Leptospirosis (Occupational disease) prevention

• By

• Dr.Ashok laddha• Occupational Health

Physician

• MBBS, PGDC ,PGDD, PGDEM, AFIH,ACLS,BLS

• Diploma in Workplace Health and safety. MBA-HA(In –Progress)

introduction

• Re-emerging infectious disease• Leptospirosis is a re-emerging zoonotic

infection. In developing countries large outbreaks have occurred in urban slums and following floods. Individuals from developed nations are also now more frequently exposed to the infection as a result of international travel and greater participation in certain outdoor recreational activities.

Overview• Primarily occupational disesase• Highly infectious• Caused by bacteria• Leptospirosis is distributed worldwide ,but is most common in the tropics.• The mortality rate in severe leptospirosis has been described as ranging

from 5-40%. • The mild form of the illness is rarely fatal, and an estimated 90% of cases fall

into this category. • Elderly and immune-compromised people are at the highest risk of

mortality overall.• Most cases are self-limiting and unreported, underreported, or even

misdiagnosed, the true incidence is difficult to determine. • The incubation period of leptospirosis is usually 5–14 days, with a range of

2–30 days.

Historical perspective• The disease was first described by Larrey in 1812 of fièvre jaune

among Napoleon's troops at the siege of Cairo.• A little over 100 years ago, Adolph Weil published his historic

paper describing the most severe form of infection that would be later known as Weil disease.

• n 1907, special staining techniques were used to confirm that a spirochete was responsible for this illness

• In October 2010 British rower Andy Holmes died after contracting Weil's Disease. His death has raised awareness of the disease among the public and medical professionals

• It was also reported among troops at Gallipoli and other battles of World War I,

incidence• The following areas and/or countries/continents are known to have the highest incidences

of leptospirosis: • Africa, • India, • China, • Central America, • Brazil,• Caribbean, • South East Asia, and Southern Russia.

Cases of infection are also reported in the following tourist hotspots: New Zealand, Australia, Hawaii, and Barbados.

After flooding, large outbreaks of leptospirosis may occur.

According to WHO (World Health Organization), approximately 10 million people are thought to come down with leptospirosis annually.

transmission

• By infected urine of animals• Transmitted by infected blood and body fluid in

slaughter home worker• Human can get infected by water ,food or soil

containing urine by infected animal• Leptospirosis is common among water-sport

enthusiasts in specific areas as prolonged immersion in water promotes the entry of the bacteria

Occupation at risk

• Occupations at risk include • veterinarians • slaughterhouse workers, • farmers, • sewer maintenance workers, • waste disposal facility workers, • land surveyors, • And people who work on derelict buildings.• military personnel • Survivors of natural disasters (e.g., flooding) • people engaging in recreational water sports (swimming, etc)

Carriers

• Rodent-first recognized carriers of leptospirosis and are considered the primary source of infection to human beings.

• Cattle, buffaloes, horses, sheep, goat, pigs and dogs are also considered common reservoirs of the bacteria that causes leptospirosis.

Symptoms-Mild Form

• Leptospirosis is a BIPHASIC DISEASE begins with flu like syndrome (Fever,chills, Intense Headache,Myalgia)

• first phase resolves, and the patient is briefly asymptomatic until the second phase begins

• Red eyes,Diarrohea,Rash• Jaundice• Pulmonary symptoms

Symptoms-Severe Form( Heart, kidney ,liver affected)

• Fatigue• Irregular heartbeat, often accelerated heartbeat • Muscle pains Nausea • Nosebleeds • Pain in the chest • Poor appetite • The hands, feet or ankles swell • Unexplained weight loss • Yellowing of the whites of the eyes, tongue and skin

(Jaundice)

Symptoms-Severe Form with meningitis

• blotchy rash appears on the skin. When a glass is pressed against it, it does not change color or fade

• Confusion or disorientation Drowsiness • Fits (seizures)• High fever, Nausea • Photophobia (sensitivity to light) Problems with physical

movements • Stiff neck • The patient is unable to speak• Vomiting • Aggressiveness, or unusual behavior

Severe manifestation

• Meningitis• Renal Failure• Respiratory Distress• Liver FAILURE• Hearing loss• Cardiovascular PROBLEMS• DIC

Diagnostic tests

• Microbiologic identification : • Blood or CSF first 10 days Urine second

week (Fletcher’s, EMJH Medium) • Serology: screening• MSTest• MATtest • detection of IgM (ELISA)

Treatment

• Leptospirosis can be treated with antibiotics that should be given as early in the course of illness as possible.

• If you have symptoms of leptospirosis and have been exposed to water potentially contaminated with urine of infected animals, consult a doctor.

• If leptospirosis is suspected, appropriate antibiotics will be prescribed.

• Treatment is most effective when started as soon as possible.

• Clinicians should never wait for the results of laboratory tests before starting treatment with antibiotics.

Treatment-2

• In uncomplicated cases the oral Doxycycline is effective

• In hospitalized patient the Penicillin G is the drug of choice

• In sever form the third-generation cephalosporin are as effective as penicillin G

Chemoprophylaxis

• Doxycycline is the drug • • • • of choice for above cause

PREVENTIVE measures• Wearing protective clothing (boots, gloves, spectacles, aprons, masks).• Covering skin lesions with waterproof dressings.• Preventing access to, or giving adequate warning about water bodies

known or suspected to be contaminated (pools, ponds, rivers). Try to avoid wading or swimming in potentially contaminated water.

• Washing or showering after exposure to urine splashes or contaminated soil or water.

• Washing and cleaning wounds.• Avoiding or preventing urine splashes and aerosols, avoiding touching ill or

dead animals, or assisting animals in giving birth.• Strictly maintaining hygienic measures during care or handling all animals.• Where feasible, disinfecting contaminated areas (scrubbing floors in

stables, butcheries, abattoirs, etc.).• Consuming clean drinking-water.

Take home message

• RODENT Control • Avoid stagnant water• Use of PPE

• "an ounce of prevention is worth a pound of cure"?