Leptospirosis

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Classification according to ICD-10
A27.0 Leptospirosis icterohaemorrhagica (Weil disease)
A27.8 Other forms of leptospirosis
ICD-10 online (WHO version 2019)

A leptospirosis (or leptospirosis ) is an infectious disease caused by certain pathogens of the genus Leptospira (of the order of spirochetes is caused). In humans, the disease is caused by Leptospira interrogans . It can affect the liver, kidneys and meninges, among others.

This is a reportable zoonosis , the natural hosts of which are mainly rats and mice, and in the case of swine keeper's disease, pigs and cattle. It is transmitted to humans through contact with urine , blood or tissue from infected animals or contaminated water, especially from streams, swamps, ponds and sewers.

A disease that was later recognized as leptospirosis was described by Friedrich von Müller in 1891 for the Silesian mud fever epidemic (also called field or harvest fever).

Leptospiroses in humans

On the basis of its antigenic properties, the human pathogen Leptospira interrogans is divided into 24 serogroups with over 200 serovars . Mention should be made here:

  • the Weil's disease (or Leptospirosis icterohaemorrhagia) ICD-10: A27.0; which can be more severe than other leptospiroses; caused by L. interrogans serovar icterohaemorrhagiae (first described in 1915 by I. Inada and Y. Ido)
  • Weil-like diseases (or "other leptospiroses"), ICD-10: A27.8; how

Leptospira biflexa is, unlike Leptospira interrogans for humans non-pathogenic .

The notifiable leptospirosis can be compensated as an occupational disease (BK 3102) for people who work closely with animals and animal waste (slaughterhouse staff, butchers, veterinarians , animal keepers, fishermen, sewer workers).

Transmission path

Leptospira enter the environment through the urine of infected mammals (rats, dogs, mice, hedgehogs). People can become infected with the pathogen through small skin injuries or through the mucous membrane.

frequency

In 2011, 51 people in Germany contracted leptospirosis, which corresponds to an incidence of 1 in around 1,600,000. This makes leptospirosis a very rare disease in Germany, which is usually only brought in from other countries in isolated cases. Occasionally, however, leptospirosis occurs here as an epidemic. In 2014, 160 cases were recorded, in 2015 85 cases and in 2016 93 cases, while in 2017 129 and 2018 117 infections. 152 diseases were recorded in 2019.

The last outbreak took place in July 2007 among harvest workers on a strawberry field near Düren . In this case, diseased about 30 workers at the field fever (also called harvest fever , mud fever , malaria , peas pickers disease , sugarcane disease , water fever and Charentefieber ). This was the first documented incident of this kind in over 40 years.

course

Clinically, a distinction is made between the milder anicteric leptospirosis (not associated with jaundice ) and the more severe jaundice form, called Weil's disease, with jaundice ( icterus infectiosus ). Both forms take place in two phases.

In about 90% of cases, leptospirosis is similar to the flu. The classic course is found primarily in Weil's disease , but other leptospira can also cause a severe course. In the host's blood, the leptospira multiply for one to two weeks, sometimes up to 26 days, before symptoms develop. These consist of fever, chills, headache and body aches. A conjunctivitis and calf and shin splints are commonly observed. This stage (first phase) lasts about 3–7 days. This is followed by a short period of 2-3 days during which the patient feels a little better.

This is followed by a second, febrile illness phase that lasts up to 4 to 30 days. This period is most likely an expression of an immune reaction with circulating immune complexes , triggered by the damage to the endothelium . In the severe form of Weil's disease , damage to the liver can occur during this time. When Canicolafieber passes the medium weight, there is a meningitis in the foreground, also when more benign extending field fever .

Complications

The most severe forms are found in Weil's disease, which is associated with liver and kidney failure and can lead to death.

The conjunctivitis can last up to 4 weeks.

diagnosis

Infection caused by Leptospira interrogans is the most common diagnosis of people in contact with contaminated water. In the first phase of the disease, the pathogen can be detected from the blood culture. However, the cultures are often too slow, so that no successful antibiotic treatment can be carried out. Therefore, antibody diagnostics are increasingly used, which enable faster detection of the leptospiral infection.

In the second phase of the disease, only serology is diagnostic . IgM and later also IgG antibodies can be detected over a longer period of time. The pathogen detection is most likely to succeed directly through dark field microscopy.

therapy

The treatment of choice for severe infections is penicillin iv, which is only effective in the first 5 days of the disease. As with other spirochetes , a Jarisch-Herxheimer reaction can occur when penicillin is used . Also doxycycline (which is also used for prophylaxis place) and cephalosporins of the third generation work well against leptospira.

If the infection is mild, amoxicillin or doxycycline can be given.

