Zhang Xiaohong Department of Infectious Diseases Sun Yat-Sen university Leptospirosis.

Zhang Xiaohong

Department of Infectious Diseases Sun Yat-Sen university

LeptospirosisLeptospirosis

A NEWS REPORTA NEWS REPORTA NEWS REPORTA NEWS REPORT

The news report

From the Yangcheng evening news paper 25 SEP 2000 In Fujian province A 27 year old young man Xu, went to the hospit

al because of chills and fever The doctor made a diagnosis as leptospirosis After the patient had been injected PG and Vira

zole, the doctor let him back home.

General Review General Review Etiology Etiology EpidemiologyEpidemiology Pathogenesis and Pathology Pathogenesis and Pathology Clinical Manifestations Clinical Manifestations Diagnosis Diagnosis Treatment and Prevention Treatment and Prevention

LeptospirosisLeptospirosis LeptospirosisLeptospirosis

A zA zoonoses of worldwide distribution caused of worldwide distribution caused by pathogenic leptospira speciesby pathogenic leptospira species

Source of infection: Rats, SwineSource of infection: Rats, Swine Basic clinical Features: high fever , conjunctiBasic clinical Features: high fever , conjuncti

val suffusion and myalgia val suffusion and myalgia Severe cases: jaundice ,renal failure, pulmonSevere cases: jaundice ,renal failure, pulmon

ary hemorrhage and ary hemorrhage and meningeal signs Effective with treatment of penicillin GEffective with treatment of penicillin G

General General General General

Thin, flexible, finely coileThin, flexible, finely coiled with a hook at the endsd with a hook at the ends

Gram-Negative, Gram-Negative, Giemsa stain: Light red

0.10.1μmμm in diameter in diameter

6-206-20μmμm in length in length

Etiology: MorphologyEtiology: Morphology Etiology: MorphologyEtiology: Morphology

Etiology: PictureEtiology: Picture (dark-field microscope)Etiology: PictureEtiology: Picture (dark-field microscope)

Motility can be seeMotility can be see

nn

It is characterized bIt is characterized b

y very active motility very active motilit

y, by roating and by, by roating and b

endingending

Obligate aerobic, slow growingObligate aerobic, slow growing

Cultured in Korthol media enriched with rabbit

serum or albumin, at 30 and an optimal PH 7.℃2 to 7.6 ， their generation time varies from 7 t

o 12 hours

It can be isolated by intraperitoneally inoculatiIt can be isolated by intraperitoneally inoculati

ng of young guinea-pigng of young guinea-pig

Etiology: CultureEtiology: Culture Etiology: CultureEtiology: Culture

It is sensitive to dry, suds, ethanol and It is sensitive to dry, suds, ethanol and

bleaching powderbleaching powder

Survive in damp soil and water for Survive in damp soil and water for 4wks-

3mths

Etiology: ResistanceEtiology: Resistance Etiology: ResistanceEtiology: Resistance

2323 Serogroups, >200 200 serotypes1919 Serogroups and 74 serotypes in China

The most common serogroups:The most common serogroups: L. icterohemorrhagic(L. icterohemorrhagic( 黄疸出血群黄疸出血群 ))L. pomona(L. pomona( 波摩那群波摩那群 ))L. canicola(L. canicola( 犬群犬群 ))L. hebdomadis(L. hebdomadis( 七日热群七日热群 ))Widest distribution in China : L.pomonaL. icterohemorrhagic causes the most severe iL. icterohemorrhagic causes the most severe i

llnessllness

Etiology: ClassficationEtiology: Classfication Etiology: ClassficationEtiology: Classfication

In 1886, Weil, a German doctor observed

4 cases of leptospirosis with jaundice, than

this disease is called as Weil disease

In China: in 1937, Professor Tang zeguang

( 汤泽光 )discovered leptospirosis in Guan

gzhou

EpidemiologyEpidemiologyEpidemiologyEpidemiology

Reservoirs of infection: rodents, dReservoirs of infection: rodents, domestic livestock (swine and cattlomestic livestock (swine and cattle), dogs and foxese), dogs and foxes

Source of infectionSource of infection– LivestockLivestock ：： swine,dogs, cattle,sheeswine,dogs, cattle,shee

p,horsesp,horses– Wild animalsWild animals ：： rats(Apodemus agarrats(Apodemus agar

ius,ius, 黑线姬鼠黑线姬鼠 ), rabbits,wolfs,snakes ), rabbits,wolfs,snakes and frogsand frogs

