Leptospirosis

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disease name

• various names in each of endemic areas
  • Weil's disease
  • 秋病み
  • Fort Bragg fever
  • mud fever
  • swamp fever
  • sugar cane fever

pathogen

• one of spirochete
• Leptospira spp. in the family Leptospiraceae
  • 10 pathogenic spp.
    • Leptospira borgpetersensii
    • Leptospira interrogans
  • 7 non-pathogenic spp.
  • 5 intermediate (unknown pathogenicity) spp.
• so many serovars
  • multiple serovars are found in mutiple spp. including both of pathogenic and non-pathogenic

life cycle and transmission

• natural non-pathogenic reservoirs
  • rodent
  • cattle
  • pig
  • other domestic and wild animals
• reside in renal tubes of natural hosts
• excreted into urine of natural hosts

transmission to human

• humans are accidental dead-end host
• direct contact to urine of infected animals
• indirect contact to urine-contaminated freshwater
• ingestion of urine-contaminated water in outbreak cases
• mainly occupational exposure
  • farmers
  • fishermen
  • miners
  • animal slaughters
  • veterinarians
  • sewage/canal workers
  • sugar cane workers
  • soldiers
• accidental exposure
  • triathron
  • canoeing
  • water rafting
  • flooding
  • hurricanes, cyclones and typhoons
• direct evidence of transmission via seawater is not known so far

epidemiology

• true disease burden unknown because of often asymptomatic to mild manifestations

clinical features

• calf muscle tenderness is one of pathognomonic symptoms but its pathophysiology is unkown

diagnosis

• MAT - microscopic agglutination test
• RDT
  • "Leptocheck" by serum
• blood culture positive only in the 1st week
• urine culture positive after 2 weeks

chemoprophylaxis

• doxycycline once a week during exposure to potentially contaminated water may be considered