LEPTOSPIROSIS IN MALAYSIA by Agnes Ling Estella Chua

LEPTOSPIROSIS IN MALAYSIA by Agnes Ling & Estella Chua

The Various Names Swineherd's disease, swamp fever, or mud fever, Weil's disease, Weil's syndrome, canicola fever, canefield fever, nanukayami fever, 7 -day fever, Rat Catcher's Yellows, Fort Bragg fever, and Pretibial fever In Malaysia: Penyakit Kencing Tikus (Rat Urine Disease)

Introduction Most common zoonotic disease worldwide Most prevalent in trophics, subtrophics Caused by pathogenic spiral bacteria that belong to the genus: Leptospira, family: Leptospiraceae order: Spirochaetales the organism enters the body when mucous membranes or abraded skin come in contact with contaminated environmental sources.

Leptospires Images above generated in 3 DS Max and are based on direct measurements and sectional profiles of Leptospira Interrogans.

Etiology In 1883, first recognized as an occupational disease of sewer workers In 1886, Weil described the clinical manifestations in 4 men who had severe jaundice, fever, and hemorrhage with renal involvement. in 1916, Inada et al identified the causal agent in Japan

Epidemiology The most important reservoirs are rodents( rats) also dogs, livestock, wild animals, and cats. Urinary shedding of organisms from infected animals A person can only be affected by direct exposure to the bacteria physically entering the bloodstream. Likelihood in freshwater, damp alkaline soil, vegetation, and mud with temperatures higher than 22°C. It is NOT contagious that is, it will not be passed from human to human.

Risk factors Partial or total immersion in mud and water plays a role in facilitating infection in sewer workers and rice field workers. Milkers may be splattered in the face, causing subsequent infection via the conjunctivae. Infection of military troops occurs as a result of direct exposure to infected urine or indirect contact with contaminated soil and water.

Cases

Cases of Leptospirosis in Malaysia Year Number of Cases 2004 263 2005 378 2006 527 2007 929 2008 1263 2009 1418 Source: Report of Morbidity and Mortility for Health of Ministry Hospitals 2004 -2009

Development of disease Pathogen enters –multiplies in blood and tissue (usually lasts about 7 days)– affect liver and kidney. Ø Ø (Anicteric leptospirosis) Systemic with aseptic meningitis (Icteric leptospirosis) Overwhelming disease (Weil’s disease) ü Vascular collapse ü Thrombocytopenia ü Hemorrhage ü Hepatic and renal dysfunction

Clinical Progression

Treatment Antimicrobial therapy(severe) Dialysis(renal failure); renal function is restored in most. Those with Weil syndrome may need transfusions of whole blood, platelets, or both. Supportive therapy and careful management of renal, hepatic, hematologic, and CNS complications

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