In the second phase of the disease, the use of antibiotics no longer makes sense because it is an immune reaction. In this phase, only the loss of fluid, the fever and possible organ damage can be treated symptomatically.

forecast

Overall, the prognosis is good for mild forms.

However, if left untreated, severe forms, especially Weil's disease, can be associated with a mortality rate of up to 30%.

Reporting requirement

In Germany, the direct or indirect detection of human pathogenic leptospira ( human pathogenic Leptospira sp. ) Must be reported by name according to § 7 of the Infection Protection Act (IfSG), provided that the evidence indicates an acute infection. This reporting obligation for pathogens primarily affects laboratories and their lines (cf. § 10 IfSG).

Leptospiral diseases are notifiable in Austria in accordance with Section 1, Paragraph 1, Number 1 of the Epidemic Act 1950 in the event of suspicion, illness or death . Doctors and laboratories, among others, are obliged to report this ( Section 3 Epidemics Act).

Leptospiroses in animals

In Germany, infections of animals with leptospires ( leptospiroses ) are among the notifiable animal diseases .

literature

  • Hanns-Wolf Baenkler, U. Clement: Internal medicine. (= Dual row internal medicine). Thieme, 2001, ISBN 3-13-128751-9 , pp. 1225-1226.
  • Ulrike Wagner, Christina Hohmann: Travel and Infectious Diseases. Govi-Verlag, Eschborn 2004, ISBN 3-7741-0987-7 , pp. 154-157.
  • Peter Georgi, Elvira Bierbach: Infectious Diseases and Infection Protection Act: General and special infectiology, commented legal texts, examination questions. Elsevier, Urban & Fischer-Verlag, 2006, ISBN 3-437-56771-3 , pp. 127-129.
  • ER Cachay, JM Vinetz: A global research agenda for leptospirosis. In: J Postgrad Med. , 2005 Jul-Sep; 51 (3), pp. 174-178. Review. PMID 16333188
  • SN Ahmad, S. Shah, FM Ahmad: Laboratory diagnosis of leptospirosis. In: J Postgrad Med. , 2005 Jul-Sep; 51 (3), pp. 195-200. Review. PMID 16333192
  • Y. Kobayashi: Human leptospirosis: management and prognosis. In: J Postgrad Med. , 2005 Jul-Sep; 51 (3), pp. 201-204. Review. PMID 16333193
  • Marianne Abele-Horn: Antimicrobial Therapy. Decision support for the treatment and prophylaxis of infectious diseases. With the collaboration of Werner Heinz, Hartwig Klinker, Johann Schurz and August Stich. 2nd, revised and expanded edition. Peter Wiehl, Marburg 2009, ISBN 978-3-927219-14-4 , pp. 209 f.
  • Karl Wurm, AM Walter: Infectious Diseases. In: Ludwig Heilmeyer (ed.): Textbook of internal medicine. Springer-Verlag, Berlin / Göttingen / Heidelberg 1955; 2nd edition, ibid. 1961, pp. 9-223, here: pp. 149-152 ( leptospiroses ).

Web links

Individual evidence

  1. ↑ Karl Wurm, AM Walter: Infectious Diseases. In: Ludwig Heilmeyer (ed.): Textbook of internal medicine. Springer-Verlag, Berlin / Göttingen / Heidelberg 1955; 2nd edition ibid. 1961, pp. 9-223, here: p. 151.
  2. ↑ Werner Köhler : Weil's disease. In: Werner E. Gerabek u. a. (Ed.): Encyclopedia of medical history. De Gruyter, Berlin / New York 2005, ISBN 3-11-015714-4 , p. 1470.
  3. ↑ Infection epidemiological yearbook of reportable diseases for 2011. (PDF) Robert Koch Institute
  4. ↑ Epidemiological Bulletin , No. 3, January 16, 2020 (PDF) Robert Koch Institute
  5. ↑ Pathogen: Leptospira grippotyphosa, more rarely L. australis and other serovars of L. interrogans.
  6. ↑ Karl Wurm, AM Walter: Infectious Diseases. In: Ludwig Heilmeyer (ed.): Textbook of internal medicine. Springer-Verlag, Berlin / Göttingen / Heidelberg 1955; 2nd edition ibid 1961, pp. 9-223, here: pp. 151 f. ( Field or harvest fever ).
  7. ↑ The return of field fever in Germany: Leptospira Grippotyphosa outbreak among strawberry pickers. (PDF) In: Epidemiological Bulletin. Robert Koch Institute , March 14, 2008.
  8. ↑ a b c Marianne Abele-Horn (2009), p. 209.
  9. ↑ Annex to Section 1 of the Ordinance on Notifiable Animal Diseases (TKrMeldpflV) in the version published on February 11, 2011 ( Federal Law Gazette I p. 252 ), last amended by Article 381 of the Ordinance of August 31, 2015 ( Federal Law Gazette I p. 1474 ).