wikidoc - User contributions [en]

User:Venkata Sivakrishna Kumar Pulivarthi

2017-03-26T16:01:26Z

Venkata Sivakrishna Kumar Pulivarthi:

__NOTOC__
=Venkata Sivakrishna Kumar Pulivarthi=
[[Image:SIVAKRISHNA P.jpeg|right|200px]]
Contact: 1-618-696-9857 
Email: [mailto:vpulivar@bidmc.harvard.edu vpulivar@bidmc.harvard.edu] 

==Current Position==
Associate Editor-in-Chief, WikiDoc.org 
Postdoctoral Research Fellow, PERFUSE Study Group, Beth Israel Deaconess Medical Center, Harvard Medical School 

==Professional Background==
Dr. Pulivarthi is a postdoctoral research fellow of cardiovascular medicine at the PERFUSE Study Group at Beth Israel Deaconess Medical Center. He received his M.B.B.S in 2014 from the Rangaraya Medical College in India. Dr. Pulivarthi is currently an Associate editor-in-chief at ''Wikidoc.org''.

==Education==
2014 - MBBS Degree, Rangaraya Medical College 

==Pages Authored==
*[[Xanthoma]]
*[[Steatorrhea]]
*[[Splenomegaly]]
*[[Pyelonephritis]]
*[[Peritonitis]]
*[[Pancreatic insufficiency]]
*[[Nocturia]]
*[[Night sweats]]
*[[Myoglobinuria]]
*[[Rhabdomyolysis]]
*[[Hyperlipoproteinemia type V]]
*[[Microscopic hematuria]]
*[[Hematuria]]
*[[Pharyngitis]]
*[[Septic arthritis]]
*[[Splenic abscess]]
*[[Pancreatic abscess]]
*[[Leptospirosis]]

User:Venkata Sivakrishna Kumar Pulivarthi

2017-03-26T16:00:56Z

Venkata Sivakrishna Kumar Pulivarthi: /* Pages Authored */

Splenic abscess

2017-03-21T15:25:41Z

Venkata Sivakrishna Kumar Pulivarthi: /* Association */

__NOTOC__
[[File:Splenic abscess.jpg|right|200px|thumb|Splenic infarction complicated with splenic abscess]]
{{SI}}
{{CMG}}; {{AE}}{{VSKP}}

{{SK}}Abscess of spleen

==Overview==
Splenic abscess is an uncommon and lifethreatening condition. Clinical presentation, etiological factors, natural history, treatment and prognosis depends on whether the abscess was solitary or multiple.<ref name="pmid4550054">{{cite journal| author=Gadacz T, Way LW, Dunphy JE| title=Changing clinical spectrum of splenic abscess. | journal=Am J Surg | year= 1974 | volume= 128 | issue= 2 | pages= 182-7 | pmid=4550054 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4550054 }} </ref> It is always fatal if left untreated. Most commonly associated with [[Immunodeficiency|immunodeficient]] patients especially, [[Hematological|hematological disorders]] such as [[leukemia]], [[sickle cell disease]] etc. Diagnostic needle aspiration is very important in the management with antibiotics as blood culture may not be the best correlate as abscess culture. Anitbiotic of choice depends on the organism, but aggressive and early surgical intervention of splenic abscess should be encouraged especially when the risk factors are present. High suspicion of splenic abscess with history of risk factors, broad-spectrum empirical antibiotic therapy should be initiated <ref name="pmid14139921">{{cite journal| author=ZATZKIN HR, DRAZAN AD, IRWIN GA| title=ROENTGENOGRAPHIC DIAGNOSIS OF SPLENIC ABSCESS. | journal=Am J Roentgenol Radium Ther Nucl Med | year= 1964 | volume= 91 | issue= | pages= 896-9 | pmid=14139921 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14139921 }} </ref>

==Definition==
Splenic abscess is defined as any infectious [[suppurative]] process involving identifiable macroscopic filling defects either in the [[Parenchyma|parenchym]]<nowiki/>a of the [[spleen]] or in the subcapsular space.<ref name="pmid3300398">{{cite journal| author=Nelken N, Ignatius J, Skinner M, Christensen N| title=Changing clinical spectrum of splenic abscess. A multicenter study and review of the literature. | journal=Am J Surg | year= 1987 | volume= 154 | issue= 1 | pages= 27-34 | pmid=3300398 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3300398 }} </ref>
==Historical Perspective==
* Since the times of Hippocrates, splenic abscess has been reported several times and he described the natural history and prognosis of splenic abscess.<ref name="pmid17865957">{{cite journal| author=Billings AE| title=ABSCESS OF THE SPLEEN. | journal=Ann Surg | year= 1928 | volume= 88 | issue= 3 | pages= 416-28 | pmid=17865957 | doi= | pmc=1398901 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17865957 }} </ref>
* In the early days of 20th century, splenic abscess most commonly caused by typhoid and then followed by malaria.<ref name="pmid17863403">{{cite journal| author=Elting AW| title=ABSCESS OF THE SPLEEN. | journal=Ann Surg | year= 1915 | volume= 62 | issue= 2 | pages= 182-92 | pmid=17863403 | doi= | pmc=1406707 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17863403 }} </ref>
* Ooi et al. described significant etiological differences such increase in the percentage of [[abscess]] cases due to [[Anaerobic|anaerobics]] as compared to [[aerobics]] (7 vs 18-28%), [[fungi]] (1 vs 18-41%) as well as [[Mycobacterium tuberculosis|Mycobacterium tuberculosi]]<nowiki/>s (0.8 vs. 14%) in the second half of 20th century.<ref name="pmid9240961">{{cite journal| author=Ooi LL, Leong SS| title=Splenic abscesses from 1987 to 1995. | journal=Am J Surg | year= 1997 | volume= 174 | issue= 1 | pages= 87-93 | pmid=9240961 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9240961 }} </ref>

==Classification==
{| border="1"
!colspan="1" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF|Classification by Mechanism of pathogenesis}}
!colspan="1" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF|Classification by Etiology}}
!colspan="1" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF|Classification by Pathological Findings}}
|-
|valign=top|
Splenic abscess is classified traditionally by ''Chun and colleagues'' based on the predisposing causes as follows:<ref name="pmid6986009">{{cite journal| author=Chun CH, Raff MJ, Contreras L, Varghese R, Waterman N, Daffner R et al.| title=Splenic abscess. | journal=Medicine (Baltimore) | year= 1980 | volume= 59 | issue= 1 | pages= 50-65 | pmid=6986009 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6986009 }} </ref><ref name="pmid4550054">{{cite journal| author=Gadacz T, Way LW, Dunphy JE| title=Changing clinical spectrum of splenic abscess. | journal=Am J Surg | year= 1974 | volume= 128 | issue= 2 | pages= 182-7 | pmid=4550054 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4550054 }} </ref><ref name="pmid9403539">{{cite journal| author=Phillips GS, Radosevich MD, Lipsett PA| title=Splenic abscess: another look at an old disease. | journal=Arch Surg | year= 1997 | volume= 132 | issue= 12 | pages= 1331-5; discussion 1335-6 | pmid=9403539 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9403539 }} </ref>
* '''Hematogenous or Metastatic infection:''' Seen in [[endocarditis]]
* '''Embolic phenomenon:''' splenic abscess developed as consequence of cellular [[embolism]] in [[hemoglobinopathies]] such as [[Sickle-cell disease|sickle cell disease]]
* '''Contagious infection:''' Splenic abscesses can develop through continuity of infection from primary sources which are anatomically close (e.g. [[Subphrenic abscess|subphrenic abscesses]])
* '''Splenic trauma:''' secondary infections may developed due to splenic trauma
* '''Depressed immune defenses:''' [[chemotherapy]]-induced abscesses developed particularily in [[Leukemia|leukemias]]
|valign=top|
Classification of splenic abscesses based on the etiological factors is as follows:<ref name="pmid9240961">{{cite journal| author=Ooi LL, Leong SS| title=Splenic abscesses from 1987 to 1995. | journal=Am J Surg | year= 1997 | volume= 174 | issue= 1 | pages= 87-93 | pmid=9240961 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9240961 }} </ref>
* Mono-microbial [[abscess]]
* Poly-microbial [[abscess]] (~10-15%)
* Sterile [[abscess]] (~30%)
|valign=top|
Lawhorne and Zuidema classified splenic abscees based on pathological findings as follows:<ref name="pmid1273753">{{cite journal| author=Lawhorne TW, Zuidema GD| title=Splenic abscess. | journal=Surgery | year= 1976 | volume= 79 | issue= 6 | pages= 686-9 | pmid=1273753 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1273753 }} </ref>
* Unilocular abscess
* Bilocular abscess
|}

==Pathophysiology==
{{Family tree/start}}
{{Family tree | | | | | A01 | | | | A02 | | | | A03 | | | | A04 | | | | | | A05 | | | | |A01='''Hematogenous'''|A02='''Splenic infarction'''|A03='''Immunodeficiency'''|A04='''Splenic Trauma'''|A05='''Contiguous'''}}
{{Family tree | | | | | |!| | | | | |`|-|-|v|-|-|'| |,|-|-|-|^|-|-|-|.| | | |!| | | | | |}}
{{Family tree | | | | | B01 | | | | | | | B02 | | | B03 | | | | | | B04 | | B05 | | | | |B01='''Septic focus'''|B02='''Superinfection'''|B03='''Hematoma'''|B04='''Bacteremia'''|B05='''Direct extension'''}}
{{Family tree | | | | | |!| | | | | | | | |!| | | | |`|-|-|-|v|-|-|-|'| | | |!| | | | | |}}
{{Family tree | | | | | C01 | | | | | | | |!| | | | | | | | |!| | | | | | | |!| | | | | |C01='''Bacteremia'''}}
{{Family tree | | | | | |`|-|-|-|-|-|-|-|-|^|-|-|-|-|v|-|-|-|^|-|-|-|-|-|-|-|'| | | | | |}}
{{Family tree | | | | | | | | | | | | | | | | | | | D01 | | | | | | | | | | | | | | | | |D01='''Splenic abscess'''}}
{{Family tree/end}}
Splenic abscess can result from various sources such as:<ref name="pmid17143953">{{cite journal| author=Zerem E, Bergsland J| title=Ultrasound guided percutaneous treatment for splenic abscesses: the significance in treatment of critically ill patients. | journal=World J Gastroenterol | year= 2006 | volume= 12 | issue= 45 | pages= 7341-5 | pmid=17143953 | doi= | pmc=4087495 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17143953 }} </ref>
{| border="2" cellpadding="4" cellspacing="0" style="margin: 1em 1em 1em 0; background: #f9f9f9; border: 1px #aaa solid; border-collapse: collapse;
!colspan="1" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF| '''Pathogenic Mechanism'''}}
!colspan="1" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF| '''Description'''}}
|-
!Hematogenous Dissemination
|
* Hematogenous Dissemination or arterial dissemination is the most common mode of infection that results in splenic abscess.<ref name="pmid4550054">{{cite journal| author=Gadacz T, Way LW, Dunphy JE| title=Changing clinical spectrum of splenic abscess. | journal=Am J Surg | year= 1974 | volume= 128 | issue= 2 | pages= 182-7 | pmid=4550054 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4550054 }} </ref>
* It is a metastatic infection through hematologic seeding from distant infections such as [[infective endocarditis]], purulent teeth-related infections and [[urinary tract infections]]
* Most common organism involved is [[Staphylococcus aureus|Staphylococcs aureus]]
* Often results in multiple [[abscesses]
|-
!Secondary infection of splenic infarction
|
* [[Embolic]] or [[thrombotic]] non-infectious events due to red cell abnormalities such as [[hemolytic]] and [[Sickle-cell disease|sickle cell anemia]] causes [[ischemia]] followed by [[superinfection]] of [[emboli]] which tend to obstruct free blood flow and oxygen delivery to the spleen on the microscopic level.
|-
!Contiguous spread of bacteria
|
* It is a mode of infection spread to the spleen from anatomically neighboring structures such as stomach or large bowel [[perforation]], infected [[pancreatic cyst]], perisplenic or [[Subphrenic abscess|subpleuric abscess]].
* Can cause either solitory or multiple [[abscesses]]<ref name="pmid3300398">{{cite journal| author=Nelken N, Ignatius J, Skinner M, Christensen N| title=Changing clinical spectrum of splenic abscess. A multicenter study and review of the literature. | journal=Am J Surg | year= 1987 | volume= 154 | issue= 1 | pages= 27-34 | pmid=3300398 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3300398 }} </ref>
|-
! Trauma
|
* secondary infections may developed due to splenic trauma during any intra-abdominal procedures.<ref name="pmid9240961">{{cite journal| author=Ooi LL, Leong SS| title=Splenic abscesses from 1987 to 1995. | journal=Am J Surg | year= 1997 | volume= 174 | issue= 1 | pages= 87-93 | pmid=9240961 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9240961 }} </ref>
|-
! Immunodeficiency
|
* It is major factor involved in the course of splenic abscess especially if the causative organism is [[fungi]] or any other atypical organism.
|}

