Leptospirosis of the eye: causes, symptoms, diagnosis, treatment

Leptospirosis is an acute infectious disease related to zoonoses. It is characterized by a primary lesion of liver, kidney, cardiovascular, nervous system and eye.

[1], [2],

Causes and Epidemiology of Leptospirosis of the Eyes

The causative agents of leptospirosis are the spirochaete leptospira. Sources leptospira in nature - rodents, some domestic animals (cows, pigs, dogs, etc.). They excrete leptospires with urine and feces, contaminating soil, water, food, household items. Infection of people occurs mainly during bathing, drinking water, less often through contaminated food, sometimes when nursing sick animals. Leptospira penetrate the human body through the mucous membrane of the mouth, the gastrointestinal tract, easily damaged skin and conjunctiva, without causing a local inflammatory reaction. Diseases of leptospirosis can be sporadic, but endemics and epidemics are possible, especially the so-called bathing epidemics in June-September. At present, jaundice and jelly-like forms of the disease are not distinguishable, since they have the same pathogenetic nature and jaundice forms can occur with jaundice.

[3], [4], [5]

Pathogenesis of leptospirosis of the eye

Leptospirae hematogenously spread to organs containing reticuloendothelial tissue, and multiply in them. Then they again enter the blood, causing hyperthermia and intoxication. In response, antibodies are produced. Destruction of leptospira proceeds with the release of toxic products, which is manifested by toxemia. Anemia, jaundice, hemorrhagic syndrome develop in connection with the damage to the endothelium of the capillaries. In addition, in response to the decay of the leptospira, the accumulation of endogenous biologically active products causes sensitization of the body, allergic reactions occur. In the 2-3th week of leptospirosis, antibodies accumulate in the blood, so the pathogen disappears from the blood, concentrating in organs and tissues (non-sterile immunity). During this period, complications from the eyes, nervous system, kidneys, liver, etc. Can occur. Inflammatory and dystrophic processes develop in them, functions are disrupted. Later on, leptospirosis agglutinins accumulate in the blood, ensuring the disappearance of the pathogen (sterile immunity).

Symptoms of Leptospirosis of the Eyes

The incubation period is from 3 to 20 days. The disease can occur in mild, moderate severity and severe forms. The process begins sharply, the body temperature rises to 39-40 C. The duration of the temperature reaction is 2-3 weeks. The temperature drops in the form of a shortened lysis. As the temperature rises, there are signs of intoxication. Characteristic features of leptospirosis are the emergence of severe pain in the calf muscles and lower back muscles, as well as a polymorphous skin rash, in some patients with hemorrhages. Symptoms of increased fragility of the vessels are noted. In the same period, the liver and spleen increase. Jaundice occurs usually early, sometimes from the 3rd to 6th day of the disease. In severe leptospirosis there is a neurological symptomatology - the phenomenon of meningism or serous meningitis. Among the complications of leptospirosis are pneumonia, often endo- and myocarditis, polyneuritis, serous meningitis or encephalomyelitis and eye damage.

Eye lesions occur both in the early and late period of the disease, but there are no specific eye symptoms. To early eye manifestations of leptospirosis is primarily catarrhal conjunctivitis, which is usually observed during fever. It is noted quite often - in 60% of cases. Often develop episcleritis, and sometimes ulcerative keratitis or lesions of the cornea, reminiscent of herpes. From the 3rd to 6th day of the disease, yellow staining of the sclera is possible. During hemorrhagic manifestations, from the 7th to the 9th day, hemorrhages are often observed: conjunctival and subconjunctival, less often in the anterior chamber of the eye, vitreous, retina, sub- and retroretinal para- In a number of cases, with the phenomena of meningoencephalitis as a result of paresis of the oculomotor nerves, diplopia appears. Due to severe intoxication, sometimes develop papillitis, neuroretinitis and retrobulbar neuritis of the optic nerve, and sometimes anterior exudative choroiditis, manifested by opacity of the vitreous and tender precipitates on the posterior surface of the cornea. Combinations of iridocyclitis and toxic optic neuritis are noted and in late terms - after 2 months or more after the transferred leptospirosis. Their duration is 2-4 weeks; the forecast is favorable.

Inflammation of the vascular tract is the most frequent lesion of the eyes in leptospirosis. It occurs in 5-44% of cases, observations indicate different forms of uveitis in leptospirosis. In the development of uveitis, it is important to have intoxication and intoxication-allergic factors.

