Leptospirosis
Acute infectious disease with systemic involvement and endemic, which may present in epidemic form under certain conditions. The infection may be asymptomatic, subclinical or cause severe clinical conditions, anicteric or icteric with high mortality. The form can simulate sub-clinical syndrome. The anicteric form occurs in 60 to 70% of cases and has two phases:
a) Phase septicemic – characterized by hepatomegaly and, more rarely, splenomegaly, gastrointestinal bleeding, myalgia involving the calves, thighs, abdomen and paraspinal muscles, photophobia, chest pain, dry cough, with or without hemoptysis, rash macular, maculopapular, urticarial or petechiae, mucosal hyperemia lasting 4-7 days;
b) Phase immune – When there is severe headache, vomiting and signs of meningeal irritation, uveitis, lasting 1-3 weeks.
The way jaundice, Weil’s disease, evolves with renal failure, hemorrhagic phenomena and hemodynamic changes. More intense symptoms than the anicteric form, lasting 1-3 weeks, with mortality rates 50 to 20%.
Synonymy: swamp fever, fever, autumnal fever of seven days, they that disease, canine typhus.
Etiologic agent: helical bacterium (spirochete) aerobic binding of the genus Leptospira, which are seven species are known pathogens, the most important being the L. interrogans. More than 200 serovars have been identified, and each one has (s) is (s) host (s) preference (s), although one animal species may harbor one or more serovars. Any serotype can determine the various forms of clinical presentation in humans and that in our country, the most serious cases are usually related to serovars icterohaemorrgahiae and Copenhagen.
Reservoir: Rodents are the main reservoirs of the disease, mainly domestic, among domestic animals, also act as carriers dogs, cattle, pigs, sheep, goats and horses.
Mode of transmission: By contact with water or soil contaminated with urine of carrier animals, especially rodents, and more rarely by direct contact with blood, tissue, organ and urine of infected animals.
Incubation period: Varies from 24 hours to 30 days, an average of 7 to 14 days.
Period of communicability: Dura while the leptospira in the urine is the person or animal. In animals, it could take months, years or for life, depending on the species infected. It is a rare infection among human beings.
Complications: Gastrointestinal bleeding and massive lung, interstitial pneumonia, acute renal failure, electrolyte and fluid balance disorders ácidobásico, circulatory collapse, congestive heart failure with multiple organ failure and death.
Diagnosis: clinical, epidemiological and laboratory.
Epidemiological Characteristics: It is a zoonosis that constitutes a public health problem. Floods and heavy rains contribute in tropical and subtropical countries for human contact with water and mud contaminated with rodent urine, favoring the emergence of outbreaks of human disease. It occurs in urban and rural areas but in Brazil, most cases are linked to living conditions and health infrastructure, especially at the household level. The entire population is susceptible and the main age group affected are the 20 to 49 years. Some professions facilitate contact with leptospires as people who work in cleaning and unclogging drains, farmers, veterinarians, animal handlers, fishermen, butchers, laboratory workers and firefighters, among others.
Objectives: To guide and adopt measures to prevent the disease, particularly before periods of heavy rains in areas of cyclical occurrence, appropriate treatment of critically ill patients in order to decrease the mortality of the disease.
Notification: It is reportable disease nationwide.
Control measures: appropriate and timely medical care to the patient; notification, search and confirmation of patient data, epidemiologic investigation of cases, detection of risk areas to be triggered control actions; protection to the population: warning her periods prior rain, to avoid entering flooded areas without personal protection. Rodent control (anti-ratização and pest control) and improving the sanitary conditions of the population. Disinfection and protection of human areas of housing, work and leisure of contamination by the urine of these animals and measures that make the environment unsuitable for the installation and proliferation of rodents. Maintain cleanliness of kennels and breeding sites and removing leftover food from these animals before dusk, they provide a attractive to rodents. Segregation and treatment of domestic animals and / or infected patients immunization of domestic animals (dogs, cattle and pigs) through the use of vaccines prepared with serovars prevalent in the region.