EpidemiologyEpidemiology ：： Source of InfectionSource of InfectionEpidemiologyEpidemiology ：： Source of InfectionSource of Infection

The main source of InfectionThe main source of Infection ：： – Apodemus agariu: L.icterohemorrhagic. FApodemus agariu: L.icterohemorrhagic. Field style

in south of China– Swine: L. pomona. FSwine: L. pomona. Flood style and raining style in

north of China

EpidemiologyEpidemiology ：： Source of InfectionSource of InfectionEpidemiologyEpidemiology ：： Source of InfectionSource of Infection

Epidemiologic stylesEpidemiologic styles ：：Epidemiologic stylesEpidemiologic styles ：：ffield style raining style fflood style

Source of Source of infectioninfection

Apodemus agariusApodemus agarius Swine and dogSwine and dog SwineSwine

serogroup L.icterohemorrhagicL.icterohemorrhagic L. pomonaL. pomona L. pomonaL. pomonafactors of factors of transmissiotransmissionn

contaminated rat contaminated rat urineurine

raining water floodoverflowing

area rice field village the area where flooded

clinical type

Influenza-typhoid feverPulmonary hemorrhageieterohemorrhageieterohemorrhage

Influenza-typhoid fever

Influenza-typhoid fevermeningoencephalitis

Infected animals excrete leptospiras in the urineInfected animals excrete leptospiras in the urine

Exposure to the water, soil or plants contaminateExposure to the water, soil or plants contaminate

d by urine of Infected animals d by urine of Infected animals

Direct contact with infected animal tissues and oDirect contact with infected animal tissues and o

rgansrgans

Ingest the drink or food contaminated by the urinIngest the drink or food contaminated by the urin

e of the reservoir animale of the reservoir animal

Epidemiology Epidemiology ：： Routes of transmissionRoutes of transmission


Leptospires can gain entry through cuts and ab

rasions in the skin or through mucous membra

nes of the eyes, nose and mouth

Human-to-human transmission is rare

– Short time for human to excrete leptospira

– Acidic urine of human



Universal: Human are susceptible to leptospira Human are susceptible to leptospira

Type-specific immunity: Get life long post-infeGet life long post-infe

ction immunity to the same serotypection immunity to the same serotype

Epidemiology SusceptibilityEpidemiology Susceptibility Epidemiology SusceptibilityEpidemiology Susceptibility

Geographic distribution: Worldwide Distribution,

in both rural and urban areas and in temperate and

tropical climates

Seasonal distribution: Summer and early fall. Peak

occurrence from June to October in our country

Age, sex : Young adult men. Males comprise 80%

of cases

Epidemiology Epidemiology ：：Epidemiologic featureEpidemiologic feature


Occupation (a significant risk factor )– It originally was thought of as being an occupational

disease, and approximately 30-50% of human cases are occupation-related

– It is an occupational hazard for people who work outdoors or with animals, such as rice and sugar-cane field workers, farmers, sewer workers, veterinarians, dairy workers and military personnel ...

– It is also a recreational hazard to those who swim or wade in contaminated waters



Epidemic style ： field style, flood style a

nd raining style

Epidemics also follow natural disasters, s

uch as floods and earthquakes, which dri

ve rats out of sewers



Pathogenesis:Pathogenesis: Pathogenesis:Pathogenesis:

leptospiraleptospiraSkin,mucous membranesSkin,mucous membranes

Blood streamBlood stream Type of Influenza-typhoid feverType of Influenza-typhoid fever

Pulmonary Hemorrhage Pulmonary Hemorrhage

ieterohemorrhageieterohemorrhage ieterohemorrhageieterohemorrhage

Renal failureRenal failure

MeningoencephalitisMeningoencephalitis

Interstitial nephritisInterstitial nephritis

Hemorrhagic pneumonitisHemorrhagic pneumonitis

HepatitisHepatitis

Meningitis and EncephalitisMeningitis and Encephalitis

OrgansOrgansOrgansOrgans

leptospiramialeptospiramialeptospiramialeptospiramia

The basic pathological finding is infectious-toxic lesion oThe basic pathological finding is infectious-toxic lesion o

f the systemic capillaryf the systemic capillary

In some cases severe damage can be seen in the organs aIn some cases severe damage can be seen in the organs a

nd tissuesnd tissues

– Liver: cellular inflitration around the portal areaLiver: cellular inflitration around the portal area– Kidney: Kidney: Interstitial nephritis– Lung: pulmonary congestion and hemorrhage– Brain: perivascular cuffing

