Leptospirosis or water fever Weil-Vasiliev is called an acute infectious disease that is transmitted from animals.
Leptospirosis is manifested by intoxication, pronounced muscle pain and kidney damage. It also affects the nervous system, liver and blood vessels. Likely jaundice.
The main causes of the disease are parasitic microorganisms – leptospira. Parasitic leptospira live in water and it is with the aquatic environment that the features of the spread of infection are associated. There are about thirty pathogenic forms of leptospira, which are common in certain areas and climates.
Leptospira has a thin convoluted body, up to 300 nm long, which is why parasites are not visible to the naked eye. They are active and move; when destroyed, they are able to release a special toxin. They can be attached to the walls of blood vessels, blood cells.
Parasites are resistant to low temperatures, live well in water, in soil, on food. Leptospira die during boiling, ultraviolet irradiation, and treatment with disinfectants.
Leptospirosis can occur anywhere except in Antarctica, the most common disease in the tropics. The source of infection is wild and domestic animals, rodents, dogs, cows and pigs. Sick people are not contagious to others.
A person becomes infected through the skin and mucous membranes by contact with contaminated water, by contact with the soil, by slaughtering livestock, cutting meat, eating unprocessed foods – milk and meat. The disease has a professional character, people of agricultural professions are suffering. The peak of the disease occurs in August.
Leptospira through microdefects of the skin are introduced into the body, through the lymphatic system enters the body and spreads to the spleen and liver, kidneys and lungs, and the nervous system. There, microorganisms multiply and accumulate. The period of incubation and accumulation of leptospira lasts from one to two weeks.
Leptospirosis can occur with varying degrees of severity.
The disease begins acutely – there is fever with chills, insomnia, headaches and thirst.
Patients are concerned about pain in the muscles, especially in the calf, thigh and lower back, which prevent normal movement.
The face and neck reddens, swells, giving a “hood symptom”, the whites of the eyes redden, there is a feeling of sand in the eyes.
Fever lasts up to 5 days or more and then decreases sharply, but repeated 1-2 peaks of fever are possible.
In severe leptospirosis, jaundice occurs with yellowing of the sclera and skin; there may be a rash on the skin, such as measles or rubella, less often scarlet. The rash is prone to fusion, can turn into hemorrhagic elements – hemorrhages in the skin, sclera and mucosal bleeding.
When leptospirosis, there are lesions of the heart with a decrease in pressure and bradycardia, with myocardial damage up to myocarditis. There is also rhinopharyngitis, pneumonia, the liver and spleen sharply increase – they are painful when probing. The nervous system is often affected with the development of meningeal symptoms, signs of serous encephalitis, although it can sometimes be purulent encephalitis.
In many patients with leptospirosis, the kidneys are affected – the amount of urine decreases sharply; a lot of protein, cylinders and epithelial cells – this indicates severe kidney damage.
Impaired kidney filtration function with a change in the level of urea creatinine, residual nitrogen. Severe leptospirosis gives signs of toxicosis with uremia, ulcerative lesions of the intestine, pericarditis, convulsions and disorders of consciousness up to a coma. Patients perish mainly from acute renal failure.
The basis of the diagnosis is an indication of the profession and season, as well as contact with animals, epidemiological problems with leptospirosis in the region. Also, typical symptoms may indicate a disease, but with jaundice, leptospirosis is difficult to distinguish from viral hepatitis.
The diagnosis is confirmed by laboratory tests – in blood tests, leukocytosis due to neutrophilic with accelerated ESR, typical changes in urine with protein and cylinders, an increase in the amount of residual nitrogen and bilirubin.
However, the final diagnosis is made on the basis of specific methods – detect the pathogen in biological fluids or detect the growth of antibodies to Leptospira. Microscopy and cultures are used only before the start of antibiotics.
Serological methods for the detection of parasites in the serum are common, they are carried out twice, for 5-7 days, and then a week later. Antibody titer increases to 1:20 and above.
Leptospirosis is treated by infectious disease doctors. Leptospira are sensitive to antibiotics and specific immunoglobulin.
The basis of the treatment is penicillins or, if they are intolerant, tetracyclines. They are especially effective in high doses up to the 4th day of illness. Drugs are used orally, less intramuscularly, with a strong toxicosis in combination with hormonal drugs.
Immunoglobulin anti- leptospira is effective, it is administered according to the scheme from the 1st to the 3rd day, after preliminary testing.
Apply a complex of vitamins and symptomatic treatment. If complications arise, hospitalization in an intensive care unit with treatment of complications is indicated.
Complications of leptospirosis can be caused by leptospirae themselves, as well as by a stratified secondary bacterial infection. The first are meningitis, encephalitis, polyneuritis. Associated with secondary infection are pneumonia, otitis, pyelitis, parotiditis.
Complications that are observed only in children include high blood pressure, cholecystitis, pancreatitis. The combination of such manifestations as myocarditis, dropsy of the gallbladder, rash, redness and swelling of the palms and soles, followed by desquamating of the skin, fit into the picture of Kawasaki syndrome (Kawasaki disease). In recent years, complications have become more frequent.
On average, treatment of leptospirosis lasts 2 -3 weeks. The outcome of the disease depends on the severity of the process. With the development of jaundice, the prognosis is the most unfavorable, mortality can reach 40%, especially in the elderly.
In terms of infection, rodent carriers are dangerous; a person with leptospirosis is not contagious to others.
With an unfavorable epidemiological situation, people, especially those engaged in agriculture, are vaccinated.