Leptospirosis in humans: symptoms and treatment

Leptospirosis is an infectious disease caused by special bacteria called leptospira. Most of the disease can be obtained by bathing in a small pond contaminated with Leptospira or eating raw water, meat or milk of animals suffering from leptospirosis. There are several types of this disease, some of which can be very dangerous for human life.

Leptospirosis affects the liver, kidneys, brain, leads to severe intoxication, can cause bleeding disorders and bleeding. Who is the source of infection, how to recognize and how to treat leptospirosis? You will find answers to all these questions in this article.

So, leptospirosis is caused by the same-named microorganisms, leptospira. Leptospira are spiraling bacteria that love a moist environment. These microorganisms die under the influence of sunlight, disinfectants and high temperature (for example, at 55 ° C - after half an hour, at 100 ° C - instantly). Among leptospira there are pathogenic varieties, that is potentially dangerous for humans, and saprophytic (neutral, not causing disease). Pathogenic varieties of leptospira are known about 200! Due to this number of pathogens, leptospirosis is heterogeneous in the symptomatology of the disease. The most studied and frequently encountered varieties of leptospirosis are infectious jaundice, Japanese 7-day fever, water fever, canine fever.

Sources of infection

The main source of leptospirosis are animals. They are a natural reservoir of infection. It can be either wild animals or domestic animals, as well as birds, amphibians, reptiles. With feces of infected animals, leptospira are released into the environment, where they can exist for a rather long time, preserving their activity. The warmer and more humid the climatic conditions, the better for leptospira, therefore, this disease occurs most massively in the tropics. The only place on earth where there is no leptospirosis is Antarctica.

How can a person get infected? There are several ways of infection with leptospirosis.

1. Contact. In cases where the pathogen enters the human body by direct contact with damaged mucous membranes and skin. This is possible, for example, when swimming in a reservoir containing leptospira (especially important are small ponds with standing water), or when cutting carcasses of patients with leptospirosis of animals, or when working with soil contaminated leptospira. Damage to the skin and mucous membranes can be microscopic, completely invisible during normal examination, but sufficient to penetrate the pathogen.
2. Water. When consumed inside the raw water containing the pathogen. Did you drink water from an unknown source somewhere in the forest? It was quite possible to swallow and leptospira (although not only them).
3. Nutritional. When eating thermally inadequately processed meat, the milk of infected animals. Food can be contaminated in another way. For example, ran around the room an ordinary house mouse, sick with leptospirosis, gnawed seeds or cookies, accidentally left on the table, and left her feces. And then the man regaled himself with cookies from the same vase - and that's all, leptospires got into the body.

Of course, employees of livestock farms, agriculture, fishermen and hunters are those people who are at risk in the first place. People are very susceptible to leptospirosis, especially the high incidence in the summer-autumn period. You should be aware that the chain of transmission of infection is interrupted on a person. This means that a person with leptospirosis is not contagious, not dangerous to others.

Symptoms

This may seem strange, but the ingestion of leptospira into the human body is not accompanied by any sensations or changes. Leptospira through the skin (mucous membranes) penetrate into the lymphatic vessels, pass through the lymph nodes (which do not delay them), and then fall into the internal organs. Leptospira "love" the kidneys, liver, spleen, lungs. In these organs they settle for a while and begin to multiply intensively. And, having already significantly enlarged their ranks with brethren, the leptospirae enter the bloodstream. Up to this point, no symptoms are found. This entire period of time is in fact an incubation period of infection and lasts from 2 to 30 days (usually 7-14 days). The duration of the incubation period varies depending on the number of leptospiraes found and the reactivity of the human body.

Entering the bloodstream marks the onset of the disease. Suddenly, body temperature rises to 39 ° -40 ° C, there is a strong chill, pain in the muscles and joints, headaches, severe general weakness, nausea and vomiting, poor appetite, thirst. The heart rate increases. The heat lasts for several days (up to 12), and then decreases. Sometimes after the normalization of body temperature, it may be re-raised after a few days, as if a second wave. Not always the normalization of body temperature means improvement. It also happens that the decrease in temperature does not reach normal figures, and then for a long time the subfebrile condition remains (that is, the body temperature rises to 37 ° -3, ° C).

The initial period of leptospirosis is characterized by reddening of the face, neck, upper chest, injection vessels of the sclera ("red eyes"), possibly the appearance of a rash on the skin (but not necessarily), an increase in lymphatic nodes.

