FACULTY OF APPLIED SCIENCE

BIO320
CASE STUDY: LEPTOSPIROSIS CASES IN
MALAYSIA

NAME: ILHAM AMNI AMANINA BINTI ISMAIL

STUDENT ID: 2018230832
GROUP: AS1204_F

PREPARED FOR: DR HAMZAH ABDUL AZIZ

DATE OF SUBMISSION: 6th July 2020
INTRODUCTION

It was first described by Adolf Weil in 1886 when he reported an "acute infectious
disease with enlargement of spleen, jaundice and nephritis". Leptospira was first
observed in 1907 from a post mortem renal tissue slice. Leptospira is the name of
genus of thin, long, spiral-shaped bacteria that are sometimes called Leptospires.
The Leptospira appear tightly coiled thin flexible Spirochetes 5 –15 microns long.The
physical is fine spiral of 0.1-0.2 microns and it one end appears bent forms a hook. It
very actively motile and seen best with dark microscopy.

Leptospirosis contagious by contact with soil or water that have contaminated animal
urine that has been infected. It happen when the skin come in contact with the soil or
water. It can infect over 160 mammal species. Rats, mice, wild rodents, dogs, wine,
cattle are principle source of infection. The above animals excrete Leptospira both in
active infection and asymptomatic stage.

The Leptospira survive and remain viable for several weeks in ponding water.
Leptospirosis occurs worldwide and can be a serious public health issue in a humid
tropical and subtropical country such as Malaysia. Although leptospirosis cases have
been reported in Malaysia since the 1920s, the actual disease burden in the country
is unknown due to it not being a notifiable disease under the Prevention and Control
of Communicable Diseases Act 1988 until recently.

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CONTENT

1. What is leptospirosis?
Leptospirosis is a rare bacterial infection that we get from animals. It is spread
through their urine, especially from rodents, dog or maybe farm animals. We should
beware to those animals because they may not have any symptoms, but they can be
carriers. Mostly, leptospirosis cases is unpleasant but not life-threatening, like a case
of the flu. Other than leptospirosis, it also known as “mud fever” or fall fever. It
caused by pathogenic spirochetes of the genus Leptospira.

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 2. Who does it affect?
Leptospira can affect both human and animals. For human, the most who can easily
get this disease is individuals who may have increased exposure to animal urine or
water contaminated with animal urine are at potential risk for infection with
Leptospira. These include veterinarians, animal care personnel, sewer workers,
farmers, rodent control workers, miners, zookeepers, and people who participate in
outdoor water sports such as kayaking, canoeing, swimming and white water rafting.
Human also can get this disease when they are going to water theme park or maybe
at the waterfall which people usually go there for having fun with their family.

3. How did it spread?

Wild mammals are the maintenance host or primary reservoir for the spirochetes.
Humans become infected through direct contact with the infected urine or indirectly
through contact with contaminated water. It enters through abraded skin or mucous
membrane. The infection started Leptospires appear in the blood. It invade all
tissues and organs particularly affecting the kidney and liver . Thus, it were cleared
from the body by the host's immune response. Leptospirosis may also settle in the
convoluted tubules of the kidneys and it shed in the urine for a few weeks to several
months or maybe longer than that. Infection is acquired from contact through skin,
mucosa or conjunctiva with soil or water contaminated with the urine of rodents,
carrier or diseased animals within the environment. Ingestion of contaminated water
may also cause infection.