=== Gross Findings ===
'''Solitary splenic abscess'''
* Enlarged spleen with due to large solitary abscesses with thick wall around the abscess to prevent dissemination is seen
'''Multiple splenic abscess'''
* At the time of [[autopsy]], spleen present as large and soft, and pus extruded organ from the cut surface.

=== Microscopic Findings ===
'''Solitary splenic abscess'''
* Microscopically the abscess consist of [[necrotic tissue]] with a fibrous wall surrounded by [[inflammatory]] cell infiltration.
'''Multiple splenic abscess'''
* Multiple microscopically visible foci of infection riddled homogeneously throughout the spleen
* Abscesses are filled with [[polymorphonuclear leukocytes]] which were scattered throughout the [[parenchyma]], intermixed with other foci of microinfarction and [[coagulation necrosis]]

===Association===
Splenic abscess is commonly associate with:<ref name="pmid23204694">{{cite journal| author=Sreekar H, Saraf V, Pangi AC, Sreeharsha H, Reddy R, Kamat G| title=A retrospective study of 75 cases of splenic abscess. | journal=Indian J Surg | year= 2011 | volume= 73 | issue= 6 | pages= 398-402 | pmid=23204694 | doi=10.1007/s12262-011-0370-y | pmc=3236272 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23204694 }} </ref>
* [[Liver disease|Paranchymal liver disease]]
* [[Pancreatitis]]
* [[Pleural effusion]]
* [[Renal cysts]]
* [[Ovarian cysts]]
* [[Lymphadenopathy|Abdominal lymphadenopathy]]
==Causes==
Spleenic abscess is caused mostly by monomicrobial but some times it can be caused by polymicrobial agents. [[Bacteria]] is more common than other microbial agents such as [[fungi]], [[protozoa]] which can cause splenic abscess in [[Immunocompromised|immunocompromised patients]].
=== Common causes ===
Common causes of splenic abscess includes:<ref name="pmid3300398">{{cite journal| author=Nelken N, Ignatius J, Skinner M, Christensen N| title=Changing clinical spectrum of splenic abscess. A multicenter study and review of the literature. | journal=Am J Surg | year= 1987 | volume= 154 | issue= 1 | pages= 27-34 | pmid=3300398 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3300398 }} </ref> Aerobes are the most predominant organisms causing splenic abscess in 50% of cases.<ref name="pmid3300398">{{cite journal| author=Nelken N, Ignatius J, Skinner M, Christensen N| title=Changing clinical spectrum of splenic abscess. A multicenter study and review of the literature. | journal=Am J Surg | year= 1987 | volume= 154 | issue= 1 | pages= 27-34 | pmid=3300398 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3300398 }} </ref><ref name="pmid8343056">{{cite journal| author=Ho HS, Wisner DH| title=Splenic abscess in the intensive care unit. | journal=Arch Surg | year= 1993 | volume= 128 | issue= 8 | pages= 842-6; discussion 846-8 | pmid=8343056 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8343056 }} </ref>
{| border="1"
!colspan="1" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF|Aerobes}}
!colspan="1" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF|Anaerobes}}
!colspan="1" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF|Fungal}}
!colspan="1" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF|Parasite}}
|-
|valign=top|
* [[Staphylococcus|Staphylococcus species]]
* [[Streptococcus|Streptococcal species]]
* [[Salmonella|Salmonella species]]
* [[Escherichia coli]]
* [[Klebsiella pneumoniae]]
* [[Pseudomonas aeruginosa]]
* [[Enterococcus|Enterococcus species]]
* [[Mycobacterium]]
|valign=top|
* [[Bacteroides]]
* [[Actinomyces]]
* [[Propionibacteriaceae|Propionibacteriums species]]
* [[Clostridium]]
* [[Fusobacterium]]
|valign=top|
* [[Candida albicans]]
* [[Candida tropicalis]]
* [[Aspergillus]]
|valign=top|
* [[Entamoeba histolytica]]
|}

=== '''Less common causes''' ===
{{columns-list|3|
*[[Aureobasidium pullulans]]
*[[Bacillus cereus]]
*[[Brucella]]
*[[Citrobacter freundii]]
*[[Cryptococcus neoformans]]
*[[Diphtheria|Diphtheroides]]
*[[Echinococcus]]
*[[Enterobacter]]
*[[Malaria]]
*[[Nocardia]]
*[[Proteus mirabilis]]
*[[Schistosomiasis]]
*[[Shigella]]
*[[Staphylococcus epidermidis]]
*[[Streptococcus pneumonia]]
*[[Streptococcus pyogenes]]
*[[Vibrio cholerae]]
}}

==Differentiating {{PAGENAME}} from Other Diseases==
Splenic abscess should be differented from other causes of left upper quadrent pain:<ref name="pmid23204694">{{cite journal| author=Sreekar H, Saraf V, Pangi AC, Sreeharsha H, Reddy R, Kamat G| title=A retrospective study of 75 cases of splenic abscess. | journal=Indian J Surg | year= 2011 | volume= 73 | issue= 6 | pages= 398-402 | pmid=23204694 | doi=10.1007/s12262-011-0370-y | pmc=3236272 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23204694 }} </ref>
* [[Splenic cyst|Splenic cysts]]
* [[Splenic infarct]]
* [[Splenic hemangioma|Splenic hematomas]]
* [[Subphrenic abscess]]

==Epidemiology and Demographics==
===Incidence===
Incidence of spelenic abscess varies between 0.1% to 0.7% based on population based autopsy studies.<ref name="pmid6986009">{{cite journal| author=Chun CH, Raff MJ, Contreras L, Varghese R, Waterman N, Daffner R et al.| title=Splenic abscess. | journal=Medicine (Baltimore) | year= 1980 | volume= 59 | issue= 1 | pages= 50-65 | pmid=6986009 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6986009 }} </ref><ref name="pmid3892934">{{cite journal| author=Gadacz TR| title=Splenic abscess. | journal=World J Surg | year= 1985 | volume= 9 | issue= 3 | pages= 410-5 | pmid=3892934 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3892934 }} </ref> Incidence of splenic abscess due to hematogenous spread is gradually declining due to increased antibiotic use, but incidence due to fungal infection is increasing due to aggressive chemotherapeutic methods.<ref name="pmid3518659">{{cite journal| author=Helton WS, Carrico CJ, Zaveruha PA, Schaller R| title=Diagnosis and treatment of splenic fungal abscesses in the immune-suppressed patient. | journal=Arch Surg | year= 1986 | volume= 121 | issue= 5 | pages= 580-6 | pmid=3518659 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3518659 }} </ref><ref name="pmid6503858">{{cite journal| author=Linker CA, DeGregorio MW, Ries CA| title=Computerized tomography in the diagnosis of systemic candidiasis in patients with acute leukemia. | journal=Med Pediatr Oncol | year= 1984 | volume= 12 | issue= 6 | pages= 380-5 | pmid=6503858 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6503858 }} </ref>
===Prevalence===
Prevalence of splenic abscess is increasing gradually due to increased risk factors and increased imaging modalities that can diagnose more accurately.<ref name="pmid15287600">{{cite journal| author=Farres H, Felsher J, Banbury M, Brody F| title=Management of splenic abscess in a critically ill patient. | journal=Surg Laparosc Endosc Percutan Tech | year= 2004 | volume= 14 | issue= 2 | pages= 49-52 | pmid=15287600 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15287600 }} </ref>
===Case Fatality Rate===
Splenic abscesses are associate with increased morbidity and mortality. If left untreated, mortality is definite (100%).<ref name="pmid3300398">{{cite journal| author=Nelken N, Ignatius J, Skinner M, Christensen N| title=Changing clinical spectrum of splenic abscess. A multicenter study and review of the literature. | journal=Am J Surg | year= 1987 | volume= 154 | issue= 1 | pages= 27-34 | pmid=3300398 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3300398 }} </ref> Mortality rate also varies with treatment of choice such as splenectomy, percutaneous drainage, anti microbial therapy carries 8%, 29%, 20% of mortality rate respectively.<ref name="pmid16489650">{{cite journal| author=Chang KC, Chuah SK, Changchien CS, Tsai TL, Lu SN, Chiu YC et al.| title=Clinical characteristics and prognostic factors of splenic abscess: a review of 67 cases in a single medical center of Taiwan. | journal=World J Gastroenterol | year= 2006 | volume= 12 | issue= 3 | pages= 460-4 | pmid=16489650 | doi= | pmc=4066069 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16489650 }} </ref>

===Age===
Splenic abscess shows bimodal distribution in age of the patients, with peak incidence seen in thirties and sixties.<ref name="pmid3300398">{{cite journal| author=Nelken N, Ignatius J, Skinner M, Christensen N| title=Changing clinical spectrum of splenic abscess. A multicenter study and review of the literature. | journal=Am J Surg | year= 1987 | volume= 154 | issue= 1 | pages= 27-34 | pmid=3300398 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3300398 }} </ref> First peak of age group is people < 40 years of age who are immunosuppressed or intravenous drug abusers, who commonly present multilocular abscesses. Second peak of age group patients > 70 years with diabetes or nonendocardic septic focus and commonly develop a unilocular abscess.

