational abrasion

thru tissue or urine of

infected animals

ingestion of contam food

droplet aerosol inhalation


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Anicteric Leptospirosis Icteric LeptospirosisWeil's Syndrome

First stage

3-7 days

Septicemic

Second stage

0-1 month

Immune

First stage

3-7 days

Septicemic

Second stage

10-30 days

Immune

Myalgia/

Myositis

Abdominal

pain

Conjunctival

suffusion

Meningitis

Uveitis

Rash

Fever

Jaundice

Hemorrhage

Renal failure

Myocarditis

Meningitis

Pulmonaryhemorrhage

Respiratory

failure

Blood

CSF

urine

Blood

CSF

urine

fever

Important

Clinicalfindings

L

epto

p

resent


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Signs and Symptoms of Leptospirosis

Icterus and hemorrhage

Acute renal failure


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Differential Diagnosis

Dengue

Rickettsial disease : Scrub typhus,murine typhus

Acute viral hepatitis

Sepsis Influenza

Aseptic Meningitis


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DIFFERENT STAGES OF

LEPTOSPIROSIS


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LEVEL AND DURATION OF IgM ANTIBODIES

AT DIFFERENT TIME INTERVALS


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IMMUNOFLOURESCENCE


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LEPTO LATERAL FLOW

based on the binding

of specific IgM

antibodies to the

broadly reactive

heat extracted

antigen preparedfrom nonpathogenic

Patoc 1 strain


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MICROSCOPIC AGGLUTINATION TEST (MAT)


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Problem with diagnosis

Low success rate of isolation

Unreliability of direct demonstration

of leptospires in clinical samplesusing dark field microscopy

Inaccessibility of moleculartechniques to most peripheralhospitals and clinics

Serological tests have low sensitivityduring acute stage


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Treatment

Early anti-microbial therapy is

importantshorten the course and

prevent carrier state Choice : Penicillin G, Ampicillin

May cause Jarish-Huxheimer type

reaction Mild cases oral Doxycycline or

Amoxicillin


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Prevention

Vaccination of domestic animals

Rodent control

Protective gloves and boots

Avoid swimming in contaminated

watersVaccination in endemic region


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Lack of rapid diagnostic kit

Difficulties in clinical

diagnosis

Actual condition ofLeptospirosis is unclear

Neglected

Infectious

Disease

Small research

funds

few researchers

Lack of rapid

diagnostic kits

and vaccine

Bacteriology

Difficulties in Leptospirosis Control

Slow colony formation

Delay in genetic research

Variety of maintenance animals

More than 250 of serovars

Epidemiology

Clinical researchLaborious culture

Presentcondition

Distribution of Leptospires

unknown


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College of Public

HealthUP Manila

Kyushu UniversityChiba Inst. Science ResearchPartnership

MOFAJICAMEXTJST Collaboration

Prevention and Control of Leptospirosis in

the Philippines

MEXT: Ministry of Education, Culture, Sports, Science and Technology

JST: Japan Science and Technology Agency

MOFA: Ministry of Foreign Affairs

JICA: Japan International Cooperation Agency

Application to the SATREPSprogram in 2008

PO/PDM Working group


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Plan of Operation (PO)

Project Design Matrix (PDM)

Working Groups in the Philippines

0. Laboratory Renovation

1. Epidemiology

1) Bacteriological surveillance

2) Burden of disease3) Environmental risk factors

2. Diagnostic kit

3. DNA vaccine

4. Advocacy

Group A: Microbiology1) Bacterial surveillance

Yoshida/ Gloriani

2) Diagnostic kit

Masuzawa

3) DNA vaccine

Yoshida

Group B: Burden of disease

Yoshida, Yabe/ Borja

Group C: Environmental risk factors

Yanagihara/ Cavinta

Group D: Advocacy

Fujii/ Guevarra

/ g g p


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Output of the LEPCONdvocacy

Burden of Disease by Bacteriological studyCenter for LEPCONDevelopment of Diagnostic kits and DN vaccinesEpidemiology and Economic burden

Documents

Leptospirosis+2010 (1)