PathologyPathology ：：PathologyPathology ：：

Diseased kidney affected by Leptospirosis

Pathological findingPathological findingPathological findingPathological finding

type of severe hemorrhage

Complicated clinical manifestations One serotype can result in many kinds of

clinical manifestations One clinical type can be caused by many

serotypes Clinical manifestations vary greatly in

different patients Incubation period: 7-13 days(2-28d)

Clinical ManifestationsClinical ManifestationsClinical ManifestationsClinical Manifestations

3 phases (according to the course of disease) :

Early phase: 1st~3rd days after illness. common manifestations of all clinical types

Second phase: 3rd~10th days after illness

Late phase complications: 7th~10th days after illness


Early phase (leptospiramia) Last 4-7days Begin with abrupt fever to 39 -40 ℃ ℃ Sometimes has a persistent high fever Non-specific symptoms caused by leptospiramia

and its toxins Such as: chills, headache, myalgia, back pain, an

orexia, nausea and vomiting A sore throat is common and herpes simplex labi

alis may occur


Second phase (organs damage) With prominent clinical presentation Patients can be classified into the following clini

cal types:1). Type of Influenza-typhoid fever (Ordinary leptospiremia)2). Pulmonary hemorrhage3). Type of ieterohemorrhageType of ieterohemorrhage (Weil disease)4). Renal function failure 5). Meningoencephalitis


Clinical ManifestationsClinical ManifestationsType of Influenza-typhoid feverType of Influenza-typhoid feverClinical ManifestationsClinical ManifestationsType of Influenza-typhoid feverType of Influenza-typhoid fever

3 Symptoms:3 Symptoms:

Chills and Fever Chills and Fever

Myalgia Myalgia

Fatigue Fatigue

3 signs:3 signs:

Conjunctival suffusion Conjunctival suffusion

Calf muscle tenderness Calf muscle tenderness

Enlargement of lymph nodesEnlargement of lymph nodes

寒热身痛一身乏，眼红腿痛淋巴大。

Clinical ManifestationsClinical Manifestations Type of pulmonary hemorrhageType of pulmonary hemorrhage

Clinical ManifestationsClinical Manifestations Type of pulmonary hemorrhageType of pulmonary hemorrhage

PulmonarPulmonary hemorrhay hemorrha

gege

PulmonarPulmonary hemorrhay hemorrha

gege

Clinical feature Clinical feature

of the early phase of the early phase

(3-4 days)(3-4 days)

Clinical ManifestationsClinical Manifestations Type of pulmonary hemorrhageType of pulmonary hemorrhageClinical ManifestationsClinical Manifestations Type of pulmonary hemorrhageType of pulmonary hemorrhage

11 ．． Type of mild hemorrhage Type of mild hemorrhage

Cough and hemoptysisCough and hemoptysis

A little bit of moist rale can be heardA little bit of moist rale can be heard

Dot-like or small nodular densities in chest X-rayDot-like or small nodular densities in chest X-ray

Prognosis is fine if treatment is given in timePrognosis is fine if treatment is given in time

Clinical ManifestationsClinical Manifestations Type of pulmonary hemorrhageType of pulmonary hemorrhageClinical ManifestationsClinical Manifestations Type of pulmonary hemorrhageType of pulmonary hemorrhage

Clinical ManifestationsClinical ManifestationsType of pulmonary hemorrhageType of pulmonary hemorrhageClinical ManifestationsClinical ManifestationsType of pulmonary hemorrhageType of pulmonary hemorrhage

2 、 Type of severe hemorrhage Fever and other toxicemia symptoms get worseFever and other toxicemia symptoms get worse Breath and pulse get faster and faster; Pallor or cyanosBreath and pulse get faster and faster; Pallor or cyanos

ed ; With more hemoptysis or even bleeding from mouted ; With more hemoptysis or even bleeding from mouth and nose; With more h and nose; With more moist rale; Patchy or confluent dmoist rale; Patchy or confluent densities can be seen on chest X-rayensities can be seen on chest X-ray

Confusion ,fear or even comaConfusion ,fear or even coma

! ! 神色惧变心发慌 , 脉速气紧罗音现


cyanosedcyanosed

comacoma


Causes of severe hemorrhage

①① High virulence of the leptospira High virulence of the leptospira L.icterohemL.icterohemorrhagicorrhagic

②② No immunity to leptospiraNo immunity to leptospira

③③ Delayed treatment and no rest Delayed treatment and no rest

④④ Herxheimer reaction after penicillin therapy Herxheimer reaction after penicillin therapy