===Gender===
Splenic abscess is more predominant in male compared to female (~2 folds).<ref name="pmid3300398">{{cite journal| author=Nelken N, Ignatius J, Skinner M, Christensen N| title=Changing clinical spectrum of splenic abscess. A multicenter study and review of the literature. | journal=Am J Surg | year= 1987 | volume= 154 | issue= 1 | pages= 27-34 | pmid=3300398 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3300398 }} </ref><ref name="pmid6986009">{{cite journal| author=Chun CH, Raff MJ, Contreras L, Varghese R, Waterman N, Daffner R et al.| title=Splenic abscess. | journal=Medicine (Baltimore) | year= 1980 | volume= 59 | issue= 1 | pages= 50-65 | pmid=6986009 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6986009 }} </ref><ref name="pmid6834894">{{cite journal| author=Linos DA, Nagorney DM, McIlrath DC| title=Splenic abscess--the importance of early diagnosis. | journal=Mayo Clin Proc | year= 1983 | volume= 58 | issue= 4 | pages= 261-4 | pmid=6834894 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6834894 }} </ref>

===Developing Countries===
In Africa, splenic abscess is common due to prevalence of hemoglobinopathies such as sickle cell disease, which is a common risk factor for this disease.<ref name="pmid4744723">{{cite journal| author=Kolawole TM, Bohrer SP| title=Splenic abscess and the gene for hemoglobin S. | journal=Am J Roentgenol Radium Ther Nucl Med | year= 1973 | volume= 119 | issue= 1 | pages= 175-89 | pmid=4744723 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4744723 }} </ref>

==Risk Factors==
Spleen abscess often co-exists with several risk factors, but the major one is the patient’s immunodeficiency. Common risk factors of splenic abscess include:<ref name="pmid23204694">{{cite journal| author=Sreekar H, Saraf V, Pangi AC, Sreeharsha H, Reddy R, Kamat G| title=A retrospective study of 75 cases of splenic abscess. | journal=Indian J Surg | year= 2011 | volume= 73 | issue= 6 | pages= 398-402 | pmid=23204694 | doi=10.1007/s12262-011-0370-y | pmc=3236272 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23204694 }} </ref>
{| border="1"
!colspan="1" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF|Infectious risk factors}}
!colspan="1" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF|Non infectious risk factors}}
|-
|valign=top|
* [[Endocarditis]]
* [[Urinary tract infection]]
* [[Immunocompromised]] conditions such as [[AIDS]]<ref name="pmid7362937">{{cite journal| author=Simson JN| title=Solitary abscess of the spleen. | journal=Br J Surg | year= 1980 | volume= 67 | issue= 2 | pages= 106-10 | pmid=7362937 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7362937 }} </ref>
* [[Intensive care unit|Intensive care unit patients]]
* [[Pulmonary tuberculosis]]
* [[Appendicitis]]
* [[Pneumonia]]
* [[Brucellosis]]
* [[Lung abscess]]
* [[Malaria]]
* [[Diverticulitis]]
* [[Amebiasis]]
* [[Sepsis|Septic syndrome]]
|valign=top|
* [[Diabetes mellitus]]
* Concomitant [[Liver disease|parenchymal liver disease]] such as [[cirrhosis]]
* [[Hemoglobinopathies]]
* [[Malignancies]]
* [[Trauma]]
* Pre-existing splenic pathology such as [[Splenic cyst|splenic cysts]], [[hemangiomas]].<ref name="pmid9240961">{{cite journal| author=Ooi LL, Leong SS| title=Splenic abscesses from 1987 to 1995. | journal=Am J Surg | year= 1997 | volume= 174 | issue= 1 | pages= 87-93 | pmid=9240961 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9240961 }} </ref>
|}

==Screening==
No specific screening test for splenic abscess.

==Natural History, Complications and Prognosis==
===Natural History===
Splenic abscess is a rare cause of abdominal abscesss, but life-threatening. Because of it's rarity, splenic abscess usually diagnosed at the late stages or after the onset of complications.<ref name="pmid4550054">{{cite journal| author=Gadacz T, Way LW, Dunphy JE| title=Changing clinical spectrum of splenic abscess. | journal=Am J Surg | year= 1974 | volume= 128 | issue= 2 | pages= 182-7 | pmid=4550054 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4550054 }} </ref> Solitory abscess present with delayed onset of presentation with history of trauma, [[sepsis]], or adjacent organ disease with [[Fever|feve]]<nowiki/>r, abdominal pain, nausea and vomiting where as multiple splenic abscess most commonly present with generalized [[sepsis]] because of an ineradicable septic focus remote from the [[spleen]]. Early diagnosis, prompt treatment can prevent complications.<ref name="pmid4550054">{{cite journal| author=Gadacz T, Way LW, Dunphy JE| title=Changing clinical spectrum of splenic abscess. | journal=Am J Surg | year= 1974 | volume= 128 | issue= 2 | pages= 182-7 | pmid=4550054 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4550054 }} </ref> Mortality rate is very high if left untreated.

===Complications===
{| border="1"
!colspan="1" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF|Life threatening complications}}
!colspan="1" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF|Common complications}}
!colspan="1" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF|Less common complications}}
|-
|valign=top|
* [[Septic shock]]
* [[Splenic rupture]] and [[peritonitis]]<ref name="pmid12107789">{{cite journal| author=Balasubramanian SP, Mojjada PR, Bose SM| title=Ruptured staphylococcal splenic abscess resulting in peritonitis: report of a case. | journal=Surg Today | year= 2002 | volume= 32 | issue= 6 | pages= 566-7 | pmid=12107789 | doi=10.1007/s005950200100 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12107789 }} </ref>
|valign=top|
* Bacterial sepsis or [[septicemia]]
* Respiratory complications such as [[Pneumonia|post operative pneumonia]]<ref name="pmid23204694">{{cite journal| author=Sreekar H, Saraf V, Pangi AC, Sreeharsha H, Reddy R, Kamat G| title=A retrospective study of 75 cases of splenic abscess. | journal=Indian J Surg | year= 2011 | volume= 73 | issue= 6 | pages= 398-402 | pmid=23204694 | doi=10.1007/s12262-011-0370-y | pmc=3236272 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23204694 }} </ref>
* [[Fistula]] formation with [[abscess]]<ref name="pmid15855993">{{cite journal| author=Nikolaidis N, Giouleme O, Gkisakis D, Grammatikos N| title=Posttraumatic splenic abscess with gastrosplenic fistula. | journal=Gastrointest Endosc | year= 2005 | volume= 61 | issue= 6 | pages= 771-2 | pmid=15855993 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15855993 }} </ref>
|valign=top|
* Wound infection
* [[Paralytic ileus]]
* [[Deep vein thrombosis]]
* [[Meningitis]]
|}

===Prognosis===
Prognosis of splenic abscess depends on the time of diagnosis and treatment. Delay in the management can lead to [[splenic rupture]] followed by spilling into [[peritoneal cavity]] or an adjacent organ which can lead to [[septicemia]] and death in severe cases.

==Diagnosis==
Splenic abscess commonly present with a triad of symptoms include [[fever]], [[Nausea and vomiting|nausea, vomiting]] and [[abdominal pain]] along with palpable spleen on examination. Early diagnosis with imaging studies and prompt drainage is required to reduce morbidity and mortality. Presence of [[fever]], left upper abdominal pain, [[leukocytosis]] and radiologic evidence shows pathology in the left [[chest X-ray]] especially in [[immunocompromised]] patients are the indications for high suspicion of splenic abscess.

===History and Symptoms===
Common symptoms of splenic abscess include:<ref name="pmid3300398">{{cite journal| author=Nelken N, Ignatius J, Skinner M, Christensen N| title=Changing clinical spectrum of splenic abscess. A multicenter study and review of the literature. | journal=Am J Surg | year= 1987 | volume= 154 | issue= 1 | pages= 27-34 | pmid=3300398 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3300398 }} </ref><ref name="pmid9240961">{{cite journal| author=Ooi LL, Leong SS| title=Splenic abscesses from 1987 to 1995. | journal=Am J Surg | year= 1997 | volume= 174 | issue= 1 | pages= 87-93 | pmid=9240961 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9240961 }} </ref>
* [[Fever]]
* [[Left upper quadrant abdominal pain|Abdominal pain localized in the left upper quadrant]] or mesogastrium
* [[Nausea and vomiting]]
* Constitutional symptoms such as [[fatigue]], loss of body weight, sweat and chills
Other symptoms include:<ref name="pmid4550054">{{cite journal| author=Gadacz T, Way LW, Dunphy JE| title=Changing clinical spectrum of splenic abscess. | journal=Am J Surg | year= 1974 | volume= 128 | issue= 2 | pages= 182-7 | pmid=4550054 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4550054 }} </ref>
* [[Referred pain]] in the left shoulder
* [[Confusion]]
* Pain in the left lower hemithorax
* [[Cough]]

===Physical Examination Findings===
===Appearance===
Patient with splenic abscess appear ill appearing and [[diaphoretic]]
===Vital signs===
* [[Fever|High-grade fever]]
* [[Tachycardia]]
If patient present with sepsis:
* [[Hypotension]]
* [[Tachycardia]]
* Increased [[capillary refill time]]
Signs of sepsis indicate that splenic abscess is most likely due to bacterial cause than fungal source.<ref name="pmid3300398">{{cite journal| author=Nelken N, Ignatius J, Skinner M, Christensen N| title=Changing clinical spectrum of splenic abscess. A multicenter study and review of the literature. | journal=Am J Surg | year= 1987 | volume= 154 | issue= 1 | pages= 27-34 | pmid=3300398 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3300398 }} </ref>

===Heart===
* New onset [[Heart murmur|murmur]] may be present
===Lungs===
* Left sided pleural effusion may be present with signs of:
** Decreased [[breath sounds]] on left side
** Dullness to percussion on left side
** Absent [[tactile fremitus]] on left side
** [[Friction rub]] over the left chest

===Abdomen ===
'''Palpation'''
* Tender [[splenomegaly]]
* Palpable spleen or abdominal mass
'''Auscultation'''
* [[Friction rub]] over the spleen<ref name="pmid4550054">{{cite journal| author=Gadacz T, Way LW, Dunphy JE| title=Changing clinical spectrum of splenic abscess. | journal=Am J Surg | year= 1974 | volume= 128 | issue= 2 | pages= 182-7 | pmid=4550054 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4550054 }} </ref>

===Laboratory Tests===
===Blood Tests===
Blood tests such [[leukocytosis]] are increased but not significant in the diagnosis of splenic abscess because these tests may not be appropriate in immunocompromised patients.
* CBC with differential
* [[Erythrocyte Sedimentation Rate|Erythrocyte sedimentation rate]] ([[Erythrocyte sedimentation rate|ESR]])
* '''Microbiological tests:''' In solitary abscesses blood culture is not sensitive in the initial stages when as in multiple abscesses it is helpful in prompt diagnosis and early treatment.<ref name="pmid4550054">{{cite journal| author=Gadacz T, Way LW, Dunphy JE| title=Changing clinical spectrum of splenic abscess. | journal=Am J Surg | year= 1974 | volume= 128 | issue= 2 | pages= 182-7 | pmid=4550054 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4550054 }} </ref>
** [[Gram staining|Gram stain]]
** Bacterial culture
** Abscess culture
* '''Mycological tests'''
** [[KOH test]]
** Fungal culture