Leptospira with blood flow are carried throughout the body, repeatedly settling in various organs and tissues. The leptospira themselves, as well as the toxins that they produce, are responsible for this or that clinical picture of the disease. With leptospirosis, the following organs and systems can be affected:

1. Muscles. The pain in muscles appears almost simultaneously with the rise in body temperature. The most painful syndrome is expressed in the calf muscles and lower back muscles, less in the muscles of the neck and abdomen. Muscle pain does not depend on the position of the body, but increases with movement and palpation. Sometimes the degree of muscle damage reaches their disintegration. In this case, it is possible to develop renal failure. Also, severe pain in the muscles can lead to diagnostic errors (for example, severe pain in the abdomen can be suspected acute appendicitis). The pain in the muscles lasts up to 10 days, gradually fading.
2. Liver. The degree of involvement of this organ can vary from insignificant (clinically practically imperceptible) to liver failure. The most obvious symptom of liver damage is jaundice. Approximately on the 4th-6th day after the onset of the disease (in severe cases - on 2-3 days), the sclera turns yellow, and then the skin becomes yellow. Jaundice can last from one to several weeks, it is associated with both direct damage to liver cells, and with increased disintegration of red blood cells. Blood increases the bilirubin content, the urine becomes dark, the feces slightly discolor, the liver increases in size, becomes painful when it feels in the right hypochondrium. Along with enlarging the liver, it is possible to increase the spleen. There may be a slight itchy skin. In general, the severity of leptospirosis corresponds to the severity of jaundice: the brighter the jaundice, the more unfavorable the disease.
3. The kidneys. Kidneys with leptospirosis are affected in 50-100% of cases. The severity of the lesion varies from minimal changes to renal failure, up to the development of uraemic syndrome with a fatal outcome. Usually, the lesion of the kidney tissue is clearly expressed from the 7th to the 10th day of the disease. In the urine appears protein, erythrocytes, leukocytes, cylinders, the amount of excreted urine decreases. But there is usually no secondary increase in blood pressure and edema and renal damage. Decrease the ability of the kidneys to neutralize toxic substances and excrete them with urine from the body leads to an increase in the content of nitrogenous products in the blood: the content of urea, creatinine in blood. In extremely severe cases of leptospirosis, urine formation ceases altogether, anuria develops. With a favorable course, the excretory function of the kidneys is restored, the urinalysis parameters and the concentration capacity of the kidneys are gradually normalized. A favorable symptom, indicative of a turning point in the case of damage to the kidney tissue, is an increase in daily diuresis after a period of its decrease.
4. Lungs. The respiratory system is involved in the process with leptospirosis in 3-60% of cases. The main forms of manifestation of the disease are acute bronchitis and, in more severe cases, pneumonia. The most formidable complication of the respiratory system in leptospirosis is the development of pulmonary edema, from which the patient may die.
5. Central nervous system. In the initial period of leptospirosis, the symptoms of nervous system damage are nonspecific. This headache, sleep disturbance, dizziness, sometimes against a background of high fever is nonsense and hallucinations. During the repetition of the leptospira of various organs and systems, targeted damage is possible central nervous system in the form of meningitis (affecting the meninges) and encephalitis (damage to the substance brain). Up to 40% of all cases of leptospirosis are accompanied by these complications. Meningeal syndrome is characterized by a sharp deterioration in the condition: headache is aggravated, indomitable vomiting, photophobia, as well as meningeal signs (stiff neck, Kernig symptoms and Brudzinsky). In such cases, a spinal puncture is indicated. In the cerebrospinal fluid, an increased content of leukocytes and protein is found. On the development of encephalitis may indicate a sudden weakness in one or more limbs, speech, vision, numbness of individual parts of the body. Encephalitis is a severe lesion of the central nervous system and can endanger the life of the patient.
6. System of blood. Leptospira secretes toxins that affect the inner shell of the capillaries, which leads to an increase in the permeability of the vascular wall. This contributes to the release of blood from small vessels. Symptoms of this condition are numerous small hemorrhages: the skin of the eyes (sclera), under the skin (in the form of a different nature of the rash), nosebleeds. Usually, similar phenomena occur on the 3-4th day of the disease, which should be regarded as a harbinger of more massive bleeding. Syndrome of bleeding as much as possible increases in the second week of the disease. Hemorrhages acquire the character of bleeding: pulmonary, gastrointestinal, uterine bleeding, bleeding from injection sites, macrogemuria (discharge of blood along with urine). By themselves, such bleeding can threaten the life of the patient (depending on the amount of blood loss). The most severe manifestation of the bleeding syndrome is the syndrome of disseminated intravascular coagulation, when the entire body "covers" literally. Mortality in the syndrome of disseminated intravascular coagulation is very high.
7. The cardiovascular system. With leptospirosis, the most frequent increase in the frequency of heartbeats (tachycardia) and their muffledness, lowering of arterial pressure, there are less violations of the heart rhythm in the form of extrasystole and ciliary arrhythmias. In 10-12% of cases, an inflammatory process develops in the cardiac muscle, myocarditis. Myocarditis occurs with severe disease.

Also, with a severe form of leptospirosis, combined lesions of various organs and systems develop. Possible development of acute hepatic and renal failure, multiple bleeding syndrome, infectious-toxic shock, which in many cases becomes the cause of death.

In addition to the most common clinical forms of leptospirosis described above, it is possible to damage other organs and systems. So, for example, it can be acute pancreatitis, cholecystitis, parotitis (inflammation of the parotid salivary glands), iridocyclitis (inflammation of the iris and ciliary body), optic neuritis nerve. It turns out that with leptospirosis, any organ can become a target.