Clinical ManifestationsClinical ManifestationsType of ieterohemorrhageType of ieterohemorrhage Clinical ManifestationsClinical ManifestationsType of ieterohemorrhageType of ieterohemorrhage

Hepatic function impairment

Jaundice

Hepatomegaly

Hemorrhage: Nose bleedingskin petechiae, purpura

Hemoptysis, hematemesis, hematuria

Kidney damage

Proteinurin, Renal failure

Leptospirosis can cause jaundice

Clinical ManifestationsClinical ManifestationsType of Type of mmeningoencephalitiseningoencephalitis

Clinical ManifestationsClinical ManifestationsType of Type of mmeningoencephalitiseningoencephalitis

headache headache vomiting vomiting neck stiffness

headache headache vomiting vomiting neck stiffness

mental confusion mental confusion

Twitch,paralysis, Twitch,paralysis,

brain edema, brain hernia, brain edema, brain hernia, respiration failurerespiration failure

mental confusion mental confusion

Twitch,paralysis, Twitch,paralysis,

brain edema, brain hernia, brain edema, brain hernia, respiration failurerespiration failure

CSFCSF ：： pressurepressure↑↑, protein, protein↑↑ WBC WBC↑↑,,GluGlu↓↓, chloride is normal, chloride is normalCSFCSF ：： pressurepressure↑↑, protein, protein↑↑ WBC WBC↑↑,,GluGlu↓↓, chloride is normal, chloride is normal

2-3days2-3days

Clinical feature in

the early phase

Clinical ManifestationsClinical ManifestationsType of renal failureType of renal failure

Clinical ManifestationsClinical ManifestationsType of renal failureType of renal failure

1. Renal impairment can be found in all ty1. Renal impairment can be found in all ty

pes of leptospirosispes of leptospirosis

2. However the type of renal failure is defi2. However the type of renal failure is defi

nitely uncommonnitely uncommon

Clinical ManifestationsClinical ManifestationsComplication in period of recoveryComplication in period of recovery

Clinical ManifestationsClinical ManifestationsComplication in period of recoveryComplication in period of recovery

Late phase complications

Late fever: recurrence of fever in the phase of convalescence

Reactive meningitis:Reactive meningitis: Meningeal symptoms, aseptic meningitis. Leptospiras not detected in CSF, good prognosis

Ocular late complication:Ocular late complication: Iritis, Cyclitis, Optic n Iritis, Cyclitis, Optic neuritis, Uveitiseuritis, Uveitis

Occlusive cerebroarteritisOcclusive cerebroarteritisAppears 0.5-5 mths after initial illness ca

used by L.pomonaAbnormal CSF, basal multiple arteritisThe symptoms are hemiparalysis and aph

asia

Clinical ManifestationsClinical ManifestationsComplication in period of recoveryComplication in period of recovery Clinical ManifestationsClinical ManifestationsComplication in period of recoveryComplication in period of recovery

DiagnosisDiagnosisDiagnosisDiagnosis

Based on : Based on :

Information of epidemiology Information of epidemiology

Clinical features Clinical features

Data of laboratoryData of laboratory

Epidemic areaEpidemic area Epidemic seasonEpidemic season （（ June-OctJune-Oct ）） Contact historyContact history

DiagnosisDiagnosisInformation of epidemiologyInformation of epidemiology DiagnosisDiagnosisInformation of epidemiologyInformation of epidemiology

DiagnosisDiagnosisClinical FeaturesClinical Features DiagnosisDiagnosisClinical FeaturesClinical Features

3 Symptoms 3 Symptoms 3 Signs 3 Signs Specific organ dysfunctionSpecific organ dysfunction

3 Symptoms 3 Symptoms 3 Signs 3 Signs Specific organ dysfunction Specific organ dysfunction

3 Symptoms 3 Symptoms Chills and fever Chills and fever

Myalgia Myalgia FatigueFatigue

3 signs3 signs Conjunctival suffusion Conjunctival suffusion

Calf muscle tenderness Calf muscle tenderness

Enlargement of Enlargement of

Lymph nodesLymph nodes


Conjunctival suffusionConjunctival suffusion

3 Symptoms , 3 Signs , Specific organ dysfunction3 Symptoms , 3 Signs , Specific organ dysfunction

OrgansOrgansOrgansOrgans

Pulmonary Pulmonary

hemorrhagehemorrhage

hepatitishepatitis

Interstitial Interstitial

nephritisnephritis

Meningitis and Meningitis and

encephalitisencephalitis

Pulmonary Pulmonary

hemorrhagehemorrhage

IcterohemorrhageIcterohemorrhage

Renal failureRenal failure

MeningoencephalitisMeningoencephalitis


DiagnosisDiagnosisData of laboratoryData of laboratoryDiagnosisDiagnosisData of laboratoryData of laboratory