===Diagnostic Evaluation of Splenic abscess===
{{Family tree/start}}
{{Family tree | | | | | | | | | | | | | | | | A01 | | | | | | | | | | | | |A01= '''Suspicion of splenic abscess''' (Patients with [[immunodeficiency|immunodeficiency disorders]], [[fever]], changes in [[chest X-ray]], [[abdominal pain]]) }}
{{Family tree | | | | | | | | | | | | | | | | |!| | | | | | | | | | | | | |}}
{{Family tree | | | | | | | | | | | | | | | | B01 | | | | | | | | | | | | |B01= '''Blood culture'''}}
{{Family tree | | | | | | | | | | | | | | | | |!| | | | | | | | | | | | | |}}
{{Family tree | | | | | | | | | | | | | | | | C01 | | | | | | | | | | | | |C01='''Patient with [[immunodeficiency|immunodeficiency disorders]]?'''}}
{{Family tree | | | | | | | |,|-|-|-|-|-|-|-|-|^|-|-|-|-|-|-|-|-|.| | | | |}}
{{Family tree | | | | | | | D01 | | | | | | | | | | | | | | | | D02 | | | |D01='''If immunodeficent patient''' Initiate wide spectrum antibiotics + antifungal medication|D02='''If [[immunocompetent]] patient''' Initiate wide spectrum antibiotics}}
{{Family tree | | | | | | | |`|-|-|-|-|-|-|-|-|v|-|-|-|-|-|-|-|-|'| | | | |}}
{{Family tree | | | | | | | | | | | | | | | | E01 |-|-| E02 | | | | | | | |E01=[[Ultrasound]] of abdominal cavity, [[CT scan]] with contrast|E02=If imaging shows negative or equivocal with high clinical '''suspicion of splenic abscess''' }}
{{Family tree | | | | | | | | | | | | | | | | |!| | | | |!| | | | | | | | |}}
{{Family tree | | | | | | | | | | | | | | | | |!| | | | E03 | | | | | | | |E03='''Arteriography'''}}
{{Family tree | | | | | | | |,|-|-|-|-|-|-|-|-|^|-|-|-|-|^|-|-|-|.| | | | |}}
{{Family tree | | | | | | | G01 | | | | | | | | | | | | | | | | G02 | | | |G01='''Presence of indications for minimally invasive procedures''' |G02='''Absence of indications for minimally invasive procedures'''}}
{{Family tree | | | | | | | |!| | | | | | | | | | | | | | | | | |!| | | | |}}
{{Family tree | | | | | | | G03 | | | | | | | | | | | | | | | | |!| | | | |G03=Aspiration or abscess drainage under US or CT guidance}}
{{Family tree | | |,|-|-|-|-|^|-|-|-|-|-|-|-|.| | | | | | | | | |!| | | | |}}
{{Family tree | | H01 | | | | | | | | | | | H02 | | | | | | | | |!| | | | |H01=Abscess cavity content culture, modification of antibiotic therapy according to culture results; Prolonged antibiotic therapy|H02=If ineffective drainage or recurrent abscess}}
{{Family tree | | | | | | | | | | | | | | | |`|-|-|-|-|v|-|-|-|-|'| | | | |}}
{{Family tree | | | | | | | | | | | | | | | | | | | | I01 | | | | | | | | |I01='''[[Spleenectomy]] or Open abscess drainage'''}}
{{Family tree | | | | | | | | | | | | | | | | | | | | |!| | | | | | | | | |}}
{{Family tree | | | | | | | | | | | | | | | | | | | | J01 | | | | | | | | |J01=Abscess cavity content culture, modification of antibiotic therapy according to culture results; Prolonged antibiotic therapy}}
{{Family tree/end}}

===Imaging Findings===
As the clinical features of splenic absecess are non specific and vague such as abdominal pain, fever and vomiting, that makes diagnosis is challenging and relied on imaging modalities. Imaging studies such as [[ultrasound]], [[computerized tomography]] made the diagnosis early and more accurate that reduces morbidity and mortality.<ref name="pmid12185032">{{cite journal| author=Thanos L, Dailiana T, Papaioannou G, Nikita A, Koutrouvelis H, Kelekis DA| title=Percutaneous CT-guided drainage of splenic abscess. | journal=AJR Am J Roentgenol | year= 2002 | volume= 179 | issue= 3 | pages= 629-32 | pmid=12185032 | doi=10.2214/ajr.179.3.1790629 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12185032 }} </ref>

====X-ray====
'''Advantages'''
* High [[sensitivity]]
* Directly points to pathological changes
* It is the first line of examination for patients suspected of an ongoing infection
* Can determine [[phrenic]]/ [[Diaphragmatic Elevation|diaphragmatic dome]] positioning and air-fluid level in the left [[hypochondrium]]
Common '''chest x- ray''' findings includes:
* Elevated and immobile left [[diaphragm]]
* Ipsilateral [[pleural effusion]]
* [[Atelectasis|Atelectalic]] and inflammatory changes in interior lung lobe
Common '''abdominal x- ray''' findings includes:
* Shift of the stomach and colon by a soft tissue mass( splenic abscess) which is more rectangular than in other causes of splenomegaly
* Increased air-fluid levels with extra alimentary gas collection in the left upper quadrant<ref name="pmid14139921">{{cite journal| author=ZATZKIN HR, DRAZAN AD, IRWIN GA| title=ROENTGENOGRAPHIC DIAGNOSIS OF SPLENIC ABSCESS. | journal=Am J Roentgenol Radium Ther Nucl Med | year= 1964 | volume= 91 | issue= | pages= 896-9 | pmid=14139921 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14139921 }} </ref>
[[File:Splenic abscess chest x-ray.jpg|500px]]

====Ultrasound====
Ultrasound shows lesions of mixed echogenicity i.e anechoic central zone with a surrounding hyperechoic area.<ref name="pmid7039270">{{cite journal| author=Ralls PW, Quinn MF, Colletti P, Lapin SA, Halls J| title=Sonography of pyogenic splenic abscess. | journal=AJR Am J Roentgenol | year= 1982 | volume= 138 | issue= 3 | pages= 523-5 | pmid=7039270 | doi=10.2214/ajr.138.3.523 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7039270 }} </ref><ref name="pmid6976726">{{cite journal| author=Pawar S, Kay CJ, Gonzalez R, Taylor KJ, Rosenfield AT| title=Sonography of splenic abscess. | journal=AJR Am J Roentgenol | year= 1982 | volume= 138 | issue= 2 | pages= 259-62 | pmid=6976726 | doi=10.2214/ajr.138.2.259 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6976726 }} </ref>

'''Advantages''' 
* Emergency radiography with high sensitivity (75-100%)<ref name="pmid9403539">{{cite journal| author=Phillips GS, Radosevich MD, Lipsett PA| title=Splenic abscess: another look at an old disease. | journal=Arch Surg | year= 1997 | volume= 132 | issue= 12 | pages= 1331-5; discussion 1335-6 | pmid=9403539 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9403539 }} </ref><ref name="pmid8161087">{{cite journal| author=Paris S, Weiss SM, Ayers WH, Clarke LE| title=Splenic abscess. | journal=Am Surg | year= 1994 | volume= 60 | issue= 5 | pages= 358-61 | pmid=8161087 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8161087 }} </ref>
* Non invasive
* Cost effective
* Determine the size of the spleen, size of the abscess, its location and [[echogenicity]]
[[File:Splenic abscess ultrasound.jpg|500px]][[File:Multiple splenic abscesses ultrasound.jpg|500px]]

====CT images====
Computerised tomography with contrast is both diagnostic and therapeutic test of choice for splenic abscess.<ref name="pmid2589597">{{cite journal| author=Faught WE, Gilbertson JJ, Nelson EW| title=Splenic abscess: presentation, treatment options, and results. | journal=Am J Surg | year= 1989 | volume= 158 | issue= 6 | pages= 612-4 | pmid=2589597 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2589597 }} </ref><ref name="pmid11206904">{{cite journal| author=Green BT| title=Splenic abscess: report of six cases and review of the literature. | journal=Am Surg | year= 2001 | volume= 67 | issue= 1 | pages= 80-5 | pmid=11206904 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11206904 }} </ref>
 '''Advantages'''
* High [[sensitivity]] (88-100%)
* Can differentiate unolocular and multilocular abscesses
* Can identify the contents of abscess
* Can determine the density index of abscess.
* Can differentiate splenic abscess from [[Splenic cyst|splenic cysts]] and [[Splenic hemangioma|splenic hematomas]]
* More precise and accurate than ultrasonography, in identifying the location of abscess in relation to other internal organs during per-cutaneous drainage.
* It is superior to all other diagnostic tests for splenic abscess.
|valign=top|
Scintigraphic studies include [[technetium-99m]] liver and spleen scans, [[gallium]] scans, and [[indium]] scans. Splenic scan is diagnostic modality to identify abscesses which relies upon splenic uptake of the [[Technetium-99m|radionuclide 99m technetium]] which shows abscess as a negative or filling defect.

'''Advantages'''
* High [[specificity]]: If patient showing high suspicion of splenic abscess and scan supports the diagnosis, then [[splenectomy]] can be performed.
'''Disadvantages:'''
* Scan can not identifie or visualize incurable small abscesses.<ref name="pmid4550054">{{cite journal| author=Gadacz T, Way LW, Dunphy JE| title=Changing clinical spectrum of splenic abscess. | journal=Am J Surg | year= 1974 | volume= 128 | issue= 2 | pages= 182-7 | pmid=4550054 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4550054 }} </ref>
* Less sensitive: If the scan shows negative or equivocal results for splenci abscess but clinical suspicion remains, an arteriogram should be ordered.
[[File:Splenic abscess CT images.gif|500px]]

===Other Imaging Studies===
====Scintigraphic studies====
Scintigraphic studies include [[technetium-99m]] liver and spleen scans, [[gallium]] scans, and [[indium]] scans. Splenic scan is diagnostic modality to identify abscesses which relies upon splenic uptake of the [[Technetium-99m|radionuclide 99m technetium]] which shows abscess as a negative or filling defect.

'''Advantages'''
* High [[specificity]]: If patient showing high suspicion of splenic abscess and scan supports the diagnosis, then [[splenectomy]] can be performed.
'''Disadvantages:'''
* Scan can not identifie or visualize incurable small abscesses.<ref name="pmid4550054">{{cite journal| author=Gadacz T, Way LW, Dunphy JE| title=Changing clinical spectrum of splenic abscess. | journal=Am J Surg | year= 1974 | volume= 128 | issue= 2 | pages= 182-7 | pmid=4550054 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4550054 }} </ref>
* Less sensitive: If the scan shows negative or equivocal results for splenci abscess but clinical suspicion remains, an arteriogram should be ordered.
====Arteriography====
Arteriography is the technique that involves injection of contrast material through a catheter passed retrograde into the [[splenic artery]] followed by rapid exposure of sequential x-ray films which shows abscesses as filling defects in the spleen.

'''Advantages:'''

More reliable and precise than splenic scan in diagnosing small abscesses.

