1. Leptospirosis (Occupational disease) prevention
• By
• Dr.Ashok laddha
• Occupational Health
Physician
• MBBS, PGDC ,PGDD,
PGDEM, AFIH,ACLS,BLS
• Diploma in Workplace
Health and safety. MBAHA(In –Progress)

2. 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.

3. Overview
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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.

4. 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,

5. incidence
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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.

6. 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

7. Occupation at risk
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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)

8. 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.

9. 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

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

11. 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

12. Severe manifestation
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Meningitis
Renal Failure
Respiratory Distress
Liver FAILURE
Hearing loss
Cardiovascular PROBLEMS
DIC

13. 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)

14. 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.

15. 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

16. Chemoprophylaxis
• Doxycycline is the drug
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of choice for above cause

17. 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.

18. Take home message
• RODENT Control
• Avoid stagnant water
• Use of PPE
• "an ounce of prevention is worth a pound of
cure"?