How to control leptospirosis using epidemiological triangle?

      

1- AGENT

Leptospirosis is a bacterial disease that affects humans and animals. It is caused by bacteria of the genus Leptospira. In humans, it can cause a wide range of symptoms, some of which may be mistaken for other diseases. Some infected persons, however, may have no symptoms at all. Without treatment, Leptospirosis can lead to kidney damage, meningitis (inflammation of the membrane around the brain and spinal cord), liver failure, respiratory distress, and even death.

MODE OF TRANSMISSION

 Leptospirosis is transmitted by the urine of an infected animal and is contagious as long as the urine is still moist. Although Leptospira has been detected in reptiles and birds, only mammals are able to transmit the bacteria to humans and other animals. Rats and mice are important primary hosts—but a wide range of other mammals including dogs, deer, rabbits, hedgehogs, cows, sheep, raccoons, opossums, skunks, and certain marine mammals carry and transmit the disease as secondary host. House-bound domestic dogs have contracted leptospirosis, apparently from licking the urine of infected mice in the house. The type of habitats most likely to carry infective bacteria are muddy riverbanks,and muddy livestock rearing areas where there is regular passage of wild or farm mammals. The incidence of leptospirosis correlates directly with the amount of rainfall, making it seasonal in temperate climates and year-round in tropical climates. Leptospirosis also transmits via the semen of infected animals. Humans become infected through contact with water, food, or soil that contains urine from these infected animals. This may happen by swallowing contaminated food or water or through skin contact. The disease is not known to spread between humans, and bacterial dissemination in convalescence is extremely rare in humans. Leptospirosis is common among water-sport enthusiasts in specific areas, as prolonged immersion in water promotes the entry of the bacteria.

PREVENTION

•  Prevention of leptospirosis include wearing protective clothing for people at occupational risk and avoidance of swimming in water that may be contaminated. 
• Leptospirosis control in animals is dependent on the serovar and animal species but may be either vaccination, a testing a culling programme, rodent control or a combination of these strategies. 
• The large number of serovars, variety of infection sources and the wide differences in transmission conditions, the prevention and control of leptospirosis is complex.
•  Effective prevention and control can be achieved by controlling the reservoir or reducing infection in animal reservoir populations such as dogs or livestock treatment or vaccination of the animals.
•  Control of wild animals may be difficult. Preventive measures must be based on knowledge of the groups at particular risk of infection.
• Prevention and control should be targeted at is a the infection source, The route of transmission between the infection source and the human host or Prompt and proper treatment of infection.

SYMPTOMS

• Leptospirosis infection in humans causes a range of symptoms, and some infected persons may have no symptoms at all. 
• The symptoms appear after an incubation period of 7–12 days.The first phase (acute or septicemic phase) ends after 3–7 days of illness. 
• The disappearance of symptoms coincides with the appearance of antibodies against Leptospira and the disappearance of the bacteria from the bloodstream. 
• The patient is asymptomatic for 3–4 days until the second phase begins with another episode of fever.
•  The hallmark of the second phase is meningitis (inflammation of the membranes covering the brain). 
• Symptoms caused disease leptospirosis are fever and headache persistent vomiting diarrhea muscle and joint pain abdominal pain Jaundice (yellow eyes) cough, eye inflammation and rash.

2-HOST

Prevention

• Can be reduce by reducing swimming in contaminated water.
• Not in contact with animals that have been exposed to infection
• Wear the PPE
• Wearing protective clothing or footwear
• Increasing the frequency goes wellness center
• Give lepto vaccine to pets although, not 100% immune.
• Pet's owner should take antibiotics as doxycyline or penniciline.
• Do not hold the urine, the blood of animals that not have proper treatment.
• Always wash hand with anti-bacterial cleaning solution. 

Mode of transmission

• Leptospirosis can effect human directly or indirectly through exposure to animal urine of the bearer. The genus leptospira bacteria enter the bloodstream through wounds,skin abrasions and through mucous membranes such as eyes, nose and mouth.
• Also spread via semen of infected animals, abattoir workers may be infected through contact with bodily fluids and direction.
• Human can be infected through exposure of water, food or soil containing urine from infected animals bacteria. May happen by swallowing contaminated food or water or by contact with the skin.
• Dog lick urine then go near this master.

3-ENVIRONMENT

Leptospirosis

          Ø  Is an emerging zoonotic disease.

Ø  It is an infectious disease caused by pathogenic bacteria called leptospires.

Ø  That are transmitted directly or indirectly from animal to human

Environment Factor

•  Animal stocking density (eg.all the animals in a place)
•  Animal movement between groups.
•  Housing (eg.ventilation,sanitation)
•  Environment condition (eg.temperature)
• Nutrient (eg.protein )

Control of Environment 

1.  Sources of infection such as exposure to infected animal and potentially contaminated bodies of water.
2. It may also include environment clean-ups and draining

•    Alert public or users regarding the hazards of possible contaminated areas.
•    Health hazards signage should be posted in areas found to be contaminated through   environment risk.
•    Advise public to keep their homes and premises free from rodents.
•   Advise public to vaccinate their pets.
•   Promote cleanliness at the recreational areas ,food premises.
•   Reduce by not swimming which contaminated with animal urine.
•    Removal of rubbish and keeping areas clean.

What are the symptoms of this disease?

- The incubation period of time, namely the period of time of exposure to onset of symptoms is between 2 to 10 days. This disease shows of variety of clinical symptoms.  Among the symptoms of leptospirosis infection can be shown by patients are high fever, headache, chills, muscle pain, vomitting, jaundis, inflammation of the eyes, abdominal pain, diarrhea, cough and a rash on the skin.

-This disease can be categorized into for category based on the clinical signs in as follow (WHO, 2003) 

• Influenza like illness that light.
• Weil's syndroms - jaundis, renal failure, bleeding in flammation of the heart muscle with an irregular heart beat.
• Meningitis
• Pulmonary hemorrhage with respiratory failure.    

Confirmation of Leptospirosis is through : 

• Verification leptospira bacteria through culture of blood samples, cerebrosipinal fluid, and urine.
• Serology test to detect specific antibodies such as Microscopic Agglutination Test ( MAT ), test immunofluorescent  techniques (IF ), and ELISA

Whether the disease can be treated?

• This disease can be treated with certain antibiotics. For those who show symptoms as above shall hasten to the nearest clinic for examination and treatment, especially for those who have a history of exposure to contaminated water and food. Early treatment with antibiotics can prevent complications and death.

Doxycyline antibiotics can be given as prophylaxis to those who are exposed to infection through work ( military, rescue workers and other ). However, the doctor's advice should be obtained before taking prophilaxis.