Introduction
The diagnosis of leptospirosis, an infectious syndrome caused by bacteria of the genus Leptospira, is particularly artificial and complex, mainly due to the marked clinical polymorphism. Strictly speaking, therapies aimed at curing leptospirosis are often a limitation, as the currently available diagnostic tests are not always clear and irrefutable.
In this concluding article we will try to examine all the possible diagnostic strategies and possible exploitable therapies.
Leptospirosis: diagnosis
- Isolation of the bacterium (pathogen)
- Specific antibody serological analysis
Starting from these considerations, it is clear that the diagnosis is based both on the symptomatological - clinical analysis, and on the anamnestic narrative which, unfortunately, often remains an unknown quantity. Regarding the study of symptoms, in most cases attention is focused on the presence of fever, myalgia, hemorrhage, jaundice and conjunctival hyperemia; as far as the anamnesis is concerned, on the other hand, the work of the patient is investigated, the journeys made in recent periods, the hygienic-sanitary conditions and, finally, the contact with potentially infected animals.
Bacteria isolation, leptospires, is carried out on specific soils and biological liquids (liquor, blood, urine - above all) and / or tissues damaged by leptospirosis (liver or kidney). It is important to point out that cultural diagnostic tests on artificial grounds are not always effective and reliable, since leptospires tend to develop very slowly. Microbiological inspection performed directly on blood, CSF, urine or damaged tissue is more reliable [taken from Zoonosi and public health, by E. Matassa].
Serological diagnostic tests (of specific antibody type) are undoubtedly more advantageous and safe, since the probability of false positives is more rare (a very common occurrence in the culture isolation of the bacterium).
Serological tests are generally performed during the initial symptoms of leptospirosis (when symptomatic); for this survey, the most widespread serotypes in the area are used. Serological tests should be repeated several times to confirm the diagnosis.
In the case of hypothesized and not fully demonstrated leptospirosis, it is possible to perform biohumoral tests, which are based essentially on leukocyte analysis (whose values are almost standard), liquor examination, transaminase test (generally not too high), search for possible hyperazotemia, hypercreatininemia, thrombocytopenia and hyperbilirubinemia.
Other diagnostic tests include:
- Microscopic Agglutination test (MAT): very specific test but particularly complex and laborious. Confirmation of leptospirosis is obtained in a relatively long time.
- ELISA : immuno-enzymatic diagnostic test, simpler than the previous one.
- Test Lepto Tek Flow and TestLepto Tek Dri Dot : rapid agglutination tests, but unfortunately not very reliable.
therapies
To learn more: Drugs for the treatment of Leptospirosis
There are two therapeutic options for leptospirosis, although they are controversial in some respects.
The first therapy is based on the oral administration of antibiotics (eg doxycycline 100mg / day), particularly indicated in all phases of the disease; the forms of leptospirosis requiring hospitalization of the patient are treated with penicillin, ampicillin, macrolides or clindamycin. Quinolones and third-generation cephalosporins (eg ceftriaxone) are also effective.
If the leptospirosis is not diagnosed immediately, the therapeutic treatment is not clearly carried out in a timely manner: in similar situations, the probabilities of ineffectiveness of antibiotics increase.
The maintenance of the electrolyte balance of the leptospirotic patient is essential.
In case of severity, supportive therapy is absolutely essential:
- dialysis is useful when leptospirosis compromises the renal system
- transfusions are useful if the disease is characterized by bleeding phenomena
- in the case of cardiovascular insufficiency associated with leptospire infections, targeted cardiological care is preferable
Finally, the timeliness of specific therapies, following diagnostic tests, is essential both to avoid complications and aggravations of the disease and to shorten the natural course of leptospirosis.
