Leptospira

This patient is suffering from Wiel’s disease caused by Leptospira.

Weils syndrome (icteric leptospirosis) is the most severe form of leptospirosis.

It is characterized by impaired kidney and liver function, abnormal mental status and hemorrhagic pneumonia and hypotension.

Penicillin is the drug of choice for treatment of leptospirosis.

Tetracycline or doxycycline may also be used.  

Ans. is ‘a’ i.e., Leptospirosis 

Ans. is ‘c’ i.e., Rat 

• Rodents, especially rats, are the most important reservoir.

. Ans. is ‘d’ i.e., Weil felix reaction 

A definite diagnosis of leptospirosis is based either on isolation of the organism from the patient or on seroconversion or a rise in antibody titer in microscopic agglutination test (MAT). 

• Other methods used for diagnosis are :‑

Microscopic demonstration

–   Leptospires may be visualized in clinical material by dark – field microscopy or by immunofluorescence or light microscopy after appropriate staining.

–  Approximately 10⁴ leptospires / ml are necessary for one cell per field to be visible in dark – ground microscopy (DGM). Microscopy of blood is of value only during the first few days of acute illness, while leptospiremia occurs. Polymerase chain reaction

–   PCR techniques have been developed but so for have not found wide spread use outside research and reference laboratories.

Molecular typing

–  There has been great interest in molecular methods for identification and subtyping.

• Other methods used for diagnosis are :‑

Microscopic demonstration

–   Leptospires may be visualized in clinical material by dark – field microscopy or by immunofluorescence or light microscopy after appropriate staining.

–   Approximately 10⁴ leptospires / ml are necessary for one cell per field to be visible in dark – ground microscopy (DGM). Microscopy of blood is of value only during the first few days of acute illness, while leptospiremia occurs. Polymerase chain reaction

– PCR techniques have been developed but so for have not found wide spread use outside research and reference laboratories.

Molecular typing

–   There has been great interest in molecular methods for identification and subtyping.

Ans. is ‘a’ i.e., Korthof 

• Media used for isolation  :-Ellinghausen – Mecullough – Johnson Harris (EMJH) medium, Fletcher medium, Korthof medium, Stuart’s medium.

Ans. is ‘e’ i.e., Tetracycline is drug of choice 

Treatment of leptospirosis

• Mild cases —> Doxycycline or amplicillin or amoxicillin
• ·Moderate or severe —> Penicillin G or ampicillin or amoxicillin or erythromycin Chemoprophvloxis
• ·Doxycycline is the DOC.

“In severe illness, I.V. benzyl penicillin is the drug of choice, for milder infections a 7-10 days course of oral amoxicillin appropriate.” – Green wood 16 /e 355

.  Patients allergic to penicillin can be treated with erythromycin.

Ans. is ‘c’i.e., Antibodies are usually detectable in the first week

Antibodies detection in leptospirosis

. Leptospiral antibodies first appear in serum by end of first week, but titre is not detectable.

. Antibodies titre reaches detectable levels in the second week.

. Leptospiral antibodies usually peaks in the fourth-fifth week.

About other options

.  Leptospiral infection can be acquired by direct contact with urine or tissues of infected animal through skin abrasion or intact mucous membrane.

. Icteric form (Weil’s disease), the most severe form of leptospirosis is characterized by mortality rate of 5-15%.

.  In severe illness, i.v. benzyl penicillin is the drug of choice. For milder infections a 7-10 days course of oral amoxacillin is appropiate———————————————— Greenwood 16^thie 355

Ans. is ‘a’ i.e., Rats are prime reservoir 

.  Rodents, especially rats, are the most important reservoir.

.   Penicillins are the drug of choice (not fluoroquniolones).

.  There is no person to person transmission ( modes of transmission of leptospirosis have been explained).

.  Hepato-renal syndrome is nothing else but Weil’s disease (icteric form of leptospirosis). Weil’s disease accounts only for 5-10% of cases of leptospirosis ( not 50%).

Ans. is ‘c’ i.e., Both 1 and 2 

Ans. is ‘b’ i.e., Rats 

Ans. is ‘b’ i.e., Mostly affects the kidney and liver

.  The leptospires are generally non pathogenic in reservoir animals (e.g. rodents).

.  The leptospires mainly infect the kidney and liver. 

.  Vasculitis is responsible for the most important manifestations of the disease. 

.  Ig M antibodies appear after one week (not disappear).

.  No vaccine of leptospira is used world wide.

“In parts of the world where the prevalence of human infection in certain group is high, selective human immunization schemes may be of benifit if suitable vaccine is available”

Ans. is ‘d’ i.e., Lice act as reservoirs of infection 

Rats and small rodents are the main reservoirs of Leptospira.

o Leptospirosis is a zoonotic disease caused by spirochete.

o Leptospira affecting wild and domestic animals worldwide. Man is an accidental host.

o Source of infection is urine of infected animals (Leptospira are shed in urine of infected animals and can survive for weeks in soil and water)

o Man gets infected by direct or indirect contact with urine of infected animals, by inhalation of air polluted with droplets of urine.

o Direct man to man infection is rare.

Ans. C i.e. High mortality

Leptospira

• Leptospirosis is transmitted by: Rat urine
• Leptospirosis is associated with: Rat, Ricefields, Rain
• Weils disease is caused by: L. icterio-hemorrhagica

Ans. is ‘a’ i.e., Leptospira