Peripheral blood: WBC↑N↑Peripheral blood: WBC↑N↑

Urine: proteinuria, hematuria, cylindruria Urine: proteinuria, hematuria, cylindruria Blood cultureBlood culture Microscopic agglutination test (MAT)Microscopic agglutination test (MAT) ：： live antigen,

determination of titer and identification of serotype. PPositive result appears in about 7 to 8 days after onset oositive result appears in about 7 to 8 days after onset of illness, and f illness, and persist for many years

The titer ≥1:400 or fourfold increased in period of recperiod of recoveryovery supports a diagnosis of leptospirosisleptospirosis

Type of influenza and typhoid fever Type of influenza and typhoid fever ：： InfluenzaInfluenza Typhoid feverTyphoid fever SSepticemia Type of pulmonary hemorrhageType of pulmonary hemorrhage ：： Bacterial pneumoniaBacterial pneumonia Pulmonary tuberculosisPulmonary tuberculosis Type of Type of icterohemorrhageicterohemorrhage ：： Viral hepatitisViral hepatitis

Differential diagnosisDifferential diagnosisDifferential diagnosisDifferential diagnosis

Type of meningoencephalitisType of meningoencephalitis ：： Viral encephalitisViral encephalitis

Tuberculotic meningitisTuberculotic meningitis

Type of renal failureType of renal failure ：： Acute nephritisAcute nephritis

Hemorrhagic fever with renal syndromeHemorrhagic fever with renal syndrome

Differential diagnosisDifferential diagnosisDifferential diagnosisDifferential diagnosis

Early finding ， early diagnosis, early treatment and treat in near hospital ( 三早一就地 )

Early diagnosis and effective treatment are very i

mportant

Antibiotic treatment will shorten the duration of fe

ver and reduce the incidence of complications

Treatment Treatment principle of treatmentprinciple of treatmentTreatment Treatment principle of treatmentprinciple of treatment

TreatmentTreatmentEtiologic treatmentEtiologic treatment TreatmentTreatmentEtiologic treatmentEtiologic treatment

Penicillin G is the first choice. The first dose of pPenicillin G is the first choice. The first dose of penicillin should be small, 50’000U as the first one, enicillin should be small, 50’000U as the first one, then increase later, 4~6 times/day, the duration is then increase later, 4~6 times/day, the duration is about 7 daysabout 7 days

For the patients who are allergic to penicillin , geFor the patients who are allergic to penicillin , gentamycin can be used, the dose is 80’000U/time, 3 ntamycin can be used, the dose is 80’000U/time, 3 times daily for 7 daystimes daily for 7 days

Tetracycline 500 mg/time 4 times/day 5~7 days

Clinical Manifestations Clinical Manifestations HerxheiHerxhei

mer Reaction (mer Reaction ( 赫氏反应赫氏反应 )) Clinical Manifestations Clinical Manifestations HerxheiHerxhei

mer Reaction (mer Reaction ( 赫氏反应赫氏反应 ))

The illness gets worse after the initiation of peniThe illness gets worse after the initiation of penicillin G therapycillin G therapy

In 0.5 to 4 hours after the first dose, it begins abIn 0.5 to 4 hours after the first dose, it begins abruptly with chills, high fever and myalgia ruptly with chills, high fever and myalgia

which persists for 0.5 to 1 hours, which persists for 0.5 to 1 hours, hypotension or shock, tachycardia

Caused by the lysis of massive leptospira and the release of toxin after PG therapy

1. General supportive measures 1. General supportive measures

2. For the severe cases 2. For the severe cases

Tranquilizer: valium, luminal, Tranquilizer: valium, luminal, wintermine and p

henergan

3. Treatment of Herxheimer reaction3. Treatment of Herxheimer reaction ：： TranquiliTranquili

zer, Corticosteroid intravenous dripzer, Corticosteroid intravenous drip

TreatmentTreatmentSymptomatic treatmentSymptomatic treatment TreatmentTreatmentSymptomatic treatmentSymptomatic treatment