'''Disadvantages:'''
* Invasive technique

==Treatment==
===Medical Therapy===
Antibiotic regimen should start before the procedure and continue until 7 days after the procedure. Diagnostic needle aspiration is very important in the management with antibiotics as blood culture may not be the best correlate as abscess culture. Anitbiotic of choice depends on the organism, but aggressive and early surgical intervention of splenic abscess should be encouraged especially when the risk factors are present. High suspicion of splenic abscess with history of risk factors, broad-spectrum empirical antibiotic therapy should be initiated <ref name="pmid14139921">{{cite journal| author=ZATZKIN HR, DRAZAN AD, IRWIN GA| title=ROENTGENOGRAPHIC DIAGNOSIS OF SPLENIC ABSCESS. | journal=Am J Roentgenol Radium Ther Nucl Med | year= 1964 | volume= 91 | issue= | pages= 896-9 | pmid=14139921 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14139921 }} </ref> Empiric antibiotic should cover [[Streptococcus|streptococci]], [[Staphylococcus aureus|staphylococci]], and [[Gram-negative bacteria|aerobic gram-negative rods]] such as [[Vancomycin]] or [[oxacillin]] plus an [[aminoglycoside]], a third- or fourth-generation [[cephalosporin]], [[fluoroquinolone]], or [[carbapenem]]. If culture shows fungi as causative organism, start [[Amphotericin B]] immediately and continue for 6-24 weeks and during the procedure [[amphotericin B]] should be administered directly into the abscess.<ref name="pmid6385895">{{cite journal| author=Johnson JD, Raff MJ| title=Fungal splenic abscess. | journal=Arch Intern Med | year= 1984 | volume= 144 | issue= 10 | pages= 1987-93 | pmid=6385895 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6385895 }} </ref>

===Surgery===
Treatment of splenic abscess depends on etiology. In bacterial abscesses, [[splenectomy]] combined with post-operative antibiotic therapy is the most appropriate treatment of choice with least mortality rate when compared to percutaneous drainage or antimicrobial therapy.<ref name="pmid16489650">{{cite journal| author=Chang KC, Chuah SK, Changchien CS, Tsai TL, Lu SN, Chiu YC et al.| title=Clinical characteristics and prognostic factors of splenic abscess: a review of 67 cases in a single medical center of Taiwan. | journal=World J Gastroenterol | year= 2006 | volume= 12 | issue= 3 | pages= 460-4 | pmid=16489650 | doi= | pmc=4066069 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16489650 }} </ref>
====Percutaneous Drainage====
Percutaneous drainage is the initial tretament of choice for splenic abscess, even though [[Splenectomy|splenectom]]<nowiki/>y is the definitive treatment because of increased risk of infections in splenectomised patient.<ref name="pmid17143953">{{cite journal| author=Zerem E, Bergsland J| title=Ultrasound guided percutaneous treatment for splenic abscesses: the significance in treatment of critically ill patients. | journal=World J Gastroenterol | year= 2006 | volume= 12 | issue= 45 | pages= 7341-5 | pmid=17143953 | doi= | pmc=4087495 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17143953 }} </ref><ref name="pmid16410091">{{cite journal| author=Choudhury S R, Rajiv C, Pitamber S, Akshay S, Dharmendra S| title=Management of splenic abscess in children by percutaneous drainage. | journal=J Pediatr Surg | year= 2006 | volume= 41 | issue= 1 | pages= e53-6 | pmid=16410091 | doi=10.1016/j.jpedsurg.2005.10.085 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16410091 }} </ref> It is genereally done under the guidance of imaging studies such as [[ultrasound]] or [[computerised tomography]] and under the guidence of imaging efficy of percuteneous drainage is equivalent to [[splenectomy]].<ref name="pmid3521422">{{cite journal| author=Teich S, Oliver GC, Canter JW| title=The early diagnosis of splenic abscess. | journal=Am Surg | year= 1986 | volume= 52 | issue= 6 | pages= 303-7 | pmid=3521422 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3521422 }} </ref><ref name="pmid1450832">{{cite journal| author=Hadas-Halpren I, Hiller N, Dolberg M| title=Percutaneous drainage of splenic abscesses: an effective and safe procedure. | journal=Br J Radiol | year= 1992 | volume= 65 | issue= 779 | pages= 968-70 | pmid=1450832 | doi=10.1259/0007-1285-65-779-968 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1450832 }} </ref>
* First line of treatment for splenic abscess
* Safe and effective than surgery in both unilocular and bilocular abscesses, especially in peripherally located abscesses.
* Preferred in critically ill patient and patients unfit for general anesthesia
'''Advantages'''
* Preserves spleen. So, it become the the treatment of choice in children to prevent post-splenectomy [[septicemia]]<ref name="pmid14530888">{{cite journal| author=Kang M, Saxena AK, Gulati M, Suri S| title=Ultrasound-guided percutaneous catheter drainage of splenic abscess. | journal=Pediatr Radiol | year= 2004 | volume= 34 | issue= 3 | pages= 271-3 | pmid=14530888 | doi=10.1007/s00247-003-1068-5 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14530888 }} </ref>
* No abdominal spillage of abscess contents
* Less expensive, high acceptance rate and less operative risk
'''Complications'''
* Splenic [[haemorrhage]]
* Injury to other abdominal organs
* [[Septicemia]]
* [[Empyema]]
* [[Pneumothorax]]
* [[Fistula|Fistula formation]]
* [[Deep vein thrombosis]]
'''Contraindications or limitations'''
* Multiple or septated abscesses<ref name="pmid3977590">{{cite journal| author=Gerzof SG, Johnson WC, Robbins AH, Nabseth DC| title=Expanded criteria for percutaneous abscess drainage. | journal=Arch Surg | year= 1985 | volume= 120 | issue= 2 | pages= 227-32 | pmid=3977590 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3977590 }} </ref><ref name="pmid9403539">{{cite journal| author=Phillips GS, Radosevich MD, Lipsett PA| title=Splenic abscess: another look at an old disease. | journal=Arch Surg | year= 1997 | volume= 132 | issue= 12 | pages= 1331-5; discussion 1335-6 | pmid=9403539 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9403539 }} </ref><ref name="pmid8343056">{{cite journal| author=Ho HS, Wisner DH| title=Splenic abscess in the intensive care unit. | journal=Arch Surg | year= 1993 | volume= 128 | issue= 8 | pages= 842-6; discussion 846-8 | pmid=8343056 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8343056 }} </ref>
* Anatomically inaccessible for drainage such as upper pole or hilar of the spleen,
* Uncontrolled [[coagulopathies]]
* [[Ascites]]
* Simultaneous surgical procedure required of other indications such as [[subphrenic abscess]]
* Abscess [[perforation]] or bleeding
* Refractoriness to abscess-content drainage
* Secondary infected [[Splenic hemangioma|spleen hematoma]]
====Splenectomy====
Splenectomy is the most effective and definitive treatment of choice for splenic abscess. splenectomy can be performed either from left subcostal incision or from midline epigastric entry.
 '''Advantages'''
* Definitive treatment for splenic abscess
* Treatment of choice if more than 2 abscesses are present
* Patients with failed percutaneous drainage
* Patient with recurrent abscesses
'''Disadvantages'''
* Splenecetomisesd patients are more prone to infections especially catalase positive bacteria such as [[Streptococcus pneumoniae]].
* Mortality rate varies between 0-20% <ref name="pmid11206904">{{cite journal| author=Green BT| title=Splenic abscess: report of six cases and review of the literature. | journal=Am Surg | year= 2001 | volume= 67 | issue= 1 | pages= 80-5 | pmid=11206904 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11206904 }} </ref>
* Extended duration operation time, larger volume of intra-operative blood loss
* Longer duration of hospital stay than percutaneous drainage procedure
'''Complications'''
* [[Lung infection]]
* Wound infection
* [[Septicemia]]
* [[Paralytic ileus]]
* [[Deep vein thrombosis]]

==Prevention==
===Primary Prevention===
Primary prevention for splenic abscess can prevent in specific cases especially patients who are at high risk such as [[Immunocompromised|immunocompromised patients]] (e.g. recipients of [[Renal transplantation|renal transplants]] or patients on [[immunosuppressive drugs]] for other reasons).
* In transplant patients best way to prevent splenic abscess is by [[splenectomy]], where as in patients with other immunocompromised states it can be achieved by proper care, early detection and aggressive treatment of minor infections.<ref name="pmid4550054">{{cite journal| author=Gadacz T, Way LW, Dunphy JE| title=Changing clinical spectrum of splenic abscess. | journal=Am J Surg | year= 1974 | volume= 128 | issue= 2 | pages= 182-7 | pmid=4550054 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4550054 }} </ref>
* Avoid [[Intravenous drug use|intravenous drug abuse]]

==References==
{{reflist|2}}

[[Category:Hematology]]
[[Category:Gastroenterology]]
[[Category:Infectious disease]]

{{WS}}
{{WH}}

Splenic abscess

2017-03-21T15:23:35Z

Venkata Sivakrishna Kumar Pulivarthi: /* Causes */

__NOTOC__
[[File:Splenic abscess.jpg|right|200px|thumb|Splenic infarction complicated with splenic abscess]]
{{SI}}
{{CMG}}; {{AE}}{{VSKP}}

{{SK}}Abscess of spleen

==Overview==
Splenic abscess is an uncommon and lifethreatening condition. Clinical presentation, etiological factors, natural history, treatment and prognosis depends on whether the abscess was solitary or multiple.<ref name="pmid4550054">{{cite journal| author=Gadacz T, Way LW, Dunphy JE| title=Changing clinical spectrum of splenic abscess. | journal=Am J Surg | year= 1974 | volume= 128 | issue= 2 | pages= 182-7 | pmid=4550054 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4550054 }} </ref> It is always fatal if left untreated. Most commonly associated with [[Immunodeficiency|immunodeficient]] patients especially, [[Hematological|hematological disorders]] such as [[leukemia]], [[sickle cell disease]] etc. Diagnostic needle aspiration is very important in the management with antibiotics as blood culture may not be the best correlate as abscess culture. Anitbiotic of choice depends on the organism, but aggressive and early surgical intervention of splenic abscess should be encouraged especially when the risk factors are present. High suspicion of splenic abscess with history of risk factors, broad-spectrum empirical antibiotic therapy should be initiated <ref name="pmid14139921">{{cite journal| author=ZATZKIN HR, DRAZAN AD, IRWIN GA| title=ROENTGENOGRAPHIC DIAGNOSIS OF SPLENIC ABSCESS. | journal=Am J Roentgenol Radium Ther Nucl Med | year= 1964 | volume= 91 | issue= | pages= 896-9 | pmid=14139921 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14139921 }} </ref>

==Definition==
Splenic abscess is defined as any infectious [[suppurative]] process involving identifiable macroscopic filling defects either in the [[Parenchyma|parenchym]]<nowiki/>a of the [[spleen]] or in the subcapsular space.<ref name="pmid3300398">{{cite journal| author=Nelken N, Ignatius J, Skinner M, Christensen N| title=Changing clinical spectrum of splenic abscess. A multicenter study and review of the literature. | journal=Am J Surg | year= 1987 | volume= 154 | issue= 1 | pages= 27-34 | pmid=3300398 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3300398 }} </ref>
==Historical Perspective==
* Since the times of Hippocrates, splenic abscess has been reported several times and he described the natural history and prognosis of splenic abscess.<ref name="pmid17865957">{{cite journal| author=Billings AE| title=ABSCESS OF THE SPLEEN. | journal=Ann Surg | year= 1928 | volume= 88 | issue= 3 | pages= 416-28 | pmid=17865957 | doi= | pmc=1398901 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17865957 }} </ref>
* In the early days of 20th century, splenic abscess most commonly caused by typhoid and then followed by malaria.<ref name="pmid17863403">{{cite journal| author=Elting AW| title=ABSCESS OF THE SPLEEN. | journal=Ann Surg | year= 1915 | volume= 62 | issue= 2 | pages= 182-92 | pmid=17863403 | doi= | pmc=1406707 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17863403 }} </ref>
* Ooi et al. described significant etiological differences such increase in the percentage of [[abscess]] cases due to [[Anaerobic|anaerobics]] as compared to [[aerobics]] (7 vs 18-28%), [[fungi]] (1 vs 18-41%) as well as [[Mycobacterium tuberculosis|Mycobacterium tuberculosi]]<nowiki/>s (0.8 vs. 14%) in the second half of 20th century.<ref name="pmid9240961">{{cite journal| author=Ooi LL, Leong SS| title=Splenic abscesses from 1987 to 1995. | journal=Am J Surg | year= 1997 | volume= 174 | issue= 1 | pages= 87-93 | pmid=9240961 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9240961 }} </ref>

