leptospirosis
DESCRIPTION
kedokteranTRANSCRIPT
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LEPTOSPIROSIS
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LEPTOSPIROSIS
ETIOLOGI:LEPTOSPIRA INTERROGANS
Tersering:•L. icterohemorrhagica → tikus•L. canicola → anjing•L. pomona → sapi dan babi
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EPIDEMIOLOGI• Terbanyak: di daerah tropis• Indonesia → negara dengan insidens leptospirosis tinggi, dan
peringkat ketiga mortalitas
Reservoar•Utamanya tikus → menetap dalam epitel tubulus
ginjal dan ikut mengalir dalam filtrat urin.
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Penularan
Kondisi lingkungan air, temperatur hangat, hujanMikroorganisme mampu bertahan ber minggu – bulan dalam pH netral/alkalis, suhu 28-32 0 C
Binatang liar / domestik : tikusKontak dengan urine binatang reservoirRisk factor : pekerjaan, rekreasi, bencana
alamMasuk tubuh melalui : kulit abrasi, mukosa
utuh: konjungtiva mata, epitel genital, saluran makanan
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Patogenesis
Leptospira masuk ke dalam tubuh melalui kulit atau selaput lendir → Masuk ke aliran darah, menyebar secara luas ke jaringan tubuh → Respon imunologik → Leptospira bertahan dalam ginjal, otak, dan mata
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Gambaran Klinis
• Masa inkubasi : 2-26 hari, biasanya 7-13 hari• Fase leptospiremia → Leptospira dalam darah
dan CSF (4-7 hari) Sakit kepala Myalgia, diikuti hiperestesi kulit Demam tinggi dan menggigil Mual, muntah, disertai mencret Bradikardi relatif Ikterus Konjungtiva suffusion dan fotofobia Rash makulopapular, atau urtikaria Splenomegali, hepatomegali, limfadenopati.
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Gambaran Klinis
•Fase imun → peningkatan titer antibodi Demam hingga suhu 40°, menggigilMyalgiaPerdarahan spontanKerusakan ginjal dan hati → uremic dan
ikterik Injectio konjungtiva dan konjungtiva
suffusion dan ikterus (gejala patognomonis)
Meningitis
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Diagnosis• Gejala klinis• Pemeriksaan penunjang:
Darah rutin,ureum/creatinin, fungsi hati: Bilirubin direk ↑, LED
Tes serologi•Diagnosis pasti: isolasi leptospira dari cairan tubuh
dan serologi
•Kultur darah → fase leptospiremia sebelum pemberian antibiotik
•Kultur urin → 2-4 minggu setelah onset penyakit
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SPECIFIC FEATURES
1. WEIL’S SYNDROME
1. WEIL’S SYNDROME (1)
~ SEVERE LEPTOSPIROSIS ~ CLINICAL MANIFESTATIONS
* JAUNDICE* AZOTEMIA* HEMORRHAGES* ANEMIA
* DISTURBANCES INCONSCIOUSNESS
* CONTINUED FEVER SEVERAL WEEKS
* HEPAR AND RENAL MANIFESTATION
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TREATMENT (1)
* ANTIMICROBIAL DRUGS:
~ PENICILLIN G/ PP
~ STREPTOMYCIN
~ TETRACYCLINE
~ CHLORAMPHENICOL
~ ERYTHROMYCIN
~ CEFTRIAXON 2-3 GRMS DAILY
~ MUST BE ADMINISTERED WITHIN 2-4 DAYS, OF
THE ONSET OF ILLNESS
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TREATMENT (2)
* SUPPORTIVE THERAPY
~ EARLY BED REST
~ FLUID & ELECTROLYTE
~ PERITONEAL DIALYSIS/HEMODIALYSIS
AZOTEMIA
~ EXCHANGE TRANSFUSION
HYPERBILIRUBUNEMIA
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PROGNOSIS
~ THE VIRULENCE OF THE ORGANISM THE
JAUNDICE:
* ANICTERIC PATIENTS DEATH <<
* JAUNDICE MORTALITY 15-40%
~ THE GENERAL CONDITION OF THE PATIENT
~ AGE:
- MORTALITY RATE:
* 10% IN <50 YRS
* 56% IN > 51 YRS