Leptospirosis is caused by infection of the bacteira genus Leptospira, and affects humans as well as other mammals, birds, amphibians, and reptiles. A patient is suspected to acquire leptospirosis when experiencing symptoms for about 1-2 weeks after exposure to the urine of the carrier animals. In this case, Ms. Angeline Dara Damaderio has experienced it. She is 11 years old, a resident of Blk. 4 Lot. 7 Phase 4Tayuman, Manila. She experienced fever for 2 days with headaches and muscle pain.
She also has a body temperature of 39 degrees centigrade and a pulse rate of 115 bpm. Last August 8, 2011 Monday, she went to the Out Patient Department of OSSAM with her father for a check-up. We met her there and we took some information about her. Based on our assessment, she appeared weak. We chose her as the subject of our case study because we want to know more about Leptospirosis and why is it harmful and may lead to the death of a patient. Introduction
Leptospirosis (also known as Weil’s syndrome, canicola fever, canefield fever, `nanukayami fever, 7-day fever, Rat Catcher’s Yellows, Fort Bragg fever, black jaundice and Pretibial fever) is caused by infection of the bacteira genus Leptospira, and affects humans as well as other mammals, birds, amphibians, and reptiles. An infectious disease caused by a particular type of bacteria called a spirochete transmitted by rats as well as by skunks, opossums, raccoons, foxes, and other vermin. Leptospirosis occurs worldwide but is most commonly acquired in the tropics.
About 100 cases of leptospirosis are reported each year in the US. The disease is becoming a greater risk as more people travel to undeveloped areas of the world. Symptoms begin from 2 to 25 days after, initial direct exposure to the urine or tissue of an infected animal. This can even occur via contaminated soil or water. Veterinarians and farm workers are at particularly high risk. The illness typically progresses through three phases. The first phase of symptoms includes headaches, muscle aches, eye pain with bright lights, followed by chills and fever.
Watering and redness of the eyes occur and symptoms seem to improve by day 5 to 9. The second phase of illness begins after a few days of feeling pretty well. The initial symptoms recur with fever and aching with stiffness of the neck. Some patients develop serious inflammation of the nerve to the eye, brain, spinal column (meningitis), or other nerves. The final third phase, from 2 to 4 weeks after the initial infection, features recurrent fever and muscle aching. Leptospirosis with liver disease is called Weil’s syndrome and is characterized by yellowing of the eyes (jaundice) from liver disease.
Patients with Weil’s syndrome can also develop kidney disease and have more serious involvement of the organs affected. Patient’s Profile Patient’s Name: Pt. X Address: Tayuman, Manila Sex: Female Civil Status: Single Religion: Roman Catholic Date of Birth: April 19 2000 Age: 11 Birthplace: TayumanNationality: Filipino A. Chief Complaint Fever for 2 days with muscle pain B. Present History of Illness Leptospirosis C. Past History of Illness Elevated Body Temperature D. Family History of Illness Hypertension Vital Signs: BP: 110/70 mmHg RR: 19 cpm PR: 115 bpm Temp: 39 Degree Celsius
Diagnosis: Elevated Body Temperature with Muscle Pain Pathophysiology of Leptospirosis The leptospires are thin, coiled, gram-negative, aerobic organisms 6-20 µm in length. They are motile, with hooked ends and paired axial flagella (one on each end), enabling them to burrow into tissue. Motion is marked by continual spinning on the long axis. Current studies identify at least 7 pathogenic species of leptospires. However, organisms that are identical serologically may be different genetically, and organisms with the same genetic makeup may differ serologically.
Although not fully understood, leptospires are believed to enter the host through abrasions in healthy skin, through sodden and waterlogged skin, directly through intact mucus membranes or conjunctiva, through the nasal mucosa and cribriform plate, through the lungs (after inhalation of aerosolized body fluid), or through the placenta during pregnancy. Virulent organisms in a susceptible host gain rapid access to the bloodstream through the lymphatics, resulting in leptospiremia and spread to all organs. The incubation period is usually 5-14 days but has been described from 72 hours to a month or more.
If the host survives the acute infection, septicemia and multiplication of the organism persist until the development of a successful immune response and rapid immune clearance. However, after clearance from the blood, leptospires remain in immunologically privileged sites, including the renal tubules, brain, and anterior chamber of the eye, for weeks to months. In humans, leptospires in the renal tubules and resulting leptospiruria rarely persist longer than 60 days. During acute infection, leptospires are thought to multiply in the small blood vessel endothelium, resulting in damage and vasculitis.