==Classification==
{| border="1"
!colspan="1" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF|Classification by Mechanism of pathogenesis}}
!colspan="1" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF|Classification by Etiology}}
!colspan="1" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF|Classification by Pathological Findings}}
|-
|valign=top|
Splenic abscess is classified traditionally by ''Chun and colleagues'' based on the predisposing causes as follows:<ref name="pmid6986009">{{cite journal| author=Chun CH, Raff MJ, Contreras L, Varghese R, Waterman N, Daffner R et al.| title=Splenic abscess. | journal=Medicine (Baltimore) | year= 1980 | volume= 59 | issue= 1 | pages= 50-65 | pmid=6986009 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6986009 }} </ref><ref name="pmid4550054">{{cite journal| author=Gadacz T, Way LW, Dunphy JE| title=Changing clinical spectrum of splenic abscess. | journal=Am J Surg | year= 1974 | volume= 128 | issue= 2 | pages= 182-7 | pmid=4550054 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4550054 }} </ref><ref name="pmid9403539">{{cite journal| author=Phillips GS, Radosevich MD, Lipsett PA| title=Splenic abscess: another look at an old disease. | journal=Arch Surg | year= 1997 | volume= 132 | issue= 12 | pages= 1331-5; discussion 1335-6 | pmid=9403539 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9403539 }} </ref>
* '''Hematogenous or Metastatic infection:''' Seen in [[endocarditis]]
* '''Embolic phenomenon:''' splenic abscess developed as consequence of cellular [[embolism]] in [[hemoglobinopathies]] such as [[Sickle-cell disease|sickle cell disease]]
* '''Contagious infection:''' Splenic abscesses can develop through continuity of infection from primary sources which are anatomically close (e.g. [[Subphrenic abscess|subphrenic abscesses]])
* '''Splenic trauma:''' secondary infections may developed due to splenic trauma
* '''Depressed immune defenses:''' [[chemotherapy]]-induced abscesses developed particularily in [[Leukemia|leukemias]]
|valign=top|
Classification of splenic abscesses based on the etiological factors is as follows:<ref name="pmid9240961">{{cite journal| author=Ooi LL, Leong SS| title=Splenic abscesses from 1987 to 1995. | journal=Am J Surg | year= 1997 | volume= 174 | issue= 1 | pages= 87-93 | pmid=9240961 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9240961 }} </ref>
* Mono-microbial [[abscess]]
* Poly-microbial [[abscess]] (~10-15%)
* Sterile [[abscess]] (~30%)
|valign=top|
Lawhorne and Zuidema classified splenic abscees based on pathological findings as follows:<ref name="pmid1273753">{{cite journal| author=Lawhorne TW, Zuidema GD| title=Splenic abscess. | journal=Surgery | year= 1976 | volume= 79 | issue= 6 | pages= 686-9 | pmid=1273753 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1273753 }} </ref>
* Unilocular abscess
* Bilocular abscess
|}

==Pathophysiology==
{{Family tree/start}}
{{Family tree | | | | | A01 | | | | A02 | | | | A03 | | | | A04 | | | | | | A05 | | | | |A01='''Hematogenous'''|A02='''Splenic infarction'''|A03='''Immunodeficiency'''|A04='''Splenic Trauma'''|A05='''Contiguous'''}}
{{Family tree | | | | | |!| | | | | |`|-|-|v|-|-|'| |,|-|-|-|^|-|-|-|.| | | |!| | | | | |}}
{{Family tree | | | | | B01 | | | | | | | B02 | | | B03 | | | | | | B04 | | B05 | | | | |B01='''Septic focus'''|B02='''Superinfection'''|B03='''Hematoma'''|B04='''Bacteremia'''|B05='''Direct extension'''}}
{{Family tree | | | | | |!| | | | | | | | |!| | | | |`|-|-|-|v|-|-|-|'| | | |!| | | | | |}}
{{Family tree | | | | | C01 | | | | | | | |!| | | | | | | | |!| | | | | | | |!| | | | | |C01='''Bacteremia'''}}
{{Family tree | | | | | |`|-|-|-|-|-|-|-|-|^|-|-|-|-|v|-|-|-|^|-|-|-|-|-|-|-|'| | | | | |}}
{{Family tree | | | | | | | | | | | | | | | | | | | D01 | | | | | | | | | | | | | | | | |D01='''Splenic abscess'''}}
{{Family tree/end}}
Splenic abscess can result from various sources such as:<ref name="pmid17143953">{{cite journal| author=Zerem E, Bergsland J| title=Ultrasound guided percutaneous treatment for splenic abscesses: the significance in treatment of critically ill patients. | journal=World J Gastroenterol | year= 2006 | volume= 12 | issue= 45 | pages= 7341-5 | pmid=17143953 | doi= | pmc=4087495 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17143953 }} </ref>
{| border="2" cellpadding="4" cellspacing="0" style="margin: 1em 1em 1em 0; background: #f9f9f9; border: 1px #aaa solid; border-collapse: collapse;
!colspan="1" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF| '''Pathogenic Mechanism'''}}
!colspan="1" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF| '''Description'''}}
|-
!Hematogenous Dissemination
|
* Hematogenous Dissemination or arterial dissemination is the most common mode of infection that results in splenic abscess.<ref name="pmid4550054">{{cite journal| author=Gadacz T, Way LW, Dunphy JE| title=Changing clinical spectrum of splenic abscess. | journal=Am J Surg | year= 1974 | volume= 128 | issue= 2 | pages= 182-7 | pmid=4550054 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4550054 }} </ref>
* It is a metastatic infection through hematologic seeding from distant infections such as [[infective endocarditis]], purulent teeth-related infections and [[urinary tract infections]]
* Most common organism involved is [[Staphylococcus aureus|Staphylococcs aureus]]
* Often results in multiple [[abscesses]
|-
!Secondary infection of splenic infarction
|
* [[Embolic]] or [[thrombotic]] non-infectious events due to red cell abnormalities such as [[hemolytic]] and [[Sickle-cell disease|sickle cell anemia]] causes [[ischemia]] followed by [[superinfection]] of [[emboli]] which tend to obstruct free blood flow and oxygen delivery to the spleen on the microscopic level.
|-
!Contiguous spread of bacteria
|
* It is a mode of infection spread to the spleen from anatomically neighboring structures such as stomach or large bowel [[perforation]], infected [[pancreatic cyst]], perisplenic or [[Subphrenic abscess|subpleuric abscess]].
* Can cause either solitory or multiple [[abscesses]]<ref name="pmid3300398">{{cite journal| author=Nelken N, Ignatius J, Skinner M, Christensen N| title=Changing clinical spectrum of splenic abscess. A multicenter study and review of the literature. | journal=Am J Surg | year= 1987 | volume= 154 | issue= 1 | pages= 27-34 | pmid=3300398 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3300398 }} </ref>
|-
! Trauma
|
* secondary infections may developed due to splenic trauma during any intra-abdominal procedures.<ref name="pmid9240961">{{cite journal| author=Ooi LL, Leong SS| title=Splenic abscesses from 1987 to 1995. | journal=Am J Surg | year= 1997 | volume= 174 | issue= 1 | pages= 87-93 | pmid=9240961 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9240961 }} </ref>
|-
! Immunodeficiency
|
* It is major factor involved in the course of splenic abscess especially if the causative organism is [[fungi]] or any other atypical organism.
|}

=== Gross Findings ===
'''Solitary splenic abscess'''
* Enlarged spleen with due to large solitary abscesses with thick wall around the abscess to prevent dissemination is seen
'''Multiple splenic abscess'''
* At the time of [[autopsy]], spleen present as large and soft, and pus extruded organ from the cut surface.

=== Microscopic Findings ===
'''Solitary splenic abscess'''
* Microscopically the abscess consist of [[necrotic tissue]] with a fibrous wall surrounded by [[inflammatory]] cell infiltration.
'''Multiple splenic abscess'''
* Multiple microscopically visible foci of infection riddled homogeneously throughout the spleen
* Abscesses are filled with [[polymorphonuclear leukocytes]] which were scattered throughout the [[parenchyma]], intermixed with other foci of microinfarction and [[coagulation necrosis]]

===Association===
Splenic abscess is commonly associate with:<ref name="pmid23204694">{{cite journal| author=Sreekar H, Saraf V, Pangi AC, Sreeharsha H, Reddy R, Kamat G| title=A retrospective study of 75 cases of splenic abscess. | journal=Indian J Surg | year= 2011 | volume= 73 | issue= 6 | pages= 398-402 | pmid=23204694 | doi=10.1007/s12262-011-0370-y | pmc=3236272 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23204694 }} </ref>
* [[Liver disease|Paranchymal liver disease]]
* [[Pancreatitis]]
* [[Pleural effusion]]
* [[Renal cysts]]
* [[Ovarian cysts]]
* [[Lymphadenopathy|Abdominal lymphadenopathy]]
==Causes==
Spleenic abscess is caused mostly by monomicrobial but some times it can be caused by polymicrobial agents. [[Bacteria]] is more common than other microbial agents such as [[fungi]], [[protozoa]] which can cause splenic abscess in [[Immunocompromised|immunocompromised patients]].
=== Common causes ===
Common causes of splenic abscess includes:<ref name="pmid3300398">{{cite journal| author=Nelken N, Ignatius J, Skinner M, Christensen N| title=Changing clinical spectrum of splenic abscess. A multicenter study and review of the literature. | journal=Am J Surg | year= 1987 | volume= 154 | issue= 1 | pages= 27-34 | pmid=3300398 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3300398 }} </ref> Aerobes are the most predominant organisms causing splenic abscess in 50% of cases.<ref name="pmid3300398">{{cite journal| author=Nelken N, Ignatius J, Skinner M, Christensen N| title=Changing clinical spectrum of splenic abscess. A multicenter study and review of the literature. | journal=Am J Surg | year= 1987 | volume= 154 | issue= 1 | pages= 27-34 | pmid=3300398 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3300398 }} </ref><ref name="pmid8343056">{{cite journal| author=Ho HS, Wisner DH| title=Splenic abscess in the intensive care unit. | journal=Arch Surg | year= 1993 | volume= 128 | issue= 8 | pages= 842-6; discussion 846-8 | pmid=8343056 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8343056 }} </ref>
{| border="1"
!colspan="1" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF|Aerobes}}
!colspan="1" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF|Anaerobes}}
!colspan="1" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF|Fungal}}
!colspan="1" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF|Parasite}}
|-
|valign=top|
* [[Staphylococcus|Staphylococcus species]]
* [[Streptococcus|Streptococcal species]]
* [[Salmonella|Salmonella species]]
* [[Escherichia coli]]
* [[Klebsiella pneumoniae]]
* [[Pseudomonas aeruginosa]]
* [[Enterococcus|Enterococcus species]]
* [[Mycobacterium]]
|valign=top|
* [[Bacteroides]]
* [[Actinomyces]]
* [[Propionibacteriaceae|Propionibacteriums species]]
* [[Clostridium]]
* [[Fusobacterium]]
|valign=top|
* [[Candida albicans]]
* [[Candida tropicalis]]
* [[Aspergillus]]
|valign=top|
* [[Entamoeba histolytica]]
|}

=== '''Less common causes''' ===
{{columns-list|3|
*[[Aureobasidium pullulans]]
*[[Bacillus cereus]]
*[[Brucella]]
*[[Citrobacter freundii]]
*[[Cryptococcus neoformans]]
*[[Diphtheria|Diphtheroides]]
*[[Echinococcus]]
*[[Enterobacter]]
*[[Malaria]]
*[[Nocardia]]
*[[Proteus mirabilis]]
*[[Schistosomiasis]]
*[[Shigella]]
*[[Staphylococcus epidermidis]]
*[[Streptococcus pneumonia]]
*[[Streptococcus pyogenes]]
*[[Vibrio cholerae]]
}}

