History and Geography

Much of the history of leptospirosis appears as an effort to separate leptospiral jaundice and meningitis from other infections. The clinical portion of this history began with Weil's description of the disease in 1886; the bacteriologic phase began with isolation

Approximate time scale Iweeksl

1

2

3

Inoculation 1 2-20

(jou

Ce idice) meningitis

nvalescent stage

CSF Urine

--—

Antibody litres hiqh low

normal

early treat

ment

namnestic

^

«•^aeloyed

Laboratory investigations and specimens required ia) Isolation of strain from

►-1st—-

— urine ---2

nd-*

— 3rd etc

Phases -1

ïpiospiroemi -

leptoipiruria and immun

ty-

Figure VIII.81.2. Phases and relevant diagnostic procedures of leptospiroses. (Reproduced with slight modification from L. H. Turner 1973, in O. Gsell. 1978. Leptospiroses and relapsing fever. In Handbook of Clinical Neurology, Part III, Chapter 18, 395-419; 399, by permission of Elsevier Science Publishing.)

Figure VIII.81.2. Phases and relevant diagnostic procedures of leptospiroses. (Reproduced with slight modification from L. H. Turner 1973, in O. Gsell. 1978. Leptospiroses and relapsing fever. In Handbook of Clinical Neurology, Part III, Chapter 18, 395-419; 399, by permission of Elsevier Science Publishing.)

Table VTII.81.2. Symptoms occurring in Leptospiroses

Symptom % cases

Fever 100

Headaches 96

Biphasic fever 96

Meningitis serosa 90—96

Pathological urinary sediment 84

Conjunct, hyperaemia 60

Pharyngitis 60

Hypotonia 38

Myalgias, arthralgias 28

Exanthema 14

Icterus 1-2

Duration of fever

Up to 8 days 77

9-14 days 16

15-19 days 7

Leukopenia under 6000

First phase 30

Second phase 43

Leukocytosis upwards of9000

First phase 25

Second phase 25

Shift to the left in blood formula

First phase 81

Second phase 72

Source: O. Gsell. 1978. Leptospiroses and relapsing fever. In Handbook of Clinical Neurology, Part III, Chapter 18, 399. New York: Elsevier Science Publishing, by permission of the publisher.

of the pathogenic germs in 1915 by Inada and Uhlenhut and Fromme. In 1918, H. Noguchi gave the name Leptospira to the newly discovered bacteria. During the years 1917-18 Y. Indo, H. Ito, and H. Wani found cases of the disease that were not characterized by jaundice — described as the 7-day fever "Nanukayami" which has the field mouse as a carrier. In the following decades, numerous different serotypes were found throughout the world. Among these are Leptospira pyrogenes (Indonesia, 1923), Leptospira autumnalis (Japan, 1925), Leptospira ba-taviae (Indonesia, 1926), L. grippotyphosa (Russia, 1928), Leptospira andaman (Andaman Islands, 1931), L. canicola (Netherlands, 1933), Leptospira australis as well as L. pomona (Australia, 1937), and Leptospira hebdomadis hardjo (Great Britain, 1968).

In Switzerland during the year 1944, L. pomona was found to be the cause of swineherds disease with the pig as its carrier, and 4 years later L. tarassovi and L. hyos were discovered to be of the same serotype and also carried by the pig. Numerous other serovars have been discovered subsequently, and after 1950 a new classification of the serotypes was accepted which classified the clinical groups into malignant and benign human leptospires, while in serology it permitted the allocation of animal and human leptospires to different serovars. In looking back on a century of research on leptospirosis, it seems remarkable that serious and widespread epidemics have been so infrequent. Today the incidence of the disease has been reduced in developed countries, probably because of a decrease in the rodent populations and because of improved human hygiene in the presence of domestic animals.

Otto R. Gsell

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