Leptospirosis

Abstract

Leptospirosis is an important zoonotic disease caused by pathogenic spirochaetes of the genus Leptospira. Because of rapid global communication the disease has been recognised as an emerging zoonosis that occurs in both developing and developed countries although it is considered as a tropical disease. Typically, leptospirosis is characterised by a sudden onset of fever, chills, jaundice, myalgia and renal failure. The disease can be subclinical. Pathophysiology of leptospirosis involves bacterial invasion, haemodynamic changes and immune response. Hypotension is a common clinical sign which may precede pulmonary symptoms and acute renal failure. Pulmonary haemorrhage is life threatening. The mortality rate of leptospirosis varies from minimal to 16%. Penicillin remains the drug of choice in leptospirosis. Cephalosporins and doxycycline are satisfactory alternatives.

Key Concepts:

  • Leptospirosis is a zoonotic disease caused by pathogenic leptospires.

  • Rodents, because of their alkaline urine, serve as an important reservoir for leptospires.

  • Leptospires enter the host through a break in the skin or through intact mucous membrane and spread through the blood stream to all organs within 48 h.

  • Bacterial clearance is by phagocytosis and humoral mechanism.

  • Organ injury is the results of inflammation induced by leptospire invasion, LPS, enzymes and outer membrane proteins.

  • Through activation of Toll‐like receptors on host cells by outer membrane proteins and LPS proinflammatory cytokines and vasoactive mediators are released.

  • Systemic vasodilatation, renal vasoconstriction and increased capillary permeabliity are the basic haemodynamic response to proinflammatory cytokines and vasoactive mediators that causes hypotension and decreased renal blood flow.

  • Pulmonary haemorrhage and acute respiratory distress syndrome caused by endothelial injury represent severe leptospirosis.

  • Renal failure in leptospirosis, due to tubular necrosis, is catabolic in type and may be associated with cholestatic jaundice.

  • Hypokalaemia and hypomagnesaemia with hyperkaliuria and hypermagnesuria due to renal tubular dysfunction are commonly observed.

Keywords: leptospire; cytokine; mediator; haemodynamics; cell injury; renal failure; jaundice; haemoptysis

Figure 1.

Pathophysiology of leptospirosis.

Figure 2.

Leptospires with a hook at both ends, shown by dark‐field microscopy; Original magnification X 1000. Courtesy of S Faine.

Figure 3.

Centrolobular necrosis (a) of the liver. Courtesy of V Boonpucknavig.

Figure 4.

Renal cortical tissue showing interstitial inflammation (a) with lymphocyte, plasma cell and eosinophil infiltration and destruction of tubular structure (b). Courtesy of V Boonpucknavig.

Figure 5.

Leukocyte infiltration and fragmentation of myocardial tissue. Courtesy of V Boonpucknavig.

Figure 6.

Acute haemorrhagic pneumonia showing blood (a) and oedematous fluid (b) in alveoli with focal dense neutrophilic infiltration (c). Courtesy of V Boonpucknavig.

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Sitprija, Visith, and Tantawichien, Terapong(Apr 2011) Leptospirosis. In: eLS. John Wiley & Sons Ltd, Chichester. http://www.els.net [doi: 10.1002/9780470015902.a0002246.pub2]