==Differentiating {{PAGENAME}} from Other Diseases==
Splenic abscess should be differented from other causes of left upper quadrent pain:<ref name="pmid23204694">{{cite journal| author=Sreekar H, Saraf V, Pangi AC, Sreeharsha H, Reddy R, Kamat G| title=A retrospective study of 75 cases of splenic abscess. | journal=Indian J Surg | year= 2011 | volume= 73 | issue= 6 | pages= 398-402 | pmid=23204694 | doi=10.1007/s12262-011-0370-y | pmc=3236272 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23204694 }} </ref>
* [[Splenic cyst|Splenic cysts]]
* [[Splenic infarct]]
* [[Splenic hemangioma|Splenic hematomas]]
* [[Subphrenic abscess]]

==Epidemiology and Demographics==
===Incidence===
Incidence of spelenic abscess varies between 0.1% to 0.7% based on population based autopsy studies.<ref name="pmid6986009">{{cite journal| author=Chun CH, Raff MJ, Contreras L, Varghese R, Waterman N, Daffner R et al.| title=Splenic abscess. | journal=Medicine (Baltimore) | year= 1980 | volume= 59 | issue= 1 | pages= 50-65 | pmid=6986009 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6986009 }} </ref><ref name="pmid3892934">{{cite journal| author=Gadacz TR| title=Splenic abscess. | journal=World J Surg | year= 1985 | volume= 9 | issue= 3 | pages= 410-5 | pmid=3892934 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3892934 }} </ref> Incidence of splenic abscess due to hematogenous spread is gradually declining due to increased antibiotic use, but incidence due to fungal infection is increasing due to aggressive chemotherapeutic methods.<ref name="pmid3518659">{{cite journal| author=Helton WS, Carrico CJ, Zaveruha PA, Schaller R| title=Diagnosis and treatment of splenic fungal abscesses in the immune-suppressed patient. | journal=Arch Surg | year= 1986 | volume= 121 | issue= 5 | pages= 580-6 | pmid=3518659 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3518659 }} </ref><ref name="pmid6503858">{{cite journal| author=Linker CA, DeGregorio MW, Ries CA| title=Computerized tomography in the diagnosis of systemic candidiasis in patients with acute leukemia. | journal=Med Pediatr Oncol | year= 1984 | volume= 12 | issue= 6 | pages= 380-5 | pmid=6503858 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6503858 }} </ref>
===Prevalence===
Prevalence of splenic abscess is increasing gradually due to increased risk factors and increased imaging modalities that can diagnose more accurately.<ref name="pmid15287600">{{cite journal| author=Farres H, Felsher J, Banbury M, Brody F| title=Management of splenic abscess in a critically ill patient. | journal=Surg Laparosc Endosc Percutan Tech | year= 2004 | volume= 14 | issue= 2 | pages= 49-52 | pmid=15287600 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15287600 }} </ref>
===Case Fatality Rate===
Splenic abscesses are associate with increased morbidity and mortality. If left untreated, mortality is definite (100%).<ref name="pmid3300398">{{cite journal| author=Nelken N, Ignatius J, Skinner M, Christensen N| title=Changing clinical spectrum of splenic abscess. A multicenter study and review of the literature. | journal=Am J Surg | year= 1987 | volume= 154 | issue= 1 | pages= 27-34 | pmid=3300398 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3300398 }} </ref> Mortality rate also varies with treatment of choice such as splenectomy, percutaneous drainage, anti microbial therapy carries 8%, 29%, 20% of mortality rate respectively.<ref name="pmid16489650">{{cite journal| author=Chang KC, Chuah SK, Changchien CS, Tsai TL, Lu SN, Chiu YC et al.| title=Clinical characteristics and prognostic factors of splenic abscess: a review of 67 cases in a single medical center of Taiwan. | journal=World J Gastroenterol | year= 2006 | volume= 12 | issue= 3 | pages= 460-4 | pmid=16489650 | doi= | pmc=4066069 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16489650 }} </ref>

===Age===
Splenic abscess shows bimodal distribution in age of the patients, with peak incidence seen in thirties and sixties.<ref name="pmid3300398">{{cite journal| author=Nelken N, Ignatius J, Skinner M, Christensen N| title=Changing clinical spectrum of splenic abscess. A multicenter study and review of the literature. | journal=Am J Surg | year= 1987 | volume= 154 | issue= 1 | pages= 27-34 | pmid=3300398 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3300398 }} </ref> First peak of age group is people < 40 years of age who are immunosuppressed or intravenous drug abusers, who commonly present multilocular abscesses. Second peak of age group patients > 70 years with diabetes or nonendocardic septic focus and commonly develop a unilocular abscess.

===Gender===
Splenic abscess is more predominant in male compared to female (~2 folds).<ref name="pmid3300398">{{cite journal| author=Nelken N, Ignatius J, Skinner M, Christensen N| title=Changing clinical spectrum of splenic abscess. A multicenter study and review of the literature. | journal=Am J Surg | year= 1987 | volume= 154 | issue= 1 | pages= 27-34 | pmid=3300398 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3300398 }} </ref><ref name="pmid6986009">{{cite journal| author=Chun CH, Raff MJ, Contreras L, Varghese R, Waterman N, Daffner R et al.| title=Splenic abscess. | journal=Medicine (Baltimore) | year= 1980 | volume= 59 | issue= 1 | pages= 50-65 | pmid=6986009 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6986009 }} </ref><ref name="pmid6834894">{{cite journal| author=Linos DA, Nagorney DM, McIlrath DC| title=Splenic abscess--the importance of early diagnosis. | journal=Mayo Clin Proc | year= 1983 | volume= 58 | issue= 4 | pages= 261-4 | pmid=6834894 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6834894 }} </ref>

===Developing Countries===
In Africa, splenic abscess is common due to prevalence of hemoglobinopathies such as sickle cell disease, which is a common risk factor for this disease.<ref name="pmid4744723">{{cite journal| author=Kolawole TM, Bohrer SP| title=Splenic abscess and the gene for hemoglobin S. | journal=Am J Roentgenol Radium Ther Nucl Med | year= 1973 | volume= 119 | issue= 1 | pages= 175-89 | pmid=4744723 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4744723 }} </ref>

==Risk Factors==
Spleen abscess often co-exists with several risk factors, but the major one is the patient’s immunodeficiency. Common risk factors of splenic abscess include:<ref name="pmid23204694">{{cite journal| author=Sreekar H, Saraf V, Pangi AC, Sreeharsha H, Reddy R, Kamat G| title=A retrospective study of 75 cases of splenic abscess. | journal=Indian J Surg | year= 2011 | volume= 73 | issue= 6 | pages= 398-402 | pmid=23204694 | doi=10.1007/s12262-011-0370-y | pmc=3236272 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23204694 }} </ref>
{| border="1"
!colspan="1" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF|Infectious risk factors}}
!colspan="1" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF|Non infectious risk factors}}
|-
|valign=top|
* [[Endocarditis]]
* [[Urinary tract infection]]
* [[Immunocompromised]] conditions such as [[AIDS]]<ref name="pmid7362937">{{cite journal| author=Simson JN| title=Solitary abscess of the spleen. | journal=Br J Surg | year= 1980 | volume= 67 | issue= 2 | pages= 106-10 | pmid=7362937 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7362937 }} </ref>
* [[Intensive care unit|Intensive care unit patients]]
* [[Pulmonary tuberculosis]]
* [[Appendicitis]]
* [[Pneumonia]]
* [[Brucellosis]]
* [[Lung abscess]]
* [[Malaria]]
* [[Diverticulitis]]
* [[Amebiasis]]
* [[Sepsis|Septic syndrome]]
|valign=top|
* [[Diabetes mellitus]]
* Concomitant [[Liver disease|parenchymal liver disease]] such as [[cirrhosis]]
* [[Hemoglobinopathies]]
* [[Malignancies]]
* [[Trauma]]
* Pre-existing splenic pathology such as [[Splenic cyst|splenic cysts]], [[hemangiomas]].<ref name="pmid9240961">{{cite journal| author=Ooi LL, Leong SS| title=Splenic abscesses from 1987 to 1995. | journal=Am J Surg | year= 1997 | volume= 174 | issue= 1 | pages= 87-93 | pmid=9240961 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9240961 }} </ref>
|}

==Screening==
No specific screening test for splenic abscess.

==Natural History, Complications and Prognosis==
===Natural History===
Splenic abscess is a rare cause of abdominal abscesss, but life-threatening. Because of it's rarity, splenic abscess usually diagnosed at the late stages or after the onset of complications.<ref name="pmid4550054">{{cite journal| author=Gadacz T, Way LW, Dunphy JE| title=Changing clinical spectrum of splenic abscess. | journal=Am J Surg | year= 1974 | volume= 128 | issue= 2 | pages= 182-7 | pmid=4550054 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4550054 }} </ref> Solitory abscess present with delayed onset of presentation with history of trauma, [[sepsis]], or adjacent organ disease with [[Fever|feve]]<nowiki/>r, abdominal pain, nausea and vomiting where as multiple splenic abscess most commonly present with generalized [[sepsis]] because of an ineradicable septic focus remote from the [[spleen]]. Early diagnosis, prompt treatment can prevent complications.<ref name="pmid4550054">{{cite journal| author=Gadacz T, Way LW, Dunphy JE| title=Changing clinical spectrum of splenic abscess. | journal=Am J Surg | year= 1974 | volume= 128 | issue= 2 | pages= 182-7 | pmid=4550054 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4550054 }} </ref> Mortality rate is very high if left untreated.

===Complications===
{| border="1"
!colspan="1" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF|Life threatening complications}}
!colspan="1" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF|Common complications}}
!colspan="1" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF|Less common complications}}
|-
|valign=top|
* [[Septic shock]]
* [[Splenic rupture]] and [[peritonitis]]<ref name="pmid12107789">{{cite journal| author=Balasubramanian SP, Mojjada PR, Bose SM| title=Ruptured staphylococcal splenic abscess resulting in peritonitis: report of a case. | journal=Surg Today | year= 2002 | volume= 32 | issue= 6 | pages= 566-7 | pmid=12107789 | doi=10.1007/s005950200100 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12107789 }} </ref>
|valign=top|
* Bacterial sepsis or [[septicemia]]
* Respiratory complications such as [[Pneumonia|post operative pneumonia]]<ref name="pmid23204694">{{cite journal| author=Sreekar H, Saraf V, Pangi AC, Sreeharsha H, Reddy R, Kamat G| title=A retrospective study of 75 cases of splenic abscess. | journal=Indian J Surg | year= 2011 | volume= 73 | issue= 6 | pages= 398-402 | pmid=23204694 | doi=10.1007/s12262-011-0370-y | pmc=3236272 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23204694 }} </ref>
* [[Fistula]] formation with [[abscess]]<ref name="pmid15855993">{{cite journal| author=Nikolaidis N, Giouleme O, Gkisakis D, Grammatikos N| title=Posttraumatic splenic abscess with gastrosplenic fistula. | journal=Gastrointest Endosc | year= 2005 | volume= 61 | issue= 6 | pages= 771-2 | pmid=15855993 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15855993 }} </ref>
|valign=top|
* Wound infection
* [[Paralytic ileus]]
* [[Deep vein thrombosis]]
* [[Meningitis]]
|}

===Prognosis===
Prognosis of splenic abscess depends on the time of diagnosis and treatment. Delay in the management can lead to [[splenic rupture]] followed by spilling into [[peritoneal cavity]] or an adjacent organ which can lead to [[septicemia]] and death in severe cases.

