a review on the clinical outlook of leptospirosis
Transkript
a review on the clinical outlook of leptospirosis
International Research Journal of Emerging Trends in Multidisciplinary ISSN 2395 - 4434 Volume 1, Issue 10 December 2015 www.irjetm.com A REVIEW ON THE CLINICAL OUTLOOK OF LEPTOSPIROSIS * ÖZGÜR ASLAN *Lecturer, ArtvinCoruh University, Faculty of Health Sciences, Artvin /TURKEY spirals hooked at one or both ends, and it ABSTRACT Leptospirosis is an infectious moves by spinning or with lateral disease, which is frequent in several movements. It could be observed using countries, generally characterized by dark field microscopy or other special symptoms stains (İkiz and Özgür, 2004; Saltoğlu, such as hemoglobinemia, icterohemoglobinuria, icterus, sepsis, and 2003;Şahin et al., 2002; ). anemia induced by leptospira genus species in all domestic animals and CLINICAL FINDINGS humans. Keywords: Leptospirozis, clinical Leptospirosis is characteristically a twophased disease: the septicemic phase outlook of leptospirosis (lasting 4 – 9 days) and immunogenic phase (lasting 4 – 30 days). In the initial INTRODUCTION period Leptospirosis is a prevalent and (septicemic phase) leptospira could be existent in the blood and BOS. significant zoonotic infections in the Leptospiromia world, induced by Leptospira genus Symptoms start to disappear with the spirochetes. Leptospirosis is an infection formation of IgM-type anti bodies and the indicated by over 240 serotypes in fever goes down. During the second, and rodents, mammals, certain birds and sometimes the third week, a relapse with reptiles caused by Leptospirainterrogans. fever that lasts a short period of time is Leptospirainterrogans is a strict aerobe, observed. The symptoms reappear. It was helicoid, slender mobile microorganism concluded that this second phase is with two periplasmic flagella. It is induced by the immune mechanism due usually 6 – 20μm long and with a to diameter of .01μm. It has thick and fixed (immune phase), neurological system lasts hypersensitivity. for In a this week. period 50 International Research Journal of Emerging Trends in Multidisciplinary ISSN 2395 - 4434 Volume 1, Issue 10 December 2015 www.irjetm.com symptoms such as meningeal irritation disease and observed in approximately symptoms, iridocyclitis, optic neuritis, or 25% encephalomyelitis patients suffer from bitemporal and and peripheral of the patients. intense Symptomatic neuropathy and miscarriages could be frontal observed. In this period called immune confusion could be observed. In several phase, leptospira could be observed in cases, cough and chest pain; hemoptysis urea, kidneys and humor aqueous, but not and pulmonary involvement in few in factor blood and BOS (Turhan et al., patients 2012). (Sünbül, 2003). are headache. significant Mental symptoms Important clinical symptoms are bleeding or non-bleeding conjunctival hyperemia, 1. Anicteric Leptospirosis eye pain, increase in muscular tonus, Many patients start with subclinical or mild symptoms. In few patients, it is sudden onset accompanied with fever. Other symptoms are tremors, headache, myalgia, abdominal pain and rarely skin rashes. The most frequent symptom observed in physical examination is high fever. Fever recedes after 1 -3 days. Fever could be biphasic and could repeat 3 – 4 days after recession (Sünbül, 2003; Sargın et al., 2012). The myalgia that holds on to back, abdomen and calf muscles is a significant symptom for hepato-splenomegaly lymphadenopathy. and Less frequent symptoms are macular, maculopapular, erythematous, urticarial or hemorrhagic rash. Serious neurological disorders such as coma, hemiplegia and transverse myelitis could rarely develop.Leptospira could be isolated from the urine 5 – 7 days after the onset of the disease. Routine urine analysis would reflect mild proteinuria,leukocyturia and/or hematuria and hyaline, granular cylinders (Sünbül, 2003). leptospira infection. Sore throat and skin rash are less frequent symptoms. 2. IctericLeptospirosis (Weil Disease) Sometimes photophobia might develop. This anicteric symptom usually lasts for A serious form of leptospirosis, Weil one week and recedes with the formation disease is characterized by jaundice, renal of or dysfunction, hemorrhagic diathesis and asymptomatic aseptic meningitis is an high mortality. It is generally observed immune phase characteristic of the with anti bodies. Symptomatic 51 International Research Journal of Emerging Trends in Multidisciplinary ISSN 2395 - 4434 Volume 1, Issue 10 December 2015 www.irjetm.com Leptosipiraicterohaemorrhagiae/copenha serum creatinine is around 2 -8 mg/dl geni serotypes, but it could also occur during the acute phase of the disease, but with other serotypes. Patients might in some cases these values could exceed develop 300 liver, kidney failures, and 18 mg/dl, respectively. hemorrhagic pneumonia and circulation Concurrent development of dehydration disorders (Sargın et al., 2012). It varies and hypotension causing hypovolemia between the disease with a mild fever to aggravates renal damage. Development the icteric-hemorrhagic form and to of anuria is a sign of bad prognosis. severe liver and kidney involvement Certain cases recover without the need (Gün et al., 2005).Kidney and liver for dialysis, while others require dialysis. symptoms are predominant in patients. Renal functions recover without leaving Jaundice is obvious. Transaminases are sequela. In cases accompanied with acute generally high, but frequently remain kidney failure, serum amylase levels are within the range of 4 – 5 times the normal significantly (Beğendik et al., 2011). pancreatitis symptoms are not frequent It displays two clinical pictures of (Levett, 2001; Aydemir et al., 2004). high, but clinical biphasic disease (anicteric form) and fulminant disease (icterohemorrhagic 4. Lung involvement form). In the biphasic disease picture, primordium is the acute or septicemic phase. It lasts for one week and indicated by sudden onset fever, retro-orbital pain, paraspinal and abdominal muscle pain, throwing up, purpuric or maculopapular rash and conjunctival rash (Okur et al., 2010). 