There is no cases of human to human transmission. Indirect transmission can

happen through contact with soil, food, water or bedding that has been contaminated
with Leptospires, usually from the urine of infected wildlife. Direct transmission
involves mucous or skin contact with frank urine, venereal discharge or tissues from
an infected animal. Because people have such close contact with their pets, this is
an important mode of transmission from these animals, although in general it is less
common than indirect transmission. The bacteria can occasionally be transferred by
bites, although Leptospires are generally not shed in saliva. Leptospires are adept at
burrowing through tissues, therefore transmission can even occur through intact skin
that's soft or macerated from moisture, although it's more likely to occur through
broken skin or a mucous membrane.
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Dogs can become infected from simply walking through a puddle in which an
infected skunk or raccoon has urinated. People can become infected from swimming
in similarly contaminated lakes or ponds. Once Leptospires penetrate the skin or
mucous membranes of a number , they enter the bloodstream and start to multiply
rapidly. The bacteria then invade other tissues including the kidney, liver, spleen,
central nervous system , eyes and genital tract, and still multiply. The mechanisms
by which Leptospires exert their damaging effects are unclear. The bacteria cause
severe vasculitis and endothelial damage, which can lead to coagulation disorders.
Damage to the renal tubules commonly leads to renal insufficiency or failure. It is
suspected that hepatic necrosis is initially caused by interference with cellular
enzyme systems. Chronic active hepatitis and hepatic fibrosis and failure may ensue
in some cases. Interstitial pneumonia and pulmonary hemorrhage have both been
reported in dogs and humans, but appear to be more common in humans.
Myocarditis, pericarditis and cardiac dysrhythmias are also well-recognized
sequelae. Although not recognized in dogs, in humans leptospirosis can result in
aseptic meningitis, which may be immune-mediated in nature. Acute or chronic
recurrent uveitis may occur because of the presence of Leptospires within the
aqueous humor and or cross-reactivity of Leptospire antibodies with ocular tissues.

Although leptospirosis may be a relatively commonly reported explanation for

abortion in cattle and swine, reproductive problems related to leptospirosis aren't
commonly reported in other species, including humans, but they can occur. In
Malaysia, an increasing number of reported cases and outbreaks which had resulted
in significant number of fatal have been observed over the past decade. There is a
great need for improvement is case surveillance, in order to define strategies in
prevention and control of case morbidity and mortality related to this disease. Thus,
under the Prevention and Control of Infectious Diseases Act 1988 leptospirosis has
been gazetted as a notifiable disease on 9 December 2010.

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 4. Where are the area in Malaysia that had the leptospirosis cases?
Leptospirosis is a zoonosis caused by pathogenic leptospiral bacteria, which are
transmitted directly or indirectly from animals to humans or animal to animal. The
first phase of this proposed study was administered to see the extent of exposure to
leptospirosis in wild mammals surrounded by human settlements around wildlife or
tourism area (Wind Cave, Fairy Cave, Bako National Park and Matang Wildlife
Center).This study reports an occurrence of leptospirosis among primates (three
captive and two free ranging), rats, bats, squirrels and mongoose around Kuching,
Sarawak area, which has been screened for Leptospirosis. Blood samples were
obtained to work out the presence of antibodies through the microscopic
agglutination test (MAT) using eighteen serovars of Leptospira commonly found in
Malaysia as antigens. It was observed that four out of thefive monkeys(80%),
rats(9/4) (44%), bats(20/5) (20.8%), squirrels 4/4 (100%) and mongoose (1) (100%)
reacted against one or more serovars of Leptospira. In this study, antibody of 5
serovars of Leptospira interrrogans Copenheni, Leptospira interrrogans Lai,
Leptospira interrrogans Pomona, Leptospira interrrogans Pyrogenes, Lepto 175*
were detected. Serovars Copenhegemi, Lai, Pomona and Pyrogenes were
considered pathogenic for different mammals including human beings. No
information about serovars lepto 175 and further studies happening . This is giving
information on the possible zoonotic importance of mammalian species in

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maintaining this disease in Sarawak. The transmission of Leptospires in rats
reported several cases and between primates. bats. squirrels. mongoose and human
isn't reported elsewhere but this might create new reservoir and transmission routes
and should affect the tourism, conservation effort and public health.

5. When did the crisis start?

Leptospirosis is typically a seasonal disease that starts at the onset of the season
and declines because the rainfall recedes. Sporadic cases may occur throughout the
year with outbreaks related to extreme changing weather events like heavy rainfall
and flooding. During this season, people should be more aware and take precautious
step to avoid from this disease because prevention is better than cure.

