Page 220 - Learnwell EVS
P. 220
7. Bacterial diseases
Laboratory
– Iso latio n thro ugh culture o f lep to sp ires fro m blo o d , cerebro sp inal fluid (d uring the
first p hase) o r urine (d uring the seco nd p hase).
– S ero d iagno sis: im m uno fluo rescence o r E L IS A (antibo d ies are d etected fro m
D ay 8 ).
– B lo o d cell co unt: p o ly m o rp ho nuclear leuk o cy to sis.
– I f m eningeal sy nd ro m e: lum bar p uncture y ield s a clear fluid , usually with raised
leuco cy te co unt and elevated p ro tein level (abo ut 1 g/ litre).
– U rine: p ro teinuria, leuk o cy turia, p o ssible haem aturia and p resence o f casts.
Treatment
– R est and treatm ent o f fever: paracetamol P O (see Fever, p age 2 6 ).
A cety lsalicy lic acid (asp irin) is co ntraind icated (risk o f haem o rrhage).
– A ntibio tic treatm ent sho uld be started as so o n as p o ssible:
• MamodoxeircailtleinfPormO
C hild ren: 5 0 m g/ k g/ d ay in 2 o r 3 d ivid ed d o ses fo r 7 d ay s
A d ults: 2 g/ d ay in 2 o r 3 d ivid ed d o ses fo r 7 d ay s
doorxycycline P O (excep t in p regnant o r breast-feed ing wo m en and ch ild ren und er
8 y ears) 7
C hild ren o ver 8 y ears: 1 0 0 m g/ d ay in 2 d ivid ed d o ses fo r 7 d ay s
A d ults: 2 0 0 m g/ d ay in 2 d ivid ed d o ses fo r 7 d ay s
eoryrthromycin P O
C hild ren: 5 0 m g/ k g/ d ay in 2 o r 3 d ivid ed d o ses fo r 7 d ay s
A d ults: 2 to 3 g/ d ay in 2 o r 3 d ivid ed d o ses fo r 7 d ay s
• SamevpeicriellifnoIrVm
C hild ren: 1 0 0 m g/ k g/ d ay in 3 injectio ns
A d ults: 4 to 6 g/ d ay in 3 injectio ns
S witch to the o ral ro ute as so o n as p o ssible, with amoxicillin to co m p lete 7 d ay s
of
etrreyathtrmomeycnitn. IV
or
C hild ren: 5 0 m g/ k g/ d ay in 3 o r 4 injectio ns
A d ults: 2 g/ d ay in 4 injectio ns
S witch to the o ral ro ute as so o n as p o ssible to co m p lete 7 d ay s o f treatm ent.
Prevention
– A vo id bathing in end em ic areas.
– R o d ent co ntro l, enviro nm ental sanitatio n (p articularly water).
– V accinatio n is restricted to p erso nnel exp o sed in the co urse o f their wo rk .
181
Laboratory
– Iso latio n thro ugh culture o f lep to sp ires fro m blo o d , cerebro sp inal fluid (d uring the
first p hase) o r urine (d uring the seco nd p hase).
– S ero d iagno sis: im m uno fluo rescence o r E L IS A (antibo d ies are d etected fro m
D ay 8 ).
– B lo o d cell co unt: p o ly m o rp ho nuclear leuk o cy to sis.
– I f m eningeal sy nd ro m e: lum bar p uncture y ield s a clear fluid , usually with raised
leuco cy te co unt and elevated p ro tein level (abo ut 1 g/ litre).
– U rine: p ro teinuria, leuk o cy turia, p o ssible haem aturia and p resence o f casts.
Treatment
– R est and treatm ent o f fever: paracetamol P O (see Fever, p age 2 6 ).
A cety lsalicy lic acid (asp irin) is co ntraind icated (risk o f haem o rrhage).
– A ntibio tic treatm ent sho uld be started as so o n as p o ssible:
• MamodoxeircailtleinfPormO
C hild ren: 5 0 m g/ k g/ d ay in 2 o r 3 d ivid ed d o ses fo r 7 d ay s
A d ults: 2 g/ d ay in 2 o r 3 d ivid ed d o ses fo r 7 d ay s
doorxycycline P O (excep t in p regnant o r breast-feed ing wo m en and ch ild ren und er
8 y ears) 7
C hild ren o ver 8 y ears: 1 0 0 m g/ d ay in 2 d ivid ed d o ses fo r 7 d ay s
A d ults: 2 0 0 m g/ d ay in 2 d ivid ed d o ses fo r 7 d ay s
eoryrthromycin P O
C hild ren: 5 0 m g/ k g/ d ay in 2 o r 3 d ivid ed d o ses fo r 7 d ay s
A d ults: 2 to 3 g/ d ay in 2 o r 3 d ivid ed d o ses fo r 7 d ay s
• SamevpeicriellifnoIrVm
C hild ren: 1 0 0 m g/ k g/ d ay in 3 injectio ns
A d ults: 4 to 6 g/ d ay in 3 injectio ns
S witch to the o ral ro ute as so o n as p o ssible, with amoxicillin to co m p lete 7 d ay s
of
etrreyathtrmomeycnitn. IV
or
C hild ren: 5 0 m g/ k g/ d ay in 3 o r 4 injectio ns
A d ults: 2 g/ d ay in 4 injectio ns
S witch to the o ral ro ute as so o n as p o ssible to co m p lete 7 d ay s o f treatm ent.
Prevention
– A vo id bathing in end em ic areas.
– R o d ent co ntro l, enviro nm ental sanitatio n (p articularly water).
– V accinatio n is restricted to p erso nnel exp o sed in the co urse o f their wo rk .
181