3. Renal involvement Picture 1: (A) Pneumonemia in a swine infected with Leptospirainterrogansserovarcopenhage Acute renal failure is characterized by ni in Brasil. (B) Healthy Guinea Pig lung sudden onset of uremia and oliguria in for comparison (Bharti et al., 2003). the second week of the disease often accompanied with jaundice. Blood urea nitrogen levels are below 100 mg/dl and 52 International Research Journal of Emerging Trends in Multidisciplinary ISSN 2395 - 4434 Volume 1, Issue 10 December 2015 www.irjetm.com Lung involvement is frequent in leptospirosis. Coughing, dyspnea, and chest pain is present. Severe hemorrhagic pneumonia and acute pulmonary distress is observed rarely (Furuncuoğlu et al., 2006; Sünbül, 2003). 6. Hematologic System Involvement syndrome could be among the significant Hemorrhagic symptoms such as petechia, symptoms of the infection and could purpura, ecchymosis, and nasal bleeding develop without hepatic and renal failure. could be observed in Weil disease. During the course of the acute disease, Furthermore, gastrointestinal bleeding, hemoptysis emerges concurrent with the pancreatic, adrenal and subarachnoid cough. bleeding are also reported rarely (Levett, With progressive lung involvement, crumb-like small nodular 2001). Thrombocytopenia densities, consolidations are observed observed in many cases, however it is frequently in the lower lobes. Wen temporal radiological involvement is dense, bibasic disseminated intravascular coagulation crackles could be heard (Levett, 2001). (Sünbül, 2003). and does not is result also in 7. Eye Involvement 5. Heart involvement Eye symptoms are reported in critical Heart involvement is observed in the leptospirosis.In majority several conjunctival hyperemia in certain series are was reported. Existence of conjunctival identified in icteric and non-icteric hyperemia accompanied with icterus in patients. Atrial fibrillation, atrial flatter, sclera is pathognomonic for Weil disease. tachycardia, and ventricular tachycardia In a few cases, after recovery from the including premature ventricular pulses acute disease, unilateral or bilateral were observed in one fifth of the patients anterior uveitis could develop. Uveitis who had cardiac monetization. In patients could persevere months or years after the without acute disease (Levett, 2001). of patients electrocardiographic critical and variations supportive care, cardiovascular collapse could develop with the Postmortem shock, causing examination most patients, 8. Other complications fatalities. frequently reveals acute coronary arteritis and aortitis, whereas congestive heart failure Acute infection in pregnancy is reported to cause abortus and stillbirth. Leptospira are isolated in breast milk. Rare 53 International Research Journal of Emerging Trends in Multidisciplinary ISSN 2395 - 4434 Volume 1, Issue 10 December 2015 www.irjetm.com Beğendik H, Oral YU, Baran Aİ, complications are cerebrovascular events, 2. rhabdomyolysis, Karahocagil MK, Erkoç R (2011) Weil thrombocytopenic thrombotic purpura, acute hastalığı, Bir olgu sunumu, Van Tıp cholecystitis, erythema nodosum, aortic Dergisi. 8(1):33-35. stenosis, Kawasaki syndrome, reactive 3. arthritis, epididymitis, nerve paralyses, Matthias MA, Diaz MM, Lovett MA, hypogonadism in males, and Guillain- Levett PN, Gilman RH, Willig MR, Barre syndrome. Cerebral arteritis is Gotuzzo E, Vinetz JM. 2003. On behalf reported. Weil disease has a high of mortality rate that varies between 5 – StatesLeptospirosisConsortium. 15% (Sünbül, 2003). Lancetİnfect. Dis. Rev. 3: 757- 771. 4. Bharti AR, Nanlly JE, Ricaldi JN, the Peru- United Furuncuoğlu Y, Yıldız A, Polat E, CONCLUSION Öztürk R. 2006. Leptospira’ya bağlı As a result, although leptospirosis is miyokardit olgusu, İst. Tıp Fak. Derg. 69: defined as a zoonotic infection in humans 87-89. and animals, characterized with jaundice, 5. high fever and hemoglobinuria, induced leptospirainsidansı by Leptospirainterrogans serotypes, the Üniversitesi Sağlık Bilimleri Enstitüsü disease displays a complex clinical Doktora Tezi, Diyarbakır. picture and is difficult to diagnose only 6. using clinical pictures (Gül, 1985; Takçı, Biberoğlu K. 2005. Weil Hastalığı: 2004). Aseptik Menenjit, akut böbrek yetmezliği Gül K. 1985. ve Bölgemizde tipleri. Dicle Gün İT, Sağlam F, Demir U, ve şiddetli üst gastrointestinal sistem kanaması ile seyreden bir olgu sunumu. REFERENCES Dahili Tıp Bilimleri Dergisi. 12(2): 1031. Aydemir S, Üstündağ Y, Borazan A, Sekitmez N, Özdemir H. 2004. Sarılık, akut böbrek yetmezliği ve 107. 7. İkiz S, Özgür Yöresindeki NY.: Trakya sığırlarda trombositopenili bir olgu; Weil hastalığı. 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