6. What is the factors of the leptospirosis?

There are many factors responsible for the emergence of leptospirosis. The first
factor is from reservoir and carrier hosts. As we know, leptospirosis has a very wide
range of natural rodent, and non-rodent reservoir hosts especially rats, cattle, dogs,
foxes, rabbits, and many more. The animals act as carriers of the Leptospires and
excrete sizable amount of Leptospires in their urine, thus liable for the contamination
of huge and little water bodies as well as soil. The next factor is flooding and
drainage congestion. Flooding and drainage congestion could also be risk factors for

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contamination of water bodies with infected animal urine. Water logged areas may
force rodent population to leave their burrows and contaminated the ponding water
by their urine. Furthermore, the potential for infection increases through exposure
from occupational or recreational activities without proper protection.

Poor cleanliness or sanitation in recreational areas may attract animal host such as
rodent that can increases the risk of contamination. These may be due to poor
maintenance of facilities, improper disposal of waste and public attitude who not
aware about this disease. Several sections of the population are more susceptible to
infection such as those not previously exposed to the bacteria in their environment
(naive immunities), and those with chronic disease and open skin wounds.

7. What are the waysto diagnosis the leptospirosis?

Hematology, serum biochemistry, urinalysis and abdominal ultrasonography are
reflective of the severity and type of primary organ dysfunction (e.g. kidneys, liver,
muscle, blood dyscrasias). Specific diagnosis supported isolation of Leptospires is
problematic. The organisms are very hard to culture in vitro, and detection of
organisms in body fluids and urine requires dark-field microscopy. This technique is
fraught with sensitivity and specificity issues and is not any longer a recommended
diagnostic for leptospirosis. Leptospiruria can be intermittent. Administration of
furosemide to a well-hydrated patient may make recovery of the bacteria more
effective, and multiple samples should be collected. In animals, urine samples for
culture should be gathered by cystocentesis.

The first way is microscopic agglutination test (MAT). This test keeps the gold
standard for diagnosis of leptospiral infection in humans and animals. The test is
meant to be serogroup-specific, but not serovar-specific. The MAT requires live test
strains of the bacteria and dark-field microscopy, so it's only performed by some
commercial labs. In dogs, diagnosis is usually supported a fourfold rise in specific
MAT antibody titre over three weeks, or one titre of 1:800 or greater. The serogroup
with the very best titre is usually considered the infecting strain, but this is often very
unreliable in acute serum samples due to high cross-reactivity. Titres could also be
negative during the primary 7-10 days of infection, and early antimicrobial therapy
decreases the magnitude of the increase in titre. Vaccination rarely causes a specific
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titre over 1:300; higher vaccine titres rarely persist for over 3 months. This is
because serovar canicola is host-adapted to dogs, dogs may shed this serovar in
their urine without developing a titre over 1:100.

The next ways is other serologic tests. Tests are developed that are not difficult to
perform, can detect antibody (IgM) titres earlier in infection and potentially
differentiate vaccine and disease-induced titres. These include enzyme-linked
immunosorbent assays (ELISAs), latex agglutination test (LAT), macroscopic slide
agglutination test (MSAT) and indirect hemagglutination assay (IHA). Most were
developed to be used in humans and aren't widely available for animal testing. The
primary problem with these tests keeps low sensitivity during the primary week of
illness.

The other ways to detect the leptospirosis is polymerase chain reaction (PCR). This
methodology can diagnose leptospiral DNA in clinical samples before serologic tests
can confirm infection, and is out there from some labs for both human and animal
testing. However, additional research is needed to work out the diagnostic reliability
and sensitivity in animals, as Leptospires can occasionally be found within the
tissues and urine of normal dogs. Thus, PCR is primarily used for outbreak
investigations in humans because of the technical demands of performing the test.

