Symptoms of leptospirosis

Leptospirosis has an incubation period that lasts from 3 to 30 (usually 7-10) days.

There is no generally accepted classification of leptospirosis.

According to the clinical course, there are mild, moderate and severe forms of leptospirosis. The mild form may occur with fever, but without significant damage to internal organs. The moderate form is characterized by severe fever and extensive symptoms of leptospirosis, and the severe form is characterized by the development of jaundice, the appearance of signs of thrombohemorrhagic syndrome, meningitis and acute renal failure. According to clinical manifestations, there are icteric, hemorrhagic, renal, meningeal and mixed forms. Leptospirosis can be complicated and uncomplicated.

Leptospirosis begins acutely, without a prodromal period, with severe chills, an increase in body temperature for 1-2 days to high numbers (39-40 ° C). The temperature remains high for 6-10 days, then it decreases either critically or by shortened lysis. In patients who have not received antibiotics, a second fever wave can be observed. Other symptoms of leptospirosis also occur, such as severe headache, lower back pain, weakness, loss of appetite, thirst, nausea, and sometimes vomiting. Conjunctivitis can also develop during this period.

A characteristic symptom of leptospirosis is muscle pain, mainly in the calves, but there may also be pain in the thigh and lumbar muscles. In severe forms, the pain is so strong that it makes it difficult for the patient to move. During galpation, sharp muscle soreness is noted. The intensity of myalgia often corresponds to the severity of the disease. Myolysis leads to the development of myoglobinemia, which is one of the causes of acute renal failure. In some patients, myalgia is accompanied by hyperesthesia of the skin. Hyperemia of the skin of the face and neck, injection of the vessels of the sclera are noteworthy. During examination, a "hood symptom" is revealed - puffiness of the face and hyperemia of the skin of the face, neck and upper half of the chest, injection of the vessels of the sclera.

In severe cases of leptospirosis, scleral icterus and skin yellowness occur on the 4th or 5th day of the disease. The clinical course can be schematically divided into three periods:

• elementary:
• height;
• recovery.

In 30% of patients, exanthema occurs at the initial stage and sometimes during the peak of the disease. The rash consists of polymorphic elements located on the skin of the trunk and extremities. The rash may be measles-like, rubella-like, and less often scarlet fever-like. Urticarial elements may also be present. Maculose rash tends to merge individual elements. In these cases, erythematous fields are formed. Erythematous exanthema is encountered most often. The rash disappears in 1-2 days. After the rash disappears, bran-like peeling of the skin is possible. Herpetic eruptions (on the lips, wings of the nose) often appear. Thrombohemorrhagic syndrome is manifested, in addition to petechial rash, by hemorrhages in the skin at the injection sites, nosebleeds, and hemorrhages in the sclera.

During this period, a slight sore throat and coughing are possible. During an objective examination, moderate hyperemia of the arches, tonsils, and soft palate is often detected, on which enanthem and hemorrhages can be seen. In some patients, the submandibular and posterior cervical lymph nodes are enlarged.

From the cardiovascular system, relative bradycardia and decreased blood pressure are noticeable. Heart sounds are muffled, and ECG may reveal signs of diffuse myocardial damage.

Specific leptospirosis pneumonia or bronchitis may develop. When it occurs, dullness of the lung sound and chest pain are observed.

The liver is enlarged, moderately painful upon palpation; in almost half of the patients, the spleen is palpable.

Signs of CNS damage in leptospirosis include meningeal syndrome: dizziness, delirium, insomnia, headache and positive meningeal symptoms (stiff neck; Kernig's sign; upper, middle and lower Brudzinski symptoms). When examining cerebrospinal fluid, signs of serous meningitis are noted: cytosis with a predominance of neutrophils.

From the urinary system, signs of acute renal failure can be observed: decreased diuresis up to the development of oliguria, the appearance of protein, hyaline and granular cylinders, renal epithelium in the urine. The content of potassium, urea, creatinine in the blood is increased.

When examining peripheral blood, an increase in ESR and neutrophilic leukocytosis with a shift in the formula to the left, often to myelocytes, and aneosinophilia are determined.

At the height of the disease, from the 5th-6th day in severe cases, the symptoms of leptospirosis increase, headache, muscle weakness increase, and aversion to food appears. Vomiting becomes more frequent, although the body temperature decreases. Some patients develop jaundice, the intensity of which corresponds to the severity of the disease and lasts from several days to several weeks. During this period, the most severe manifestations of hemorrhagic syndrome are observed: hemorrhages in the skin and mucous membranes, bleeding from the gums, gastrointestinal bleeding. hemoptysis, hemorrhages in the membranes and substance of the brain. Hemorrhagic syndrome is more often observed in the icteric form of the disease. Clinical and ECG signs of damage to the heart and meninges occur. Kidney damage deserves special attention: increasing azotemia, proteinuria.

As a result of hemolysis and erythropoiesis disorders, hyporegenerative anemia, thrombocytopenia, leukocytosis, lymphopenia increase, platelet aggregation capacity is impaired, ESR reaches 40-60 mm/h. Biochemical blood tests reveal moderate hyperbilirubinemia with increased levels of both bound and free bilirubin with a slight increase in transferase activity. At the same time, due to muscle damage, creatine phosphokinase activity increases sharply, the protein-synthetic function of the liver is impaired, and albumin levels decrease.

The condition begins to improve from the end of the second week, the recovery period from the 20th-25th day of the disease. During this period, a relapse of the disease is possible, which usually proceeds more easily than the main wave. In other cases, the body temperature is steadily normalized, but the asthenic syndrome persists for a long time, a polyuric crisis is possible. The functions of the liver and especially the kidneys are restored slowly, the insufficiency of the tubular function persists for a long time, which is manifested by isohyposthenuria and proteinuria; trophic disorders, anemia increase are possible.

In different regions, the course of the disease may differ in the frequency of icteric forms, damage to the central nervous system, and the development of acute renal failure. The most severe form of leptospirosis is caused by L. interrogans icterohaemorragiae. Abortive and latent forms of the disease are common, occurring with short-term (2-3 days) fever without typical organ pathology, when the symptoms of leptospirosis are poorly expressed.

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Complications of leptospirosis

Infectious toxic shock, acute renal failure, acute hepatorenal failure, acute respiratory failure (respiratory distress syndrome). massive bleeding, hemorrhage, myocarditis, pneumonia, in the later stages - uveitis, iritis, iridocyclitis.

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Mortality and causes of death

Leptospirosis has a mortality rate that varies from 1 to 3%. The causes of death are the complications listed above, most often acute renal failure.