Leptospirosis, eatiologi,sign and symptome,Diagnoses Leptospirosis
A. DEFINITIONS
Leptospirosis is a disease caused by a pathogen Leptospira to humans, who entered the human darh flow and cause a fever that lasted a minute. In some virulent strains will cause the lesions of acute inflammation, especially dihati, kidney, lining of the brain, muscle and eyes. While the term special Weil’s disease caused by L. ictherohemorrhagiae.
B. Aetiology
The genus Leptospira consists of 2 groups or complexes:
1. Complex L. interrogans a pathogen of humans and animals
2. Complex L. biflexa is not pathogen
Of the complex L. interrogans is obtained sub-sub-group group that can infect humans include:
? L. icterrohemorragiae
? L. Andaman
? L. australis
? L. pyrogenes
? L. autumnalis
? L. bataviae
? L. canicola
? L. ballum
? L. grippotyphosa
? L. hepdomanis
? L. Pamona
? L. javanica
? L. celledonia
? L. cynopteri
? L. tarrassovi
Leptospira is a long shape, thin with 6-9 u in length and width of 0.25 u with a pointed tip and curved. Looks fine thread throughout her body curled in a spiral. Although without flagella, they can do undulasi movement, turning and pushing.
C. Pathophysiology and Pathways
Through the entrance of the bare skin or through mucous membranes, oral, nasal, etc. konjungtival, Leptospira into the blood, breed, and then spread to the organs and tissues.
With the immune response (humural and cellular) will be removed Leptospira / reduced in number by the mechanism of phagocytosis and increased concentration of specific antibody. Liver, kidney, muscle and blood vessels are the most common tissue affected by this Leptospira.
Heart:
Leptospira only partially found in the liver in the cases autopsied. Usually these organs are among parenkhim cells, but rarely to penetrate these cells
Kidneys:.
In general, renal damage in leptospirosis is more real than the liver damage and also more frequently found in Leptospira. Most of these microorganisms will reach the tubules and live there then be formed colonies in the lumen wall and then into the bladder. Leptospira can be found in the urine of about 8 days to several weeks after infection, and for months or even years. Kidney itself also enlarged and yellow bile.
Muscles:
In muscle fibers will be visible latitude regions and the loss vakuolisa fibers sarkolema nuclei. Lymphocyte infiltration also occurs and plasma cells. Leptospira obtained here are not. There punctata hemorrhage and focal necrosis of muscle fibers.
Blood vessels:
Often found bleeding / petechiae in the mucous, serous surfaces and viscera tools. In severe forms found in the skin purpura and bleeding in the digestive tract, pulmonary tract, and urinary tract. Leptospira infection can cause the elongation period and reduced protrombin coagulation factor V and X which may be caused by or due to comsumption koagulopathy liver disfunction. Besides that produced Leptospira endotoxin can cause damage to capillary endothelial wall, causing extended periods of bleeding.
Leptospirosis is a disease transmitted by water (water borne disease). Stagnant water or slow flowing water that doused the animal art – animals that contain these bacteria, a major source of this infection, but infection can also through the rapid water flow in the forest or elsewhere.
Tikusus is the main vector of L.icterhemorrhagiae causes Weil’s disease in humans. Leptospira in the body in the rat kidney and urine, and not found in the blood, liver or other tissue. Leptospira was settled and established breeding colonies and in convolutus renal tubular epithelium of rats and should be kept mene will come flowing in the urine filtrate. And unfortunately initidak colonies affected by the antibodies in the animal’s body.
Carrier in the urine can be a little while ( “incidental hosts”), but can also rest of his life ( “maintenance / reservoir host”). That the above items are important factors in the epidemiology of leptospirosis because without excretion in the urine would not have leptospirosis. Generally the infection with L. Icterohemorrhagiae will find a contact or contamination of urine of rats.
Sometimes this disease is due to rat bite or by contact with the culture of Leptospira segaja it in the laboratory.