8. What are the treatments of leptospirosis?

For animal, standard therapy should be employed for the animal’s condition based
on the body systems involved and the severity of signs, and may include intravenous
fluids, plasma, blood transfusion, gastroprotectants, and diuretics. Specific therapy
for leptospirosis consists of antimicrobial therapy. It is vital to administer
antimicrobials as early as possible to cut back Leptospiremia and avoid further organ
damage. Penicillins are the antimicrobials of choice initially (e.g. ampicillin 22 mg/kg
PO, SC or IV, q6-8h for two weeks in both dogs and cats, but won't clear the renal
carrier state.

Doxycycline can also be used in dogs (5 mg/kg PO or IV, q12h for 2 weeks), and
may be advantageous in animals with marked renal dysfunction but minimal hepatic
dysfunction, as it is primarily excreted in the faeces. Options for antimicrobial therapy

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which will be wont to clear the renal carrier state include doxycycline, tetracycline,
and macrolides (e.g. erythromycin) at standard doses, although the latter have not
been well studied.

Aminogylcosides are very effective for clearing the renal carrier state, but they ought
to only tend to animals with normal renal function test results. Chloramphenicol and
sulfonamides are not effective for clearing leptospires from the tissues.
Fluoroquinolones have been variably effective when used in experimental models.
All animals with Leptospiruria, no matter clinical presentation, should be treated with
antimicrobials because of the associated public health risk. Once an animal begins
treatment, viable organisms should not be shed in the urine, but shedding of viable
organisms may recur if antimicrobial therapy is withdrawn before renal colonization is
completely eliminated.

Currently the foremost prevalent serovars of Leptospira found in dogs in North

America include grippotyphosa, pomona, bratislava and maybe , eventhough it's not
been confirmed, autumnalis. Previously the foremost common serovars were
canicola and icterohemorrhagiae. There are currently vaccines available for dogs for
serovars canicola and icterohemorrhagiae, grippotyphosa and pomona, and
tetravalent vaccines for all four of those serovars. The vaccines don't provide cross-
protection to other serogroups. Newer vaccines are effective at reducing renal
colonization and shedding also as clinical disease, but no vaccine is 100% effective.

Older vaccines were whole-cell bacterins, which attended be quite allergenic,

however the newer subunit vaccines that are produced are less problematic during
this regard. A primary series of three injections 2-3 weeks apart is suggested .
Because immunity tends to wane over time, for dogs at increased risk of exposure,
annual vaccination is suggested . Leptospiral vaccines for humans are not available
in North America.

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CONCLUSION
Due to this disease, people should aware the way to avoid this in order that we will
enjoy our life in healthy way. We should always know how to take care of our
surroundings clean so that wild mammal will not bring the bacteria among human.
Keeping our surroundings clean is our responsible. As going says, prevention is
better than cure. Awareness, control and protective measures, early detection and
prompt treatment are the keys to reducing the morbidity & mortality risks from
leptospirosis. Due to the massive number of serovars, sort of infection sources and
therefore the wide differences in transmission conditions, the prevention and control
of leptospirosis is complex.
Effective prevention and control are often achieved by controlling the reservoir or
reducing infection in animal reservoir populations like dogs or livestock via treatment
or vaccination of the animals. Control of untamed animals could also be difficult.
Preventive measures must be supported knowledge of the groups at particular risk of
infection and therefore the local epidemiological factors. Government should
providing continue awareness for healthcare personnel and public like inn service
training, guidelines, seminar, media and articles.

Health education activities are to be administered to make awareness among the

general public about the disease and motivate them to require preventive actions.
This must be done through multiple strategies in order to succeed in the precise
target groups. this might be done by using the electronic printed and interpersonal
means. It's important to make sure that messages delivered are relevant, timely and
culturally acceptable to the target groups. a correct needs assessment has got to
done to determine the target groups’ needs so as to alleviate their fear and
concerns.

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ral_Infection_in_Wildlife_in_Sarawak_Malaysia

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4. Brazier, Y. (2018, August 9). MedicalNewsToday. Retrieved from Leptospirosis: What you
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