LEPTOSPIROSISDEPT. OF COMMUNITY MEDICINE,

UPRIMS&R, SAIFAIUNDER GUIDANCE OF : DR. A.M. DIXIT SIR

PRESENTED BY: PRANJAL AGARWALROLL NO. 55

INDEX• HISTORY• WHAT IS LEPTOSPIROSIS?• AGENT• SOURCE OF INFECTION • HOST FACTORS• ENVIRONMENTAL FACTORS• MODE OF TRANSMISSION• CLINICAL FEATURES• BURDEN OF DISEASE

INDEX (CONT.)• WORLD STATUS• STATUS IN INDIA• OUTBREAKS• NICD GUIDELINES FOR PREVENTION &

CONTROL• TREATMENT OF LEPTOSPIROSIS• INTERNATIONAL INITIATIVES• INITIATIVES BY INDIA• PREVENTION & CONTROL• REFERENCES

HISTORY• The spirochete was first isolated in

Japan by Inada in 1915 .

• Weil described the clinical disease in 1886.(WEIL’S DISEASE)

• Leptospirosis was known in China and Japan by “rich harvest jaundice” and “autumn fever”.

--RUDYARD KIPLING

• I KEEP SIX HONEST SERVING* MEN. THEY TAUGHT ME ALL I KNEW. THEIR NAMES ARE: WHAT, WHY, WHEN, HOW, WHERE & WHO.

*taken from Textbook of P.S.M. by K.Park 23rd edition Ch-3 : Epidemiology

WHAT IS LEPTOSPIROSIS?

[Zoonoses + environmental disease + occupational disease]

• Leptospirosis is essentially animal infection by several serotypes of Leptospira (Spirochetes) and transmitted to men under certain environmental conditions.

AGENT• 2 species :

L. interrogans• PathogenicL. biflexa• Saprophytic

The leptospira serovars predominantly present in India are L.ictohaemorrhageae

SOURCE OF INFECTION

• Excreted in the urine of infected animals for a long time.

• ANIMAL RESERVOIRS:o Rodents – mice, rats and voles. o Domestic animals – cattle, sheep, goat,

water buffalo, pigs, horses, dogs may act as carriers.

o RATS: R. norvegicus most important Mus musculus reservoirs

HOST FACTORSo AGE&SEX human infection: accidental. males > females due to greater

occupational exposure. more frequent in age group 20-30 yrso HIGH RISK GROUPS Agricultural workers Fishermen, sewer workers Lorry drivers and masons

ENVIRONMENTAL FACTORS

• Drainage congestion and water logging

• Soil salinization

• Soil temperature

• Seasonal variation – Starts at the onset of Rainy season & declines as the rains recede.

• Heavy RAINS & FLOODS

• Poor housing

• Limited water supply

• Inadequate method of waste disposal

MODE OF TRANSMISSION

•

MODES OF TRANSMISSIO

N

DIRECT CONTACT

INDIRECT CONTACT

DROPLET INFECTIO

N

NOTE- Direct man to man infection is rare.

CLINICAL FEATURES

Two types of leptospirosis are

described

ICTERIC LEPTOSPIROSIS

ANICTERIC LEPTOSPIROSIS

I.P. = 10 days with a range of 4 to 20 days

ICTERIC LEPTOSPIROSIS

o It is the severe form of the disease.

o It is characterized by jaundice and is usually associated with involvement of other organs.

o About 5-10% of patients have these type of manifestations

• ANICTERIC LEPTOSPIROSIS

o It is the milder form of the disease.

o Patients have fever, myalgia but do not have jaundice.

o Almost 90% Of patients have this type of illness.

SIGNS & SYMPTOMS

• Fever with chills• Myalgia of calf, abdominal & lumbosacral

muscles• Conjunctival Suffusion• Headache- throbbing, frontal• Renal infestation- mild proteinuria with few

casts/cells• Pulmonary infestation- cough/chest

pain/haemoptysis• PETECHIAL hemorrhage

ANICTERIC

CONJUNCTIVAL SUFFUSION

PETECHIAL RASH

• JAUNDICE

• Fever(Same as in anicteric leptospirosis but may be more severe)

• All the symptoms and signs of Anicteric along with Organ Involvement.

