leptospirosis+2010 (1)
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TAKING A CLOSER
LOOK AT
LEPTOSPIROSIS
Lilen C. Sarol PhDCollege of Public Health
University of the Philippines Manila
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Leptospirosis in the worldIncidence of severe cases 300,000-500,000 per year
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NUMBER OF LEPTOSPIROSIS CASES AND
DEATHS ACCORDING TO REGION
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NUMBER OF CLINICALLY CONFIRMED
LEPTO CASES ACCORDING TO REGION
(Jan. 1 Aug. 14, 2010)
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Ryoukichi Inada1874-1950
Discovery of Pathogen
in 1915
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Causative Agent
highly motile
flexiblehelical or coiled
aerobic bacteria
with bent orhooked ends
Yasuda et al. Deoxiribonucleic acid relatedness between
seogroups and serovars in the family Leptospiraceae. Int J
Sys Bacteriol 1987; 407-415
Spirochaeta icterohaemorrhagiae
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killed at 500C in 10 mins or 600C in 10
seconds susceptible to dessication,
hypochlorite disinfectants and pH
outside of 6.2 to 8.0 acid urine, non-aerated sewage and
polluted water
Sensitivity
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PHENOTYPIC CLASSIFICATION OF LEPTOSPIRES
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GENOTYPIC CLASSIFICATION OF LEPTOSPIRES
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TRANSMISSION CYCLE OF LEPTOSPIROSIS
INDIRECT CONTACT
DIRECT CONTACT
contact with moist
soil or vegetation
contaminated with
urine of infected animals
swimming or wading in
floodwaters
accidental immersion
occupational abrasion
thru tissue or urine of
infected animals
ingestion of contam food
droplet aerosol inhalation
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Anicteric Leptospirosis Icteric LeptospirosisWeil's Syndrome
First stage
3-7 days
Septicemic
Second stage
0-1 month
Immune
First stage
3-7 days
Septicemic
Second stage
10-30 days
Immune
Myalgia/
Myositis
Abdominal
pain
Conjunctival
suffusion
Meningitis
Uveitis
Rash
Fever
Jaundice
Hemorrhage
Renal failure
Myocarditis
Meningitis
Pulmonaryhemorrhage
Respiratory
failure
Blood
CSF
urine
Blood
CSF
urine
fever
Important
Clinicalfindings
L
epto
p
resent
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Signs and Symptoms of Leptospirosis
Icterus and hemorrhage
Acute renal failure
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Differential Diagnosis
Dengue
Rickettsial disease : Scrub typhus,murine typhus
Acute viral hepatitis
Sepsis Influenza
Aseptic Meningitis
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DIFFERENT STAGES OF
LEPTOSPIROSIS
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LEVEL AND DURATION OF IgM ANTIBODIES
AT DIFFERENT TIME INTERVALS
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IMMUNOFLOURESCENCE
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LEPTO LATERAL FLOW
based on the binding
of specific IgM
antibodies to the
broadly reactive
heat extracted
antigen preparedfrom nonpathogenic
Patoc 1 strain
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MICROSCOPIC AGGLUTINATION TEST (MAT)
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Problem with diagnosis
Low success rate of isolation
Unreliability of direct demonstration
of leptospires in clinical samplesusing dark field microscopy
Inaccessibility of moleculartechniques to most peripheralhospitals and clinics
Serological tests have low sensitivityduring acute stage
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Treatment
Early anti-microbial therapy is
importantshorten the course and
prevent carrier state Choice : Penicillin G, Ampicillin
May cause Jarish-Huxheimer type
reaction Mild cases oral Doxycycline or
Amoxicillin
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Prevention
Vaccination of domestic animals
Rodent control
Protective gloves and boots
Avoid swimming in contaminated
watersVaccination in endemic region
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Lack of rapid diagnostic kit
Difficulties in clinical
diagnosis
Actual condition ofLeptospirosis is unclear
Neglected
Infectious
Disease
Small research
funds
few researchers
Lack of rapid
diagnostic kits
and vaccine
Bacteriology
Difficulties in Leptospirosis Control
Slow colony formation
Delay in genetic research
Variety of maintenance animals
More than 250 of serovars
Epidemiology
Clinical researchLaborious culture
Presentcondition
Distribution of Leptospires
unknown
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College of Public
HealthUP Manila
Kyushu UniversityChiba Inst. Science ResearchPartnership
MOFAJICAMEXTJST Collaboration
Prevention and Control of Leptospirosis in
the Philippines
MEXT: Ministry of Education, Culture, Sports, Science and Technology
JST: Japan Science and Technology Agency
MOFA: Ministry of Foreign Affairs
JICA: Japan International Cooperation Agency
Application to the SATREPSprogram in 2008
PO/PDM Working group
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Plan of Operation (PO)
Project Design Matrix (PDM)
Working Groups in the Philippines
0. Laboratory Renovation
1. Epidemiology
1) Bacteriological surveillance
2) Burden of disease3) Environmental risk factors
2. Diagnostic kit
3. DNA vaccine
4. Advocacy
Group A: Microbiology1) Bacterial surveillance
Yoshida/ Gloriani
2) Diagnostic kit
Masuzawa
3) DNA vaccine
Yoshida
Group B: Burden of disease
Yoshida, Yabe/ Borja
Group C: Environmental risk factors
Yanagihara/ Cavinta
Group D: Advocacy
Fujii/ Guevarra
/ g g p
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Output of the LEPCONdvocacy
Burden of Disease by Bacteriological studyCenter for LEPCONDevelopment of Diagnostic kits and DN vaccinesEpidemiology and Economic burden