TreatmentTreatmentTreatment of pulmonary hemorrhage Treatment of pulmonary hemorrhage TreatmentTreatmentTreatment of pulmonary hemorrhage Treatment of pulmonary hemorrhage

Tranquilizer Tranquilizer

Hydrocortisones Hydrocortisones

Cedilanid Cedilanid for cardiac failure

Haemostatic for bleeding

TreatmentTreatmentTreatment of type of icterohemorrhageTreatment of type of icterohemorrhageTreatmentTreatmentTreatment of type of icterohemorrhageTreatment of type of icterohemorrhage

It is similar to the treatment of icteric hepatitis It is similar to the treatment of icteric hepatitis

Bed restBed rest

Liver protectionLiver protection

Supportive measure and nutritionSupportive measure and nutrition

The treatment of renal failure

For mild type, if the treatment is given in time,treatment is given in time,

the prognosis is fine the prognosis is fine

For the type of severe hemorrhage, severe ieteiete

rohemorrhage, severe meningitis and encepharohemorrhage, severe meningitis and encepha

litis, the mortality rate is highlitis, the mortality rate is high

PrognosisPrognosisPrognosisPrognosis

A NEWS REPORTA NEWS REPORTA NEWS REPORTA NEWS REPORT

Did the physician make any mistakes? What should the physician do after the first

dose of PG therapy? What was the diagnosis of the patient when he

came to the hospital again? What was the patient died from?

disscutiondisscutiondisscutiondisscution

Control the source of infection Control the source of infection ：： Maintain swine, dogs , cowsMaintain swine, dogs , cows

Eradicate ratsEradicate rats

Interrupt the routes of transmissionInterrupt the routes of transmission– wearing protective clothingwearing protective clothing– refrain from contact with infected animals and refrain from contact with infected animals and

from swimming in contaminated waterfrom swimming in contaminated water

Prevention Prevention Prevention Prevention

Protect susceptible people: Protect susceptible people: – Immunization with leptospira vaccinesImmunization with leptospira vaccines

• Peoples who live in the severe epidemic areaPeoples who live in the severe epidemic area

• Peoples who have more chances to contact Peoples who have more chances to contact

with the contaminated water or soilwith the contaminated water or soil

• Peoples who just enter the epidemic areaPeoples who just enter the epidemic area

• One month before epidemic season(April~May)One month before epidemic season(April~May)

• Hypodermic, 1ml/time, after a week,repeat itHypodermic, 1ml/time, after a week,repeat it


Protect susceptible people: Protect susceptible people: – ChemoprophylaxisChemoprophylaxis

• When people who enter the epidemic area , taWhen people who enter the epidemic area , ta

ke doxycycline, 200mg orally once weekly durke doxycycline, 200mg orally once weekly dur

ing the risk of exposureing the risk of exposure


Leptospirosis is a zoonotic disease caused by pathogenic lezoonotic disease caused by pathogenic le

ptospiraptospira

Apodemus agarius and swine are the chief sources of infectApodemus agarius and swine are the chief sources of infect

ionion

The main route of transmission is exposure to the contamiThe main route of transmission is exposure to the contami

nated water or soilnated water or soil

The basic clinical features are 3 symptoms and 3 signsThe basic clinical features are 3 symptoms and 3 signs

summy summy (1)(1)summy summy (1)(1)

There are 3 phases and 5 clinical types

MAT is a important test for diagnosis

PG is the first choice of etiologic treatment ,the first dosetiologic treatment ,the first dos

e should be smalle should be small

Pay attention to the Herxheimer reactionPay attention to the Herxheimer reaction

Prophylactic inoculation and Chemoprophylaxis are useChemoprophylaxis are use

ful methods of preventionful methods of prevention

summy summy (2)(2)summy summy (2)(2)

Zoonoses are defined by the WHO as "Diseases and infections which are naturally transmitted between vertebrate animals and man"

A zoonotic agent may be a bacterium, virus, fungus, parasite, or other communicable agent

Zoonoses cover a broad range of diseases with different clinical and epidemiological features and control measures

zoonoseszoonoseszoonoseszoonoses

Japanese encephaliti

s

Yellow fever

West Nile fever

Haemorragic fevers

Rabies

SARS

Hepatitis E

Avian influenza

zoonoseszoonoseszoonoseszoonoses

Apodemus agariusApodemus agariusApodemus agariusApodemus agarius

Zhang Xiaohong Department of Infectious Diseases Sun Yat-Sen university Leptospirosis.

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Transcript of Zhang Xiaohong Department of Infectious Diseases Sun Yat-Sen university Leptospirosis.