ICTERIC

• ORGAN INVOLVEMENT-ORGAN CLINICAL FEATURES

KIDNEY Decrease in urine output,features of uremia

LIVER Jaundice, hepatomegaly

LUNG Cough, haemoptysis, dyspnoeawith increase in respirationrate and basal crepts

HEART Hypotension, irregular pulse

BLOOD Bleeding tendencies

BRAIN Altered consciousness withneck rigidity

IS IT IMPORTANT TO STUDY

LEPTOSPIROSIS??

BURDEN OF DISEASE

• BEARS EPIDEMIC POTENTIAL• The annual incidence of leptospirosis is

estimated from 0.1 to 1 per 100 000 per year in temperate climates to 10 or more per 100 000 per year in the humid tropics.

MOST WIDESPREAD ZOONOSIS

Leptospirosis is treatable and preventable!• If Leptospirosis is detected early, antibiotics can be administered that can successfully treat the disease.

WHERE IS LEPTOSPIROSIS PREVALENT??

WORLD STATUS• 63% in AMERICAS (Brazil, Nicaragua,

Argentina)

• 15% in WESTERN PACIFIC

• 14% in SOUTH EAST ASIAN REGION

• 08% in EUROPE

• Rest in AFRICAN & Eastern MEDITERRANEAN.

STATUS IN INDIACoastal Districts of • Gujarat • Maharashtra• Kerala• Tamil Nadu• Andhra Pradesh HAVE

REPORTED• Karnataka OUTBREAKS• Andamans• Orissa

HAVE THE OUTBREAKS

OCCURRED ??

OUTBREAKS• 1995 – 1998 – Prevalent in the United States only.

• 1999 - A post-cyclone outbreak was reported in Orissa, India

• 2002 – Outbreak after flooding in Jakarta, Indonesia

• 2002-05 – In South Gujarat

• 2000,2002,2005 – After flooding in Mumbai, Maharashtra

• 2008 – After flooding in Sri Lanka

• 2009 – After Cyclone in Philippines

• 2011 - Outbreak in Canyoning athletes in the Caribbean island of Martinique.

• July, 2015 – Outbreak in Mumbai, Maharashtra

CASES : 21, DIED : 12

CAN WE PREVENT & CONTROL

LEPTOSPIROSIS?? + INITIATIVES TAKEN

TILL DATE.

H

Guidelines for Prevention and

Control of Leptospirosis:

National Institute of Communicable

Diseases (Zoonosis Division) 2006

Recommended case definition

Acute febrile illness with headache, myalgia and prostration associated with any of the following:

• Conjuctival suffusion• Meningeal irritation• Jaundice• Hemorrhages (from the intestines; lung

bleeding is notorious in some areas)• Cardiac arrhythmia or failure

CASE CLASSIFICATION

• Suspected: A case that is compatible with clinical description.

• Confirmed: A suspect case with positive laboratory test.

Laboratory criteria for diagnosis

Collection and Transportation of serum sample

Labelling and transportation of the sample Collection of clinical samples for isolation of

leptospires blood urine CSF Other specimen include autopsy tissues such as kidney or liver.

SEROLOGICAL DIAGNOSIS OF

LEPTOSPIROSIS

1. Enzyme Linked Immuno Sorbent Assay (ELISA)

2. Rapid immunodiagnostics based on IgM detection.

TREATMENT OF LEPTOSPIROSIS

3 LEVELS

PHC LEVELCHC/ DIST HOSPITAL

LEVELTERTIARY

LEVEL

TREATMENT AT PHC/CHC/DIST. HOSPITALS IN

ENDEMIC AREAS• CLINICAL SUSPECT- Tab. Doxycycline 100

mg twice daily for 7 days.

• MILD DISEASE & RAPID IMMUNODIAGNOSTIC TEST +VE - Inj. Crystalline penicillin 20 lacs I.U. i.v. every 6 hrly in adults for 7 days.(CHILDREN - 2 – 4 lacs units/kg/day for 7 days.)

