The leptospirosis

The leptospirosis is a group of acute infectious disease caused by Leptospira and characterized by similar clinical and epidemiological data. The most common forms of leptospirosis are: Vasiliev-Weyl disease (see) and water fever (see).
Etiology. The agents of the leptospirosis - various leptospirs, morphologically similar and related antigenic structure. Leptospira are subtle, moving with a faint spiral curls. The natural habitat of leptospires is the body of animals. In reservoirs Leptospira able to keep activity up to 30 days. When heated to a temperature 50-56° they die within 25 minutes; quickly killed by the impact of disinfectants. In the USSR the most common and best studied are Leptospira: L. grippotyphosa, L. hebdomadis, L. nero, L. ussuri and other Epidemiological significance of certain types Leptospira different.
Epidemiology. The source of infection Vasilyeva - Weyl diseases are rats. Sick more often working slaughter-houses, warehouses, fisheries, minesand plumbery, plumbers and others Spread the disease by type of intestinal infections. The prevailing part of the people infected by drinking infected water.
The source of infection water fever are rodents-vole, as well as cattle, pigs, dogs. Sick animals secrete agent with the urine, which may be contaminated water, soil, food and so on, the disease Spread mainly through water standing water when bathing, and using it for drinking and household purposes. Infection is possible when mowing wetlands, harvesting rice, sugar cane, the processing of raw materials, as well as by drinking infected milk. The leptospirosis occurs in the form of epidemic outbreaks in summer and autumn and sporadic cases throughout the year. Transferred disease leaves durable and long-specific immunity.
Pathogenesis all of leptospirosis are very similar: it is based on the liver, kidneys, blood vessels (mainly capillaries) and Central nervous system. Leptospira enter the body through the damaged skin and mucous membranes of the oral cavity, esophagus, conjunctiva of the eyes, and inflammation at the site of entry no. After 3-5 minutes Leptospira penetrate into the blood, where detects up to 5-6-th day of illness, and then only in the tissues, especially in the kidneys and the liver where is their rapid reproduction. In the liver Leptospira cause degenerative and necrotic changes. The origin of jaundice caused by damage to the parenchyma of the liver, and to a lesser extent - by the destruction of red blood cells. From the 2nd week of Leptospira are located almost exclusively in convoluted renal tubule (disappearing from the blood and other organs) and are a violation of urine formation. The most frequent cause of death - uremia.
The clinical picture. The leptospirosis is divided conditionally on severe forms with high mortality and relatively benign (Busselton). When illness Vasilyeva - Weyl (see Vasilyeva - Weil's disease) jaundice occurs often, mortality reaches 4-8%; water fever (see) occurs, as a rule, without jaundice, and death are extremely rare. However, complete dependence between the severity of the disease and serotypes of pathogens is not observed.
The disease starts acutely. Rising temperatures (up to 30-40 degrees) is accompanied by chills, headache, pain in the calf and other muscle groups. In the future, depending on the severity of the disease join other symptoms: nausea, vomiting (often mixed with blood), delirium, insomnia, bleeding from the nose. The temperature remains high 4-9 days. With the fall of temperature in severe cases develop jaundice, bleeding, often hemorrhagic herpes. The liver is enlarged, palpation its painful. Reduced amount of urine up to anuria with the development of uraemia. There are a recurrence of fever. The most frequent cause of death - uremia (see).
The clinical picture in benign leptospirosis is different from severe forms of more moderate defeat of the cardiovascular system, kidneys and liver. In particular, there are usually no uremia, jaundice and severe hemorrhagic diathesis. Other symptoms are similar or coincide with the observed in severe forms.
Laboratory diagnostics. For detection of Leptospira in the first week of illness produce blood cultures, for 2-3 weeks - sowing urine and cerebrospinal fluid in a special nutrient medium. From the 2nd week of the disease are serological reactions (agglutination and lysis).
The differential diagnosis should be carried out with the flu (see), typhoid fever (see), typhus (see), fever mosquito (see), hepatitis epidemic (see).
Treatment. Compulsory hospitalization, in bed, dairy and vegetable diet and drink plenty of water.
At headaches and muscle pain appoint amidopyrine 0.5 g 3 times a day, analgin 0.5 g 3 times a day. Shown cardio-vascular equipment.
Antibiotics are effective with early application; designate standard dosage. In severe cases, intramuscularly penicillin 900 000-1 500 000 IU a day, and gamma-globulin.
Prevention is based on the destruction of rodents - sources of infection and other events, as in intestinal infections. On epidemiological indications applied vaccination of people. The vaccine is injected subcutaneously in a dose of 2 ml twice, the interval between injections to 7 days.

The leptospirosis (leptospiroses) - a group of acute infectious diseases, similar clinical manifestations, pathogenesis, pathology, epidemiology, epizootology. Sporadic cases and epidemic outbreaks in humans and domestic animals described in almost all countries of the world.