Modern man coexists with the animal world and can no longer imagine his diet without meat products. Unfortunately, such "proximity" is fraught with many dangers. Rodents and livestock are carriers of many diseases. One of these is leptospirosis or Weil's disease. This is a serious infectious pathology, leading to serious complications and even death.
What is leptospirosis?
This is an acute zoonotic infectious disease characterized by intoxication and damage to blood vessels, central nervous system, liver and kidneys. It belongs to the number of natural focal. Distributed everywhere and in various climatic zones. The exceptions are deserts and the Arctic.
For the first time, a detailed description of the pathology was presented by the German scientist Weil in 1886. At the same time, the Russian scientist Vasiliev was engaged in its study. In 1888, he published a characteristic of the disease called "infectious jaundice." From that moment, scientists from around the world conducted research to identify the causes of the disease. However, even today, doctors are unable to avoid fatal outcomes in severe cases.
In medical sources, there are several synonyms for leptospirosis: Vasiliev-Weil disease, infectious jaundice, mow-meadow fever.
Causative agent of the disease
The causative agent of the disease is a bacterium belonging to the leptospira family of the spirochete class. It has a spiral shape, has high mobility. The aquatic environment is recognized as her favorite habitat, which explains the high risk of infection of humans and animals.
In addition, leptospira have the following distinctive features:
- Bacteria in artificial conditions grow quite slowly. It is sometimes difficult to make a timely diagnosis, since they can be detected a week after cultivation.
- After penetration into the body, they attach to the inner layer of blood vessels and blood cells, actively damaging them.
- Pathogenic flora is resistant to low temperatures. They are practically not affected by ultraviolet, acid and alkali.
- The causative agent of leptospirosis can live in water for up to 3 weeks, and in soil for at least three months.
- After destruction, the bacteria release endotoxins, which damage the cells of all body systems.
Transmission ways
The source of infection in case of leptospirosis is wild and domestic animals that have already suffered an illness or are in the stage of its active development. During this period, they infect the soil and water with urine and excrement. The main carriers of infection in nature are small rodents. However, other animals can transmit leptospirosis: cattle (cattle), rats, hedgehogs, guinea pigs, horses, dogs, and field voles.
The causative agent of the infection enters the human body, usually with food or water. First of all, it appears on the skin and mucous membranes, and then settles in the lymph nodes, where it begins to multiply actively. Then leptospirosis spreads to other organs, accumulating mainly in the kidneys and liver. The vital activity of the pathogenic flora leads to necrotic and degenerative tissue changes, the development of DIC, and hemorrhagic rashes.
There are several ways to transmit leptospirosis:
- Contact. In this case, the bacterium penetrates the human body through wounds and cuts on the skin, mucous membranes.
- Alimentary. Infection occurs through the mouth and gastrointestinal tract. Microorganisms can remain on vegetables and fruits that have been washed with water from open water for a long time. In addition, leptospira live in the meat and milk of infected animals.
- Aspirated. Penetration of water contaminated with bacteria into the respiratory tract is carried out by inhalation through the nasopharynx or oral cavity.
- Transmissible. An infection enters the human body after being bitten by a tick or lice, which act as a carrier.
People who work on farms, meat processing plants and wetlands are highly likely to be affected. Also at risk are veterinarians, employees of animal shelters and utilities.
Leptospirosis is characterized by seasonality. The incidence is more common in the summer-autumn period. After the infection, a person develops a stable immunity to it.
Main symptoms
The incubation period is from 3 to 30 days. As a rule, it does not exceed two weeks. The range of clinical manifestations is very wide. Weil's disease can occur in icteric or anicteric form, with a pronounced clinical picture or worn out. It is characterized by a polymorphism of symptoms observed with other ailments. Therefore, it requires differential diagnosis.
During the disease, it is customary to distinguish several stages: initial, peak period, convalescence. Each of them has a specific clinical picture and features.
Initial or febrile stage
The disease usually begins acutely with an increase in temperature to 39-40 degrees. A person is tormented by chills and weakness, nausea and vomiting. Fever, as a rule, persists for a week, is permanent or recurrent. Another sign of an illness in the initial stage is muscle pain. They increase with palpation.
The appearance of the patient is striking. The skin on the face and upper torso becomes red, puffy. In the area of the lips and wings of the nose, herpetic eruptions are possible. The tongue is always dry, covered with gray or brown coating.
On 3-6 days, a point rash appears throughout the body. Leptospira secrete endotoxin, which destroys red blood cells. This leads to multiple hemorrhages, nosebleeds.
An increase in the size of the liver and spleen is also noted. There may be signs of kidney damage: pain in the lower back, a change in the shade of urine to reddish.
Leptospira bacteria sometimes cross the blood-brain barrier, reaching the brain. In 20% of cases, patients develop meningeal syndrome. It is characterized by severe headaches that cannot be stopped with analgesics, and vomiting.
The period of heat and damage to internal organs
From about the second week, the temperature begins to decline. However, the patient’s condition does not improve and is supplemented by jaundice.
During the height of the ailment, the manifestations of hemorrhagic syndrome intensify. Hemorrhages appear on the skin and mucous membranes, internal bleeding is possible. For example, with lung damage, the clinical picture is supplemented by signs of respiratory failure. If the disease spreads to the adrenal gland, Waterhouse-Friedericksen syndrome develops. Symptoms of anemia are gradually increasing.