For other vector vector can be a pet animal such as: amjing, pigs, cattle, horses, cats, guinea pigs or wild animals
Transmission of a placental keseorang and through rare and never reported it through sexual contact.
Leptospira is rarely that can penetrate intact skin and not through the stomach or upper intestine because they will be destroyed by the acid atmosphere.
People who have a high risk of getting this disease are: people who work dipejagalan, agriculture, fields of sugar cane plantations, tanibang, sewer, trash disposal, pelabuahan, fisheries, construction, farm pig / cow / chicken, or the person who held a camp in the forest forests and tentera tentera operating dirawa swamp. Similarly, veterinary doctors associated with cattle, pigs, dogs, chickens.
Regarding gender more present in men, but is related to the job. There is no difference in sensitivity of both sexes.
D. SIGNS AND SYMPTOMS
After the incubation period is 7-13 days with the onset of symptoms-deck, Leptospira into the bloodstream, multiply and spread throughout the network kehampir.
Course of the disease consists of 3 stages:
1. Leptospiremia phase that lasted 7 days
2. Phase Immune / toxic that lasted 7 days
3. Phase Reconvalence (healing) which starts the third week of the pad
Phase Leptospiremia:
• a sudden fever, high fever (39-40 C), chills
• muscle pain, especially the calf muscles, back, abdomen
• Symptoms of central nervous system characterized by severe headache, especially frontal, occipital, or bitemporal sometimes accompanied by a chaotic and mental stimulation eningeal
• Nausea, vomiting, and no appetite
• Infection konjuntiva, red eyes and fotofobia
• Bleeding from the nose, gastrointestinal tract, lungs, kidneys, muscles and skin
• In 40% of patients will experience a bronchopneumonia with cough, haemoptysis and moist rhonchi
• 70% of patients experienced jaundice between the fourth and seventh
• Hepatomegaly, splenomegali
• proteinuria
• Azotemia
Phase Immune / toxic:
The second week was marked with a normal body temperature started, but sometimes with no clinical improvement was followed by others. At this stage can be increased jaundice with liver and kidney damage is more real.
• Hepatomegaly accompanied by itching and bilirubinuria
• In the circulating blood IgM, lGC, and IgA
• Increased lekosit and erytrosit
• Oliguria to anuria accompanied even increased blood urea
• There is also temporarily bradikardi arrhythmias and conduction defects
• a great weakness with low blood pressure
Phase Rekonvalence:
Starting at the beginning of the third week, or delayed until the fourth rue severe infection.
• Recovery of consciousness
• jaundice disappearance
• Blood pressure increases
• urine production Peningktan
• Falling levels of urea
E. SUPPORTING DIAGNOSIS AND EXAMINATION
On the day the first day of this disease is often doubted by some diseases accompanied dmam, such as influenza, typhoid fever, brucellosis, or sepsis olch for any other reason.
If symptoms develop symptoms of liver, kidney or meningen, it must be distinguished from viral hepatitis, acute nephritis or bakteriel or viral meningitis.
When a history of employment or the possibility of contact with mice, the sudden onset, the early weakness, muscle pain and “conjunctival injection” striking, it must be alert to the possibility of leptospirosis infection. Further combinations for signs of jaundice with nephritis and / or support the diagnosis of meningitis was. Cerebrospinal fluid is xanthochrome and pleiositosis important clue, because this combination is rare in the form of jaundice is not due to Leptospira, which is very difficult to be recognized is the case does not arise cases where jaundice
1. Blood
• Lekositosis
• Neutrophils rose
• The rate of elevated blood creep
• Anemia
• BUN, urea, creatinine rise (complications of the kidney)
• transaminase and bilirubin elevation (complications of liver)
• fosfokinase creatinine elevation (CPK)
2. Specific laboratory bacteriological examination and serological
• Examination by bacteriological culture / culture of Leptospira with the culture medium Stuart, Fletcher, and Korthof
• serological examination with microscopic Agglutination tests specific IgM dot ELISA
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