PBL today:Diagnosed of Leptospirosis
Yukk..mengenali apekah leptospirosis itu...
Leptospirosis, an infectious disease that affects humans and animals, is considered the most common zoonosis in the world.1 Leptospirosis is often referred to as swineherd's disease, swamp fever, or mud fever. The organism enters the body when mucous membranes or abraded skin come in contact with contaminated environmental sources.
1. Primary bacteremic infection caused by Leptospira interrogans, contact directly or indirectly from urine of infected carrier host(rodents and marsupials).
2.Bacteria enter host via damaged skin, certain mucous membrane ,conjuctiva membrane.The transfer required bacteria to be enveloped in water, entry via lung requires onhalation of aerosol droplets.
onces the bacteria enter the body,migrate to lymphatic and circulatory systems within minute.The growth rate slow and the incubation period range 2-28 days@3-14 days
Very sudden onset of symptoms with severe and incapaciteting headache, bilateral conjuctival suffusion, sign og meningism, pyrexia@fever 39 degree and above.
Red transient non blanching rash , myalgia, fatigue, nausea, reproductive cough with minor haemopthysis(kahak berdarah).The psychological changes (depressed, confused,aggresive), psychotic (schizophrenia, hallucinatioan, personality change and violence).
First few days, bacteria present in the bloodstream but later confined to tissue
UNIPHASE INFECTION:
mild cases, 3-7 hari.Symptoms appear on day 1, peak on day 2, reduce thereafter
antibiotic beneficial but pt will recover without intervention.
BIPHASE INFECTION:
Initial septicaemia, then transient remission then rapid decline one or two das later
Icteric symptoms
can progress to mortality(mati) within short time w/o intervention
CLINICAL FEATURES::
PUO:pyrexia of unknown origin
2phases:
1)Leptospiraemic phase(lasting to a week)
2)Immune phase; generally separated from the former phase by asymptomatis period of 1-3 days.
Leptospiraemic phase
Anorexia, nausea and vomiting
Recurrent chills, high spiking temperature, headache, severe myalgia(cutaneous hyperesthesia), conjunctival suffusion
Uncommon finding: skin rashes,petechiae, hepatosplenomegaly and lymphadenopathy.
The phase terminate with defervescence and improvement in symptoms.This coincides with disappearance of leptospiras from the blood and CSF.
Immune phase
appearance of Ig M antibodies. After relative asymptomtic period of 1-3days, the fever and earlier symptoms recur.
Other features :Meningism and CSF lymphocytosis+ Increased in CSF protein
Recovery is complete but small proportions enter the Weil's syndrome
Weil syndrome is common with L.icterohemorrhagic .There ie hepatitis, renal tubular necrosis and meningitis
A=>HEPATITIS
Tender hepatomegaly
Jaundice: due to hepatocellular jaundice, predominant intracellular block to bilirubin excretion-> CONJUGATED BILIRUBINAEMIA
B=>RENAL TUBULAR NECROSIS
Oliguris renal failure(uremia)
Microscopic haematuria(kencing berdarah)
Proteinuria
Pyuria
C=> MYOCARDITIS
Atrial and ventricular dysrhythmias
Congestive cardiac failure
D=> Hemorrhagic manifestation
due to diffuse vasculitis with capillary injury
Haemolytic anaemia,Epistaxis,Hemoptysis, GI bleeding and hemorrhage into adrenal gland
Majority of pt, enter the convalescent phase by 3rd and 4th week of illness
PATHOGENESIS:
NO inflammatory response at site of entry of organism
Incubation period:10-12days
During the period, the leptospires spread from the site of entry through bloodstream and multiply in the blood and liver.There is no toxin.Symptoms are due to damage to endothelial lining of capillaries in the various organs
This damage results:
Increased capillary permeability
Hemorrhages
Diminishe oxygen supply to tissue
Jaundice if it is dua to hepatocellular damage w/o necrosis of liver cells.
::At time of onset of symptoms, organisms are found in the blood, CSF and in tissue of many organs including the kidney.As antibodies develop during first week(6th day) of illness the organism disappear but can be found in urine for anothe 2weeks
Penat aih...hihih
sudaa la dulu ek..mau tdoo~~
tHIs iS sCHOOL OF DENTAL sCIENCES,USM, MALAYSIA
dENTISTRY iS tOO hOT TO gO::KUATKAN HATI..MOGA DIKUATKAN HATIKU INI..HEEE~~~
