Leptospirosis Main

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Kamilah Fernandez, Kemba Lewis and

Resul Boncu.

Leptospirosis


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Leptospirosis

Leptospirosis is caused by exposure toseveral types of the Leptospira, abacteria

is from the genus spirochete which can be

found in fresh water that has been

contaminated by animal urine.

Scan showing the

leptospira bacteria and its

characteristic elongatedspiral structure.


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MODES OF TRANSMISSION

By direct or indirect contact of nasal, oral, or eyemucosal membranes or abraded or traumatized

skin with urine or carcasses of infected animals.

Urine: Indirect exposure through water, soil, or

foods contaminated by urine from infected

animals is the most common route. After a short

period of circulating high levels of the spirochete

in their blood, animals shed the spirochete intheir urine, contaminating the environment.

Inhalation of droplet aerosols of contaminated

fluids can occasionally occur.


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Leptospirosis- Chain of Infection


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Leptospirosis- Symptoms Symptoms can take 2 - 26

days (average 10 days) todevelop, and may include:

Dry cough

Fever

Headache

Muscle pain

Nausea, vomiting, and

diarrhea

Shaking chills

Less common symptoms

include: Abdominal pain

Abnormal lung sounds

Bone pain

Conjunctivitis

Enlarged lymph glands

Enlarged spleen or liver

Joint aches Muscle rigidity

Muscle tenderness

Skin rash

Sore throat


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Leptospirosis Diagnosis

The diagnosis of Leptospirosis is made

by culture of the bacterial

organism Leptospirafrom infected

blood, spinal fluid, or urine.

The diagnosis can also be made on

rising Leptospiraantibody levels in the

blood


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Leptospirosis Treatment

Medications to treat Leptospirosis include: Ampicillin

Ceftriaxone

Doxycycline

Penicillin

Complicated or serious cases may need

supportive care or treatment in a hospitalintensive care unit (ICU).


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Leptospirosis in Georgia

Year Number of cases Prevalence per100000

2001 9 0.203

2002 7 0.157

2003 7 0.157

2004 10 0.225

2005 6 0.135

2006 27 0.608

2007 28 0.631

2008 18 0.405

2009 16 0.36

2010 72 1.623

Total 200 4.504

Table #1 : The prevalence per 100000 of



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A sporadic occurrence of

leptospirosis can be observed

within the Republic of Georgia.

Cases showed similar occurrences

in the years 2001 to 2005, Then a

slight increase in the years 2006

and 2007. It then decreased slightlyin the years 2008 and 2009 with a

sudden increase to 72 in the year

2010.


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Ages Age Specific Rate per 100000

>1 0

1-4 0

5-14 0.2

15-19 1.17

20-29 0.99

30-59 0.98

60 0.81

Table#2: Table showing the Age Specific Rate

of Leptospirosis in Georgia


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No cases occurred under the age of 4

years of age while a rate of 0.2 occurred

between the ages of 5-14.

An average of 0.93 occurred within the

age groups 20 to 60 years of age.

The highest cases occurred within the age

group 15 to 19.


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Month Number of cases

January 1

February 1

March 1

April 1

May 1

June 1

July 5August 8

September 9

October 5

November 2

December 0

Table#3: Table showing the monthly distribution of

Leptospirosis in Georgia from 2008 to 2010


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The most cases occurred between the

months of July to October.

These months had the highest rainfall.


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Leptospirosis In Georgia


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Region Number of Cases Prevalence per 100000

Tbilisi 5 0.46

Kakheti 3 0.737

Imereti 3 0.428Samgrelo and Zemo

Svaneti

2 0.429

Adjara 16 4.25

Shida Kartli 2 0.636

Kvemo Kartli 2 0.40

Guria 1 0.699

Samtskheti Javakheti 1 0.48

Mtsketa Mtianeti 0 0

Kacha Lechkhumi 0 0

Table#4: Table showing the number of cases and prevalence of

Leptospirosis for the regions of Georgia


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Leptospirosis in GeorgiaSpot Map showing the cases of Leptospirosis in the different

regions in Georgia.


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Region Prevalence Per 100000 Average AnnualPrecipitation (mm)

Tbilisi 0.46 568

Kakheti 0.737 1000

Imereti 0.428 1730

Samgrelo 0.429 2100

Adjara 4.25 8060

Shida 0.636 585Kvemo 0.40 425

Guria 0.699 1900

Samtskhe 0.480 550

Mtsketa 0 650

Racha 0 900

Table#5: Table showing the prevalence and average annualprecipitation for each region in Georgia


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0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

0

1000

2000

3000

4000

5000

6000

7000

8000

9000

Prevalenceper100000

Average

AnnualPrecipitation

Regions in Georgia

Graph showing the relationship between the prevalence ofleptospirosis and the average annual precipitation

Average Annual Precipitation

Prevalence per 100000


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From the graph showing the relationshipbetween Leptospirosis prevalence and

average annual precipitation it can be

seen that the greater the amount ofrainfall the greater the prevalence

This is especially seen in the region of

Ajara where the prevalence of

Leptospirosis and the average annual

precipitation were both substantially high


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Leptospirosis in Georgia Trend of Leptospirosis was studied in

Georgia. Prevalence rate has significantlyincreased since 2006 to 2007 with a

decrease in 2008 to 2009 and 500%

increase from 2009 to 2010 the highest rate 1.632 per 100 000 population.