Kidney damage is also characteristic of the high season. The patient progresses anuria. Already at this stage, in the absence of treatment, a fatal outcome is not excluded. It occurs mainly due to renal or liver failure.
Convalescence Stage
With timely diagnosis and treatment, the symptoms of leptospirosis in a person begin to subside in the third week of the disease. Gradually, the skin acquires a natural shade, diuresis normalizes.
However, it is during this period that one should be wary of complications. Moreover, approximately every third patient has relapses of the disease. They occur with less pronounced clinical signs. Usually there is a fever that lasts up to 6 days. In case of relapse, the disease lasts 2-3 months.
Diagnostic Methods
When the first symptoms of leptospirosis appear, contact an infectious disease specialist. Diagnosis begins with an examination of the patient and a study of his medical history. Be sure the doctor studies the condition of the mucous membranes, skin.
The next stage of diagnosis is the appointment of a survey. There is no specific analysis for leptospirosis. To confirm the preliminary diagnosis, the following activities are carried out:
- General blood analysis. An increase in white blood cells and ESR indicates the presence of an infectious pathogen in the body.
- Blood chemistry. It is carried out to assess the condition of internal organs. For example, an increase in ALAT and ASAT indicates liver damage. In the case of an icteric form of the disease, bilirubin values usually exceed the norm.
- Microscopic examination of blood, urine or cerebrospinal fluid. This analysis reveals leptospira, but often it has false negative results.
- Serological diagnosis. It implies the identification of specific antibodies specific for Weil’s disease.
- PCR This is the most informative diagnostic method. Its accuracy reaches 99%.
Differential diagnosis is carried out with influenza, viral hepatitis, meningitis.
Possible complications
The consequences of Weil’s disease are difficult to predict even with timely medical attention. Complications are usually observed in severe illness. Among them, the most common are the following:
- renal, liver failure;
- muscle paralysis;
- meningitis;
- acute bleeding;
- damage to the eyes and hearing aid;
- pneumonia;
- stomatitis;
- hemorrhagic pulmonary edema;
- uremic coma.
Principles of Therapy
Treatment of patients is carried out exclusively in a hospital. Patients with severe leptospirosis are placed in intensive care units for continuous monitoring of their health. The prescribed treatment has two goals at the same time: the fight directly with the pathogen, the elimination of the consequences of the disease.
Much attention is paid to the detoxification of the body, since the main complications develop against the background of poisoning by toxins. For this purpose, as a rule, the use of various droppers is recommended:
- "Hemodez." What is this drug prescribed for? It is necessary to restore plasma volume and normalize the water-electrolyte balance.
- Enterodez. Due to the components present in the composition, it attaches toxins and removes them from the body.
- Mannitol. It is indicated for impaired renal function. It has a pronounced diuretic effect, normalizes blood volume.
- Polysorb, Enterosgel. These drugs absorb harmful substances from the digestive tract, remove them from the body along with feces.
The fight against the causative agent of the disease involves the use of antibiotics. Particularly effective are the drugs from the penicillin group (Penicillin, Erythromycin, Doxycycline). The duration of such therapy is 10-14 days.
In some cases, it may be necessary to carry out plasmapheresis after a dropper with "Hemodez". Why is this procedure prescribed? It involves the purification of the patient’s blood through special devices. In this case, the plasma is removed and replaced by physiological solutions. As a result, the body is cleansed of toxins, and the patient's well-being improves.
Rehabilitation period
After eliminating the symptoms of leptospirosis in humans and treating the patient, they are put on a dispensary account. Within six months, rehabilitation measures are carried out, including consultations with narrow specialists (optometrist, neuropathologist, therapist). After this time, the patient should come to the therapist once a month to monitor the dynamics of recovery, passing tests.
If, after the end of the rehabilitation period, a repeated examination does not give positive results, the patient is deregistered. Otherwise, the observation continues for the next 2 years with a mandatory periodic examination.
Vaccination and other methods of prevention
The most effective method for the prevention of leptospirosis is vaccination. However, vaccination against ailment is not given to all people, but only to a certain category of citizens:
- veterinarians and livestock breeders;
- slaughterhouse workers;
- scavengers;
- lab workers;
- people working in foci of infection.
Vaccination against leptospirosis is done exclusively according to indications and, starting from the age of seven. An inactivated vaccine is used, that is, killed bacterial strains. They can not cause an infection, but reliably protect against it. Immunization is single. However, revaccination to citizens at risk is carried out annually.
Side effects from vaccination are extremely rare. In most cases, they are associated with individual intolerance to the drug. Sometimes there is swelling and redness on the skin at the injection site. Vaccination is contraindicated in pregnant women, children under 7 years of age, and people with advanced CNS pathologies.
Other prevention options include the following rules:
- annual vaccination of domestic animals;
- destroy rodents; regularly disinfect the premises;
- eat fruits and vegetables washed under running water;
- heat treat meat products;
- during fishing, you must wear rubber shoes;
- exclude contact with stray animals.
It is important to explain to children the dangers of stray animals. They also need to talk about the high probability of infection after bathing and drinking water from open water.
The main burden in matters of prevention falls on state bodies, in particular on sanitary and epidemiological services. They are responsible for timely vaccination of people at risk and cattle from leptospirosis. In addition, it is important to carry out the burial of animals in accordance with established rules in order to prevent outbreaks of epidemics and the spread of infections.