Patients with mild forms of the disease after 2 weeks begin to recover. Gradually the body temperature normalizes, symptoms of intoxication decrease, jaundice goes away, diuresis normalizes. In more severe cases, recovery begins only after a month. The average duration of the disease is 4-6 weeks. Postponed leptospirosis leaves a long and persistent immunity, but only to that kind of leptospira that caused it. And since there are about 200 of them, the probability of recurrence of the disease remains high.

In 20-60% of cases after a persistent improvement in the condition, a relapse of the disease or even a few is possible. In such cases, a wave of fever and other symptoms of the disease is repeated, but in a more mild form. Usually relapses are much shorter: their duration is 1-6 days.

Postponed leptospirosis can leave behind a trail in the form of asthenic syndrome, muscle weakness, as well as damage to the organ of vision (impaired vision, including blindness, uveitis, iridocyclitis, optic nerve atrophy) and the nervous system (arachnoiditis, neuritis, paralysis, and so on Further).

Treatment

Since leptospirosis is a serious disease, its treatment is carried out only in a hospital. Usually it is an infectious disease department, however in severe cases the patients are transferred to the intensive care unit.

The main directions in the treatment of leptospirosis are direct control of the pathogen and individual pathogenetic therapy (which implies the treatment of affected organs, taking into account the mechanism of disease development).

Direct control of the pathogens to date is done with the help of antibiotics. Previously, for the same purpose, a specific leptospirosis immunoglobulin was used. However, the use of this agent in severe forms did not give the expected result, so at present it is not used.

Among a huge number of modern antibiotics for leptospirosis, a banal group of penicillin is preferred. As it turned out, penicillin series is most damaging for leptospira. Penicillin is prescribed in a dose of 4 to 12 million units per day, dividing it into several methods. The total duration of antibiotic therapy is 10-14 days. It is more favorable for recovery, if such therapy is started in the first four days after the onset of the disease, otherwise the effectiveness of treatment is lower.

With intolerance to antibiotics of the penicillin series, Levomycetin is prescribed in a dose of 30-50 mg / kg per day. Another drug of choice for leptospirosis is Doxycycline in a dose, g per day. If a repeated course of antibiotics is required, cephalosporins are used.

Pathogenetic therapy is aimed at reducing the symptoms of intoxication, replenishment of fluid losses in the body, correction of blood system parameters and homeostasis. Basically it includes the use of:

• analgesics and non-steroidal anti-inflammatory drugs (Ibuprofen, Paracetamol, Xefokam and others);
• antihistamine (antiallergic) drugs (Suprastin, Loratadine, Zodak, Suprastinex and others);
• enterosorbents (Enterosgel, Polysorb, Polyphepan and others);
• infusion solutions and detoxification preparations (physiological sodium chloride solution, glucose solutions, potassium preparations, Ringer's solution, Reosorbilact, Reamberin and so on);
• antioxidants and antihypoxants (vitamin E, C, Mexidol, Mildronate, Cytoflavin, Essentiale, Glutargin, Actovegin, Cerebrolysin, Oktolipen and others). The choice of a particular drug is determined by the damage of one or another organ. Thus, for example, in the defeat of the liver, Essentiale is preferable, and in the case of brain tissue damage, Cerebrolysin;
• hormones (they are especially indicated in severe cases, with increased bleeding and severe intoxication). Assign a short course with a gradual decrease in dose (Prednisolone, Dexamethasone).

It is almost impossible to list all groups of medicines used in leptospirosis. Everything depends on the damage to one or another organ and the symptoms present.

In severe cases, some medication is not enough. Renal and hepatic insufficiency may require extracorporeal methods of detoxification (hemodialysis, plasmapheresis, hemosorption, hemofiltration). The number of procedures will be determined by the parameters of homeostasis, urine and blood tests, the general condition of the patient.

Prevention

What are the measures to prevent leptospirosis? There are only two groups of them: nonspecific and specific (vaccination). Nonspecific measures consist in observing the rules of personal hygiene, eating thermally processed foods, protecting water bodies from pollution by excreting animals, fighting rodents.

Vaccination against leptospirosis is carried out by animals and people at risk (agricultural and construction workers in high-impact areas morbidity, livestock farms and slaughterhouses, fishermen, hunters, employees of immunological laboratories working with pathogens leptospirosis). To ensure that the vaccine can provide immunity, it must be administered at least one month before the alleged contact with the pathogen.

Thus, leptospirosis is a dangerous infectious disease that has a very nonspecific symptomatology. The outcome of the disease can be either complete recovery or death from complications. Treatment of leptospirosis is complex, sometimes using extracorporal methods of purifying the body. The effectiveness of treatment is higher the earlier it was started.

The first Republican TV channel, the program "Your Health" on the topic "Leptospirosis

TRK Forum, a story on the topic "Prevention of leptospirosis