The major clinical manifestations of the disease are believed to be secondary to this mechanism, which can affect nearly any organ system: – In the kidneys, interstitial nephritis, tubular necrosis, and impaired capillary permeability, as well as the associated hypovolemia, result in renal failure. – Liver involvement is marked by centrilobular necrosis and Kupffer cell proliferation, with hepatocellular dysfunction. – Pulmonary involvement is secondary to alveolar and interstitial vascular damage resulting in hemorrhage.
This complication is considered to be the major cause of leptospirosis-associated death. The skin is affected by epithelial vascular insult. – Skeletal muscle involvement is secondary to edema, myofibril vacuolization, and vessel damage. – The damage to the vascular system as a whole can result in capillary leakage, hypovolemia, and shock. Many patients with leptospirosis may develop disseminated intravascular coagulation (DIC), hemolytic uremic syndrome (HUS), thrombotic, thrombocytopenic purpura (TTP), and vasculitis. – Thrombocytopenia indicates severe disease and should raise suspicion for a risk of bleeding.
Clinical manifestations of leptospirosis after the acute infection are the result of the inflammatory response, as well as action of the remaining organisms in the aqueous humor. Nursing Physical Assessment We have noted for the patient’s vital signs and all such are as follows: Blood Pressure: 110/70 mmHg (normal) Respiration Rate: 19 cpm (normal) Pulse Rate: 115 bpm (normal) Temperature: 39 Degree Celsius (abnormal) Related Treatments The doctor ordered to infuse aqueous penicillin G 50,000 units/kg per day divided in to 4-6 doses for 7-10 days. Also the doctor ordered Tetracycline 20 mg/kg per day divided in to 4 doses.
- Nursing Care Goal
- Short Term Goals
- To maintain normal body temperature
- To prevent further infection from the said disease and other complications
Long Term Goals a. To provide knowledge to the parent and the patient of what are the complications and the risks of Leptospirosis Nursing Diagnosis A patient is suspected to acquire leptospirosis when experiencing symptoms for about 1-2 weeks after exposure to the urine of the carrier animals. This disease can only be confirmed through blood tests to detect the presence of leptospira bacteria.
Leptospira bacteria can be isolated from blood, urine or cerebrospinal fluid (CSF) during the first phase of the illness. They are several criteria to confirm if a patient has the leptospirosis disease. Firstly, it may be confirmed through the isolation of leptospira from a clinical specimen. Besides, leptospirosis infection is confirmed if there is fourfold or greater increase in leptospira agglutination titer between acute and convalescent phase serum specimens obtained in 2 weeks or more apart and studied at the same laboratory. Other than that, urine analysis is also reliable.
If a urine test gives a positive result during the second week of illness and continues on up to 30 days, the patient is confirmed to have leptospirosis. If there is single case or household cluster case, some information should be collected. Firstly, the occupation of the suspected person must be identified. This is because farmers, veterinarians, sewer and abattoir workers have a higher risk of contracting the disease. Next, recent exposure to water or soil potentially contaminated with the urine of the carrier animal can be determined.
Besides that, recent contact of the individual with animal tissue or fluids is looked into. Lastly, the patient is checked to have recently travelled to endemic or epidemic areas of the disease or not. Nursing Interventions 1. Impaired nutritional needs related to anorexia Expected Result: * Nutritional needs are met
Patients are able to eat in accordance with a given portion Intervention:
- Review complaints of nausea and vomiting
- Give small but frequent feeding
- Assess how to eat that which is served
- Give a warm meal Measure the patient’s body weight every day
- Increased body temperature related to increase metabolic disease Expected Result:
- Temperature within normal limits, free from cold
Patient is free complications related to leptospirosis Intervention:
- Use a warm compress, avoid alcohol use
- Instruct patient to drink plenty of fluids
- Collaboration in the provision of antipyreti
Disruption of daily activities related to physical weakness Expected Result:
- Activities of daily needs are met
- Patient’s capability of self reliance Intervention: Assess the patient’s complaint
- Assess the activities that can and can not be done by the patient
- Help the patient to meet his/her daily activities
Put things in place, easily accesible Evaluation After two weeks of performing the appropriate symptomatic nursing interventions for treating leptospirosis, the patient has been responding well to the medication which the doctor has ordered. Signs and symptoms of the said disease had their disoccurrence. The patient is doing well and appeared way better than the day before the interventions were applied.
Recommendations Every nurse must follow the doctor’s order for the betterment of his/her patient. Efficiency and effectiveness of the nursing interventions should be observed. For further treatment to future patient with leptospirosis, health care providers should always monitor the patient’s fluid intake and output and watch out for signs and symptoms. Prevention is better than cure. Moreover, what matters most is to keep the patient’s environment clean to prevent the infection from invading the patient’s body or generally, another person’s body.
