Symptoms of leptospirosis

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

There is no generally accepted classification of leptospirosis.

According to the clinical course, a light, moderate and severe form of leptospirosis is isolated. An easy form can occur with fever, but without a pronounced injury to the internal organs. The severe form is characterized by severe fever and unfolded symptoms of leptospirosis, and for severe form jaundice development, the appearance of signs of thrombohemorrhagic syndrome, meningitis and acute renal failure are characteristic. According to clinical manifestations, there are icteric, hemorrhagic, renal, meningeal and mixed forms. Leptospirosis can be complicated and uncomplicated.

The disease of leptospirosis begins acutely, without a prodromal period, with a strong chill, an increase in body temperature for 1-2 days to high digits (39-40 ° C). The temperature remains high for 6-10 days, then it decreases either critically or by a shortened lysis. In patients who did not receive antibiotics, you can observe a second febrile wave. There are other symptoms of leptospirosis, such as severe headache, back pain, weakness, lack of appetite, thirst, nausea, sometimes vomiting. During this period, conjunctivitis may also be gassed.

A characteristic symptom of leptospirosis is muscle pain, mainly gastrocnemia, but pain in the muscles of the thigh and lumbar region may occur. In severe forms, the pain is so severe that it makes it difficult for the patient to move. When galpatsii note the sharp soreness of the muscles. The intensity of myalgias often corresponds to the severity of the course 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. Draw attention to the hyperemia of the skin of the face and neck, the injection of vessels of the sclera. Upon examination, the "hood symptom" is revealed - puffiness of the face and flushing of the skin of the face, neck and upper half of the thorax, injection of vessels of the sclera.

In severe leptospirosis from the 4th-5th day of the disease, icteric sclera and icterus of the skin develop. The clinical course can be schematically divided into three periods:

• elementary:
• the height;
• recovery.

In 30% of patients in the initial, and sometimes in the period of the height of the disease, there is an exanthema. The rash consists of polymorphic elements located on the skin of the trunk and extremities. According to the nature of the rash can be korepodobnoy, rubella-like, less scarlet-like. Urticaria can also occur. Macular rash is prone to the fusion of individual elements. In these cases, erythematous fields are formed. Erythematous exanthem is met most often. The rash disappears after 1-2 days. After the disappearance of the rash, it may lead to a puffy skin peeling. Often there are herpetic eruptions (on the lips, wings of the nose). Thrombohemorrhagic syndrome manifests, in addition to petechial rash, hemorrhages in the skin at the injection sites, nosebleeds. Hemorrhages in the sclera.

During this period, a slight pain in the throat, coughing. In objective research, there is often a mild hyperemia of the arches, tonsils, soft palate, on which one can see enanthema, hemorrhages. In some patients, the submaxillary, posterior cervical lymph nodes increase.

From the side of the cardiovascular system, attention is drawn to relative bradycardia, lowering blood pressure. Heart tones are muffled, and ECG can detect signs of diffuse myocardial damage.

Perhaps the development of a specific leptospirosis pneumonia or bronchitis. When it occurs, blunting of the pulmonary sound and pain in the chest are observed.

The liver is enlarged, moderately painful on palpation, almost half of the patients have a palpable spleen.

Symptoms of CNS involvement in leptospirosis are meningeal syndrome: dizziness, delirium, insomnia, headache and positive meningeal symptoms (stiff neck, Kernig symptom, upper, middle and lower symptoms of Brudzinsky). In the study of 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: a decrease in diuresis up to the development of oligoanuria, the appearance of protein, hyaline and granular cylinders, and renal epithelium in the urine. In the blood, the content of potassium, urea, and creaginine is increased.

In the study of peripheral blood, the increase in ESR and neutrophilic leukocytosis is determined with a shift of the formula to the left, often to the myelocytes, aneosinophilia.

At the height of the disease from the 5th-6th day in severe cases, the symptoms of leptospirosis increase, headache, muscle weakness, disgust to food. Vomiting increases, although body temperature decreases. Some patients develop jaundice, the intensity of which corresponds to the severity of the course of the disease and which 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, hemorrhage into the membranes and brain substance. More often hemorrhagic syndrome is observed with icteric form of the disease. There are clinical and ECG signs of damage to the heart, the membranes of the brain. Of particular note is the damage to the kidneys: increasing azotemia, proteinuria.

As a result of hemolysis and erythropoiesis, anemia of hyporegenerative type, thrombocytopenia, leukocytosis, lymphopenia, aggregation capacity of platelets, ESR is 40-60 mm / h. In a biochemical blood test, moderate hyperbilirubinemia with increased content of both bound and free bilirubin is detected with a slight increase in transferase activity. At the same time, in connection with muscle damage, the activity of creatine phosphokinase increases sharply, the protein-synthetic function of the liver is violated, and the albumin level decreases.

The condition begins to improve from the end of the second week, the period of convalescence from the 20-25th day of the disease. During this period, a relapse of the disease is possible, which usually flows more easily than the main wave. In other cases, the body temperature stably normalizes, but the asthenic syndrome persists for a long time, a polyuric crisis is possible. Functions of the liver and especially of the kidneys are restored slowly, the inadequacy of the function of the tubules persists for a long time, which is manifested by isohypostenuria and proteinuria; possible trophic disorders, the growth of anemia.

In different regions, the course may differ in the frequency of icteric forms, CNS damage, the development of acute renal failure. The most severe leptospirosis is caused by L. Interrogans icterohaemorragiae. Ubiquitous abortive and erased forms of the disease, occurring with a short-term (2-3 days) fever without a 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 hepatic-renal failure, acute respiratory failure (respiratory distress syndrome). Massive bleeding, hemorrhage, myocarditis, pneumonia, in later terms - uveitis, iritis, iridocyclitis.

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Mortality and causes of death

Leptospirosis has a lethality, which varies from 1 to 3%. Causes of death - the above complications, most often acute renal failure.