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 severe 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 natural focal. It is widespread throughout the world and in various climatic zones. The exceptions are the 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 Vasilyev was also studying it. In 1888 he published a description of the disease called "infectious jaundice". Since then, scientists from all over the worldconducted research to identify the cause of the disease. However, even today, doctors fail to avoid deaths in severe cases.
In medical sources, there are several synonyms for leptospirosis: Vasiliev-Weil disease, infectious jaundice, mowing meadow fever.
Pathogen
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. Its favorite habitat is the aquatic environment, which explains the high risk of human and animal infection.
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 entering 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 unaffected by ultraviolet, acids and alkalis.
- The causative agent of leptospirosis can live in water for up to 3 weeks, and in soil for at least three months.
- After destruction, endotoxins are released by the bacterium, which damage the cells of all body systems.
Transmission routes
The source of infection in the case of leptospirosis are wild and domestic animals that have already suffered from the disease or are in the stage of its activedevelopment. During this period, they infect the soil and water with urine, 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, voles.
The causative agent 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 actively multiply. Then leptospirosis spreads to other organs, accumulating mainly in the kidneys and liver. The vital activity of pathogenic flora leads to necrotic and degenerative changes in tissues, the development of DIC and hemorrhagic rashes.
There are several transmission routes for leptospirosis:
- Contact. In this case, the bacterium enters the human body through wounds and cuts on the skin, mucous membranes.
- Alimentary. Infection occurs through the mouth and gastrointestinal tract. Microorganisms can remain for a long time on vegetables and fruits that have been washed with water from open water. In addition, leptospira live in the meat and milk of infected animals.
- Aspiration. The penetration of water contaminated with bacteria into the respiratory tract is carried out by inhalation through the nasopharynx or oral cavity.
- Transmissive. The infection enters the human body after the bite of a tick or lice, which act as a carrier.
People working on farms, meatpacking plants and wetlands are at high risk of the disease. also inrisk groups include veterinarians, animal shelter workers and public utilities.
Leptospirosis is characterized by seasonality. The incidence is more common in the summer-autumn period. After an infection, a person develops a strong immunity to it.
Main symptoms
The incubation period is from 3 to 30 days. As a rule, it does not exceed two weeks. The spectrum of clinical manifestations is very wide. Weil's disease can occur in an icteric or anicteric form, with a pronounced clinical picture or erased. It is characterized by polymorphism of symptoms observed in other ailments. Therefore, it requires a differential diagnosis.
During the course of 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. The person suffers from chills and weakness, nausea and vomiting. Fever, as a rule, persists for a week, is permanent or recurrent. Another sign of the disease at the initial stage is muscle pain. They increase on palpation.
The appearance of the patient is also striking. The skin on the face and upper body 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 a gray or brown coating.
A spot rash appears on the whole body on the 3-6th day. Leptospira secrete endotoxin, which destroys red blood cells. This leads to multiple hemorrhages, nosebleeds.
There is also an increase in the size of the liver and spleen. There may be signs of kidney damage: pain in the lower back, a change in the color of urine to reddish.
Bacteria Leptospira sometimes penetrate 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 starts to drop. However, the patient's condition does not improve and is supplemented by jaundice.
During the height of the disease, manifestations of hemorrhagic syndrome intensify. There are hemorrhages 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. In the case of the spread of the disease to the adrenal glands, the Waterhouse-Frideriksen syndrome develops. Symptoms of anemia gradually increase.
The period of peak is also characterized by kidney damage. The patient develops anuria. Already at this stage, in the absence of treatment, a lethal outcome is not excluded. It occurs mainly due to kidney or liver failure.
Convalescence stage
With timely diagnosis and treatment, the symptoms of leptospirosis in humans begin tosubside in the third week of illness. Gradually, the skin acquires a natural shade, diuresis normalizes.
However, it is during this period that complications should appear. Moreover, about every third patient has a relapse of the disease. They proceed with less pronounced clinical signs. Usually there is a fever that lasts up to 6 days. In case of recurrence, the disease lasts 2-3 months.
Diagnostic Methods
When the first symptoms of leptospirosis appear, you should contact an infectious disease specialist. Diagnosis begins with examining the patient and studying his medical history. Be sure the doctor examines the condition of the mucous membranes, skin.
The next step in the diagnosis is the appointment of an examination. There is no specific analysis for leptospirosis. To confirm the preliminary diagnosis, the following activities are carried out:
- Complete blood count. An increase in leukocytes and ESR indicates the presence of an infectious agent in the body.
- Biochemical blood test. 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 the icteric form of the disease, bilirubin levels usually exceed the norm.
- Microscopic method for examining blood, urine or cerebrospinal fluid. This test detects Leptospira, but it often has false negative results.
- Serological diagnostics. It implies the detection of specific antibodies characteristic of Weil's disease.
- PCR. This is the most informative method.diagnostics. 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 care. Complications are usually observed in the severe course of the disease. Among them, the most common are the following:
- renal, liver failure;
- muscle paralysis;
- meningitis;
- acute bleeding;
- eye and hearing damage;
- 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 constant monitoring of their he alth. The prescribed treatment pursues two goals at the same time: the fight directly with the pathogen, the elimination of the consequences of the disease.
Great attention is paid to detoxification of the body, since the main complications develop against the background of poisoning with toxins. For this purpose, as a rule, the use of various droppers is recommended:
- Hemodez. Why is this drug prescribed? It is necessary to restore plasma volume and normalize fluid and electrolyte balance.
- "Enterodesis". Due to the components present in the composition, it attaches toxins to itself and removes them from the body.
- "Mannitol". Indicated in violation of the kidneys. It has a pronounced diuretic effect, normalizes blood volume.
- "Polysorb", "Enterosgel". These drugs absorb harmful substances from the gastrointestinal 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 drugs from the penicillin group ("Penicillin", "Erythromycin", "Doxycycline"). The duration of such therapy is 10-14 days.
In some cases, plasmapheresis may be required after a dropper with "Hemodez". What is this procedure for? It involves the purification of the patient's blood through special devices. In this case, the plasma is removed and replaced with saline 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 record. Within six months, rehabilitation measures are carried out, including consultations with narrow specialists (oculist, neuropathologist, therapist). After this time, the patient should visit a therapist once a month to track the dynamics of recovery and take tests.
If after the end of the rehabilitation period the re-examination does not give positive results, the patient is removed from the register. Otherwise, follow-up continues for the next 2 years with mandatory periodic examinations.
Vaccination and other prevention methods
Vaccination is recognized as the most effective method of preventing leptospirosis. However, the vaccine against the disease is not given to all people, but only to a certain category of citizens:
- veterinarians and breeders;
- meat packing plant workers;
- vacuum trucks;
- laboratory workers;
- people working in outbreak areas.
Vaccination against leptospirosis is done exclusively according to indications and starting from the age of seven. An inactivated vaccine is used, that is, killed strains of bacteria. They cannot cause infection, but they reliably protect against it. Single immunization. However, revaccination of citizens at risk is carried out annually.
Vaccination side effects 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 progressive CNS pathologies.
Other prevention options include the following rules:
- annual vaccination of pets;
- destroy rodents, regularly disinfect premises;
- eat fruits and vegetables washed under running water;
- heat process meat products;
- rubber shoes must be worn while fishing;
- avoid contact with stray animals.
It is important to explain to children the danger of homeless animals. They should also be told about the high risk of infection after swimming and drinking water from open water.
The main burden in matters of prevention falls on government agencies, in particular on the sanitary and epidemiological services. They are responsible for the timely vaccination of people at risk and cattle against 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.
