Leptospirosis
A Leptospirosis is an infectious disease that is caused by certain pathogens of the genus Leptospira ( from the order of spirochetes ).
This is a reportable zoonotic disease whose natural hosts mainly rats and mice, in the case of swineherd disease are also pigs and cattle. Transmission to humans occurs through contact with urine, blood or tissues of infected animals or contaminated water.
Leptospirosis in human
On the basis of its antigenic properties of the human pathogen Leptospira interrogans infesting is divided into 24 serogroups with over 200 serovars. Mention may be made here:
- Weil 's disease, ICD -10: A27.0; which can take more often than others leptospirosis become severe; caused by L. interrogans serovar icterohaemorrhagiae
- Because -like illness (or " other leptospirosis " ), ICD- 10: A27.8; as Batavia Fever, known in Italy as " rice field fever," caused by L. bataviae
- The swineherd disease or " Bouget - Gsell 's disease," by L. Pomona
- The cane fever ( the Zuckerplantagenleptospirose ) by L. interrogans serovar australis or pyrogenic.
- The Canicola fever by L. Canicola
Leptospira biflexa is non-pathogenic in contrast to Leptospira interrogans, for the people.
Leptospirosis can be an occupational disease (BK 3102 ) in persons occupationally close contact with animals and animal waste have ( abattoir workers, butchers, veterinarians, keepers, fishermen, sewer workers ), compensated.
Transmission
Leptospires pass via the urine of infected mammals (rats, dogs, mice ) into the environment. Through small skin lesions or mucosal humans can be infected with the pathogen.
Frequency
2011 in Germany 51 diseased human leptospirosis, which corresponds to an incidence of 0.1 per 100,000. Thus, leptospirosis is a very rare disease in Germany, which is introduced in the rule only in individual cases from other countries. Occasionally, leptospirosis occurs but also to epidemic proportions.
The last eruption took place in July 2007 under the harvest workers on a strawberry field near Düren. This diseased about 30 workers at the field fever. This was the first such incident documented for over 40 years.
Course
In about 90 % of cases, leptospirosis is similar to the flu. The classic course can be found especially in Crohn Weil, but other Leptospira can cause a severe course. In the blood of the host, the leptospires multiply one to two weeks, sometimes up to 26 days before symptoms develop. These consist of fever, chills, headache and body pain. Conjunctivitis and calf and shin pain are frequently observed. This stage lasts about 3-7 days. This is followed by a short period of 2-3 days, which is concerned with the patient slightly better.
This is followed by a second febrile phase of the disease, which takes up to 30 days. This period is best expression of an immune reaction with circulating immune complexes, triggered by the endothelial. In the severe form, the disease because, it can come at this time to damage the liver. When Canicolafieber which runs moderate, meningitis is important, as the more benign field running a fever.
Complications
Severest forms can be found in Crohn Weil, associated with liver and kidney failure and can lead to death.
The conjunctivitis can last up to 4 weeks.
Diagnosis
In the first phase of the disease, a pathogen from blood culture succeed. Frequently, however, the cultures are too slow, so no more successful antibiotic treatment can take place. Therefore, antibody detection is increasingly being used, which allows for faster detection of Leptospira infection.
In the second phase of the disease is diagnostic only serology promising. IgM and later, IgG antibodies can be detected over time. The pathogen most likely to succeed directly by dark-field microscopy.
Therapy
Treatment of choice is penicillin iv, which, however, only effective in the first 5 days of the disease. As with other spirochetes a Jarisch -Herxheimer reaction may occur with the use of penicillin. Also doxycycline and cephalosporins 3rd generation work well against leptospires.
In the second phase of the disease, the use of antibiotics is no longer useful, as it is an immune reaction. In this phase, only the fluid loss, fever and possible organ damage can be treated symptomatically.
Forecast
Overall, the prognosis is good with mild course forms.
Severe progressive forms, in particular the Crohn Because, however, may be associated untreated with a mortality rate ( mortality ) of up to 30%.
Leptospirosis of animals
- Leptospirosis of the dogs
- Leptospirosis in ruminants
- Leptospirosis of pig
- Moon blindness ( Leptispirose -associated eye disease in horses )