The highest prevalence was observed the

age group 15-19. There was an increase prevalence from the

month of July to October.

Ajara had the highest prevalence


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Source of infection were: Contact with a natural water

reservoir- 54%

Ground contaminated with rodentexcretions- 8%

Cattle-raising activity- 8%

Unknown source- 15.5%

Leading to an overall fatality of 7-

14%


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Leptospirosis in Trinidad and

Tobago

A total of 278 cases were recorded, with an

average annual incidence rate of 1.84 per

100,000 population. 75% of the cases

occurred during the wet season, with thehighest number of cases recorded in

November.

A positive correlation was found betweennumber of cases and rainfall.


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Leptospirosis in Trinidad and Tobago

(1996 to 2007)

Males constituted 80% of all cases, and theoverall male: female ratio was 4.6:1

The total case fatality rate was 5.8%, withdeaths among males four times more

common than in females.

Clinical Leptospirosis was greatest in the 10-

19 age group and lowest in the 0-9 age

group.


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Leptospirosis in Trinidad and

Tobago The total prevalence was 22 per 100,000

population, with the highest prevalence 41

per 100,000 recorded in the regional

corporation of Sangre Grande and the lowest(6 per 100,000) in the city of Port of Spain.

The lack of important information and active

surveillance showed that the level of

awareness of the disease is low in the

country.


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Leptospirosis in T&T and

GeorgiaParameter Country

Georgia Trinidad and Tobago

Highest Annual Prevalence per 100000 1.632 1.84

Age most Prevalent 15-19 10-19

Month most Prevalent September November

Sex most Prevalent NA Males

Region most Prevalent Ajara Sangre Grande

There is also a direct relationship between Leptospirosis prevalenceand season as Leptospirosis is most prevalent in Trinidad and

Tobago during the rainy season and Leptospirosis is most prevalent

in Georgia during the rainiest periods (July to October) of the year at

the end of summer to the beginning of autumn.


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Leptospirosis- Conclusion

Leptospirosis has a direct correlation withthe rainy periods of the year and cases

occurred in areas with the highest

prevelance of rainfall (hospital/general practitioner/laboratory) to

intermediate level.


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Recommendations

Inform the public that the risk of acquiring

Leptospirosis can be greatly reduced by

not swimming or wading in water that

might be contaminated with animal urine,or eliminating contact with potentially

infected animals.

Immediate case-based reporting ofsuspected or confirmed cases.


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All cases must be investigated since

investigation can identify environmentalpoint sources of transmission and lead to

control measures.

Routine reporting of aggregated data ofconfirmed cases from intermediate to

central level. Hospital-based surveillance

may give information on severe cases of

leptospirosis. Serosurveillance may give

information on whether leptospiral

infections occur or not in certain areas or

populations


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References

Epidemiology of human leptospirosis in Trinidad and Tobago, 1996-2007: aretrospective study.

Mohan AR, Cumberbatch A,Adesiyun AA, Chadee DD.

Source

Department of Life Sciences, The University of The West Indies, St. Augustine,

Trinidad and Tobago.
http://www.ncbi.nlm.nih.gov/pubmed?term=Mohan%20AR%5BAuthor%5D&cauthor=true&cauthor_uid=19679092http://www.ncbi.nlm.nih.gov/pubmed?term=Cumberbatch%20A%5BAuthor%5D&cauthor=true&cauthor_uid=19679092http://www.ncbi.nlm.nih.gov/pubmed?term=Adesiyun%20AA%5BAuthor%5D&cauthor=true&cauthor_uid=19679092http://www.ncbi.nlm.nih.gov/pubmed?term=Chadee%20DD%5BAuthor%5D&cauthor=true&cauthor_uid=19679092http://www.ncbi.nlm.nih.gov/pubmed?term=Chadee%20DD%5BAuthor%5D&cauthor=true&cauthor_uid=19679092http://www.ncbi.nlm.nih.gov/pubmed?term=Adesiyun%20AA%5BAuthor%5D&cauthor=true&cauthor_uid=19679092http://www.ncbi.nlm.nih.gov/pubmed?term=Cumberbatch%20A%5BAuthor%5D&cauthor=true&cauthor_uid=19679092http://www.ncbi.nlm.nih.gov/pubmed?term=Mohan%20AR%5BAuthor%5D&cauthor=true&cauthor_uid=19679092

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