At an earlier time after the disease, leptospirosis (during the first 2 months) develops non-granulomatous iridocyclitis of one or both eyes, characterized by the appearance of small precipitates on the posterior surface of the cornea, posterior synechia, irregular pupil shape and diffuse opacification of the vitreous. The disease is characterized by a short course, a favorable outcome. Significantly less at the same time, anterior exudative choroiditis develops, which is manifested only by a small number of precipitates on the posterior surface of the cornea and a slight opacification of the vitreous humor. In most cases, early eye changes disappear within a few weeks without much consequence.

After months and even 8-12 years after the disease with leptospirosis, heavier lesions of the uveal tract appear in the form of non-granulomatous anterior uveitis or iridochoroiditis of both eyes. In this case, there are edema, folds of Descemet's bacillus, precipitates on the posterior surface of the cornea, hyperemia of the iris, posterior synechia, and significant opacification of the vitreous humor due to exudation. Sometimes in the vitreous body, snow-like opacities or dense membranes and white precipitates are found; possibly the development of the papillitis of the optic nerve, repeated hemorrhages in the anterior chamber of the eye, "the glove. Visual acuity is sharply reduced. Changes remain genera and are characteristic of leptospirosis lesions. Treatment of this form of uveitis is not effective enough. There are exacerbations and relapses.

Perhaps the development of leptospirosis bilateral hypopion-uveitis, which is characterized by the appearance of exudate in the anterior chamber and in the pupil area, a sharp decrease in vision. In the punctate of the anterior chamber of the eye, mainly lymphocytes, polynucleated leukocytes and reticuloendothelial cells are found. These forms of uveitis can be combined with serous meningitis or encephalomyelitis.

Thus, the most characteristic eye complications are:

1. non-granulomatous iridocyclitis with a favorable course;
2. anterior exudative, rapidly flowing choroiditis with a tendency to complete resolution and restore vision;
3. heavy iridochorodites with persistent turbidity of the vitreous;
4. neuritis of the optic nerve.

The course of eye diseases with leptospirosis can be prolonged, but the prognosis is favorable in most cases. Only in 4,5% of cases development of complicated cataracts is observed, and in 1.8% - partial atrophy of optic nerves. They are mainly responsible for a significant decrease in vision and blindness.

Diagnosis of Leptospirosis of the Eyes

Diagnosis of leptospirosis eye lesions is carried out taking into account epidemiological data, features of the clinical picture of the disease. Laboratory research is necessary, especially if the pathology of the eye develops in the long term after the transferred leptospirosis. In peripheral blood with leptospirosis, neutrophilic leukocytosis and elevated ESR are observed. The most reliable is the detection of leptospira in the blood, cerebrospinal fluid, urine, and also in the chamber moisture of the eye. Blood in the acute period of the disease is taken twice with an interval of 5-7 days. High specificity is characterized by serological reactions for the detection of antibodies in blood serum: agglutination, lysis and complement binding, as well as microagglutination of the moisture in the anterior chamber of the eye. A positive diagnostic titer of agglutipype 1: 100 and higher (up to 1: 100 000) appears at week 2. Its increase with the course of the disease is taken into account, which confirms the diagnosis of leptospirosis. RSK is conducted according to the generally accepted methodology. Diagnostic titers are serum dilutions 1:50 - 1: 100. Specific antibodies are found in patients who have recovered for several years. Relative value is a biological test - infection of laboratory animals by intraperitoneal, subcutaneous injection into the anterior chamber of the eye of a material containing leptosdir (blood, cerebrospinal fluid, urine, chamber moisture). Laboratory diagnostics of leptospirosis is carried out in the departments of especially dangerous infections of the republican, regional and regional sanitary-epidemiological stations.

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Treatment of eye leptospirosis

Treatment of leptospirosis lesions of the eyes is reduced primarily to the treatment of leptospirosis. Patients are hospitalized in the infectious disease department, where appropriate therapy is provided. First of all intramuscularly injected within 3-4 days of anti-leptospirosis gamma-globulin of 5-10 ml. Apply antibiotics (penicillin, levomycetin or chainin, antibiotics of the tetracycline series). Disintoxication preparations are also shown: intravenously injected haemodes, polyglucin, reopolyglucin, 5-10% glucose solution. In severe cases, prednisolone is used (up to 40 mg per day). Widely prescribed ascorbic acid, kokarboksilazu, vitamins complex B in normal doses. Angioprotectors, hyposensitizing agents (suprastin, pipolfen, dimedrol, calcium gluconate) are shown. When the eyes are affected, symptomatic treatment is also performed (locally mydriatic, corticosteroids, chronic forms pyrogenic substances, resorptive agents). Treatment of patients with late complications of leptospirosis is performed in ophthalmologic institutions.

Prevention of eye leptospirosis

Prevention is reduced to general measures, including combating carriers of leptospira, disinfection, active immunization of people in areas where outbreaks occur. Early diagnostics of leptospirosis and timely complex treatment are necessary (order