• IF FEATURES OF ORGAN DYSFUNCTION PRESENT, REFER TO HIGHER CENTRE.

TREATMENT AT MEDICAL COLLEGE/ TERTIARY CENTRE

2 STEP TREATMENT

CHEMOTHERAPY

ORGAN SPECIFIC

CAREAdults : T. Doxycycline 100 m.g. twice a day for seven days; Children : < 6 yrs.Cap. Amoxy/Ampicillin

Organ specific and symptomatic treatment.

INTERNATIONAL INITIATIVES

• INTERNATIONAL LEPTOSPIROSIS SOCIETY

The International Leptospirosis Society Inc. (ILS) was formed in 1994 to promote

knowledge on leptospirosis through the organisation of regional and global

leptospirosis meetings.

INTERNATIONAL INITIATIVES(CONT.

)

Leptospirosis Burden Epidemiology Reference

Group (LERG)• The LERG, an advisory group to the

DirectorGeneral of the WHO on the epidemiology of leptospirosis, was established in 2009 following an informal WHO consultation in 2006.

• The Objective :� to provide estimates for human

leptospirosis worldwide, according to age and sex and by WHO region

INITIATIVES BY INDIA

• A Pilot Project on Control of Leptospirosis was approved as a “New Initiative” in the 11th Five Year Plan in 5 endemic states with the objective to reduce the morbidity and mortality in pilot project areas.

• Proposal for Leptospirosis control in the 12th Plan

Proposal for Leptospirosis control

in the 12th Plan AIM : To expand and implement the strategy for prevention

and control of Leptospirosis developed during 11th Plan in all the endemic states during the 12th Plan period.

NCDC is the nodal agency for this project.

The thrust areas of the project are- —Early diagnosis & treatment of Leptospirosis —Strengthening of lab & patient management facilities —Training of manpower —IEC in the community —Inter- sectoral coordination

BUDGET : Rs. 3.69 crores

Who CAN HELP IN CONTROLLING THE DISEASE??

IT’S YOU, ME,WE

PREVENTION & CONTROL

Protection of people against contagion by available means.

Health education Vaccination of animals Rodent control Mapping of water bodies for establishing a

proper drainage system Health impact assessment of developmental

projects Leptospirosis should be made a reportable

disease in all endemic states Chemoprophylaxis

VACCINATION OF ANIMALS

Species Name of the vaccine

Dog Novivac-DHPPI-2LEurican-DHPPI-2LVanguard-DHPPI-2LDuramax-DHPPI-2L

Cattle Leptavoid

SpirovacLeptoferm-5

Cattle & swine

Farrowsure-Plus

REFERENCES1. Textbook of Preventive & Social Medicine by

K.Park2. Report of the Second Meeting of the

Leptospirosis Burden Epidemiology Reference Group 2011

3. Leptospirosis situation in the WHO South-East Asia Region

4. Sethi S, Sharma N, Kakkar N, Taneja J, Chatterjee SS, et al. (2010) Increasing Trends of Leptospirosis in Northern India: A Clinico- Epidemiological Study. PLoS Negl Trop Dis 4(1): e579. doi:10.1371/journal.pntd.0000579

5. A Global Research Agenda for Leptospirosis ER Cachay, JM Vinetz J Postgrad Med. Author manuscript; available in PMC 2008 March 20.Published in final edited form as: J Postgrad Med. 2005; 51(3): 174–178.

REFERENCES(CONT.)6. Human leptospirosis: Guidance for

diagnosis, surveillance and control 20037. Leptospirosis – An Overview: TK Dutta, M

Christopher; JAPI , VOL. 53, JUNE 2005, 545-51

8. The Prevention & Control of Leptospirosis by John TJ, J POSTGRAD MED September 2005 Vol 51 Issue 3

9. NCDC Newsletter Volume 4, Issue 1, January- March, 2015

10.NCDC Newsletter Volume-1, Issue-1, October 2012

11.NCDC Newsletter July–September 2014 Volume 3, Issue 3

EVERY LIFE IS PRECIOUS.

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