==Association==
Splenic abscess is commonly associate with:<ref name="pmid23204694">{{cite journal| author=Sreekar H, Saraf V, Pangi AC, Sreeharsha H, Reddy R, Kamat G| title=A retrospective study of 75 cases of splenic abscess. | journal=Indian J Surg | year= 2011 | volume= 73 | issue= 6 | pages= 398-402 | pmid=23204694 | doi=10.1007/s12262-011-0370-y | pmc=3236272 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23204694 }} </ref>
* [[Liver disease|Paranchymal liver disease]]
* [[Pancreatitis]]
* [[Pleural effusion]]
* [[Renal cysts]]
* [[Ovarian cysts]]
* [[Lymphadenopathy|Abdominal lymphadenopathy]]
==Diagnosis==
Splenic abscess commonly present with a triad of symptoms include [[fever]], [[Nausea and vomiting|nausea, vomiting]] and [[abdominal pain]] along with palpable spleen on examination. Early diagnosis with imaging studies and prompt drainage is required to reduce morbidity and mortality. Presence of [[fever]], left upper abdominal pain, [[leukocytosis]] and radiologic evidence shows pathology in the left [[chest X-ray]] especially in [[immunocompromised]] patients are the indications for high suspicion of splenic abscess.

===History and Symptoms===
Common symptoms of splenic abscess include:<ref name="pmid3300398">{{cite journal| author=Nelken N, Ignatius J, Skinner M, Christensen N| title=Changing clinical spectrum of splenic abscess. A multicenter study and review of the literature. | journal=Am J Surg | year= 1987 | volume= 154 | issue= 1 | pages= 27-34 | pmid=3300398 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3300398 }} </ref><ref name="pmid9240961">{{cite journal| author=Ooi LL, Leong SS| title=Splenic abscesses from 1987 to 1995. | journal=Am J Surg | year= 1997 | volume= 174 | issue= 1 | pages= 87-93 | pmid=9240961 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9240961 }} </ref>
* [[Fever]]
* [[Left upper quadrant abdominal pain|Abdominal pain localized in the left upper quadrant]] or mesogastrium
* [[Nausea and vomiting]]
* Constitutional symptoms such as [[fatigue]], loss of body weight, sweat and chills
Other symptoms include:<ref name="pmid4550054">{{cite journal| author=Gadacz T, Way LW, Dunphy JE| title=Changing clinical spectrum of splenic abscess. | journal=Am J Surg | year= 1974 | volume= 128 | issue= 2 | pages= 182-7 | pmid=4550054 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4550054 }} </ref>
* [[Referred pain]] in the left shoulder
* [[Confusion]]
* Pain in the left lower hemithorax
* [[Cough]]

===Physical Examination Findings===
===Appearance===
Patient with splenic abscess appear ill appearing and [[diaphoretic]]
===Vital signs===
* [[Fever|High-grade fever]]
* [[Tachycardia]]
If patient present with sepsis:
* [[Hypotension]]
* [[Tachycardia]]
* Increased [[capillary refill time]]
Signs of sepsis indicate that splenic abscess is most likely due to bacterial cause than fungal source.<ref name="pmid3300398">{{cite journal| author=Nelken N, Ignatius J, Skinner M, Christensen N| title=Changing clinical spectrum of splenic abscess. A multicenter study and review of the literature. | journal=Am J Surg | year= 1987 | volume= 154 | issue= 1 | pages= 27-34 | pmid=3300398 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3300398 }} </ref>

===Heart===
* New onset [[Heart murmur|murmur]] may be present
===Lungs===
* Left sided pleural effusion may be present with signs of:
** Decreased [[breath sounds]] on left side
** Dullness to percussion on left side
** Absent [[tactile fremitus]] on left side
** [[Friction rub]] over the left chest

===Abdomen ===
'''Palpation'''
* Tender [[splenomegaly]]
* Palpable spleen or abdominal mass
'''Auscultation'''
* [[Friction rub]] over the spleen<ref name="pmid4550054">{{cite journal| author=Gadacz T, Way LW, Dunphy JE| title=Changing clinical spectrum of splenic abscess. | journal=Am J Surg | year= 1974 | volume= 128 | issue= 2 | pages= 182-7 | pmid=4550054 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4550054 }} </ref>

===Laboratory Tests===
===Blood Tests===
Blood tests such [[leukocytosis]] are increased but not significant in the diagnosis of splenic abscess because these tests may not be appropriate in immunocompromised patients.
* CBC with differential
* [[Erythrocyte Sedimentation Rate|Erythrocyte sedimentation rate]] ([[Erythrocyte sedimentation rate|ESR]])
* '''Microbiological tests:''' In solitary abscesses blood culture is not sensitive in the initial stages when as in multiple abscesses it is helpful in prompt diagnosis and early treatment.<ref name="pmid4550054">{{cite journal| author=Gadacz T, Way LW, Dunphy JE| title=Changing clinical spectrum of splenic abscess. | journal=Am J Surg | year= 1974 | volume= 128 | issue= 2 | pages= 182-7 | pmid=4550054 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4550054 }} </ref>
** [[Gram staining|Gram stain]]
** Bacterial culture
** Abscess culture
* '''Mycological tests'''
** [[KOH test]]
** Fungal culture

===Diagnostic Evaluation of Splenic abscess===
{{Family tree/start}}
{{Family tree | | | | | | | | | | | | | | | | A01 | | | | | | | | | | | | |A01= '''Suspicion of splenic abscess''' (Patients with [[immunodeficiency|immunodeficiency disorders]], [[fever]], changes in [[chest X-ray]], [[abdominal pain]]) }}
{{Family tree | | | | | | | | | | | | | | | | |!| | | | | | | | | | | | | |}}
{{Family tree | | | | | | | | | | | | | | | | B01 | | | | | | | | | | | | |B01= '''Blood culture'''}}
{{Family tree | | | | | | | | | | | | | | | | |!| | | | | | | | | | | | | |}}
{{Family tree | | | | | | | | | | | | | | | | C01 | | | | | | | | | | | | |C01='''Patient with [[immunodeficiency|immunodeficiency disorders]]?'''}}
{{Family tree | | | | | | | |,|-|-|-|-|-|-|-|-|^|-|-|-|-|-|-|-|-|.| | | | |}}
{{Family tree | | | | | | | D01 | | | | | | | | | | | | | | | | D02 | | | |D01='''If immunodeficent patient''' Initiate wide spectrum antibiotics + antifungal medication|D02='''If [[immunocompetent]] patient''' Initiate wide spectrum antibiotics}}
{{Family tree | | | | | | | |`|-|-|-|-|-|-|-|-|v|-|-|-|-|-|-|-|-|'| | | | |}}
{{Family tree | | | | | | | | | | | | | | | | E01 |-|-| E02 | | | | | | | |E01=[[Ultrasound]] of abdominal cavity, [[CT scan]] with contrast|E02=If imaging shows negative or equivocal with high clinical '''suspicion of splenic abscess''' }}
{{Family tree | | | | | | | | | | | | | | | | |!| | | | |!| | | | | | | | |}}
{{Family tree | | | | | | | | | | | | | | | | |!| | | | E03 | | | | | | | |E03='''Arteriography'''}}
{{Family tree | | | | | | | |,|-|-|-|-|-|-|-|-|^|-|-|-|-|^|-|-|-|.| | | | |}}
{{Family tree | | | | | | | G01 | | | | | | | | | | | | | | | | G02 | | | |G01='''Presence of indications for minimally invasive procedures''' |G02='''Absence of indications for minimally invasive procedures'''}}
{{Family tree | | | | | | | |!| | | | | | | | | | | | | | | | | |!| | | | |}}
{{Family tree | | | | | | | G03 | | | | | | | | | | | | | | | | |!| | | | |G03=Aspiration or abscess drainage under US or CT guidance}}
{{Family tree | | |,|-|-|-|-|^|-|-|-|-|-|-|-|.| | | | | | | | | |!| | | | |}}
{{Family tree | | H01 | | | | | | | | | | | H02 | | | | | | | | |!| | | | |H01=Abscess cavity content culture, modification of antibiotic therapy according to culture results; Prolonged antibiotic therapy|H02=If ineffective drainage or recurrent abscess}}
{{Family tree | | | | | | | | | | | | | | | |`|-|-|-|-|v|-|-|-|-|'| | | | |}}
{{Family tree | | | | | | | | | | | | | | | | | | | | I01 | | | | | | | | |I01='''[[Spleenectomy]] or Open abscess drainage'''}}
{{Family tree | | | | | | | | | | | | | | | | | | | | |!| | | | | | | | | |}}
{{Family tree | | | | | | | | | | | | | | | | | | | | J01 | | | | | | | | |J01=Abscess cavity content culture, modification of antibiotic therapy according to culture results; Prolonged antibiotic therapy}}
{{Family tree/end}}

===Imaging Findings===
As the clinical features of splenic absecess are non specific and vague such as abdominal pain, fever and vomiting, that makes diagnosis is challenging and relied on imaging modalities. Imaging studies such as [[ultrasound]], [[computerized tomography]] made the diagnosis early and more accurate that reduces morbidity and mortality.<ref name="pmid12185032">{{cite journal| author=Thanos L, Dailiana T, Papaioannou G, Nikita A, Koutrouvelis H, Kelekis DA| title=Percutaneous CT-guided drainage of splenic abscess. | journal=AJR Am J Roentgenol | year= 2002 | volume= 179 | issue= 3 | pages= 629-32 | pmid=12185032 | doi=10.2214/ajr.179.3.1790629 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12185032 }} </ref>

====X-ray====
'''Advantages'''
* High [[sensitivity]]
* Directly points to pathological changes
* It is the first line of examination for patients suspected of an ongoing infection
* Can determine [[phrenic]]/ [[Diaphragmatic Elevation|diaphragmatic dome]] positioning and air-fluid level in the left [[hypochondrium]]
Common '''chest x- ray''' findings includes:
* Elevated and immobile left [[diaphragm]]
* Ipsilateral [[pleural effusion]]
* [[Atelectasis|Atelectalic]] and inflammatory changes in interior lung lobe
Common '''abdominal x- ray''' findings includes:
* Shift of the stomach and colon by a soft tissue mass( splenic abscess) which is more rectangular than in other causes of splenomegaly
* Increased air-fluid levels with extra alimentary gas collection in the left upper quadrant<ref name="pmid14139921">{{cite journal| author=ZATZKIN HR, DRAZAN AD, IRWIN GA| title=ROENTGENOGRAPHIC DIAGNOSIS OF SPLENIC ABSCESS. | journal=Am J Roentgenol Radium Ther Nucl Med | year= 1964 | volume= 91 | issue= | pages= 896-9 | pmid=14139921 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14139921 }} </ref>
[[File:Splenic abscess chest x-ray.jpg|500px]]

====Ultrasound====
Ultrasound shows lesions of mixed echogenicity i.e anechoic central zone with a surrounding hyperechoic area.<ref name="pmid7039270">{{cite journal| author=Ralls PW, Quinn MF, Colletti P, Lapin SA, Halls J| title=Sonography of pyogenic splenic abscess. | journal=AJR Am J Roentgenol | year= 1982 | volume= 138 | issue= 3 | pages= 523-5 | pmid=7039270 | doi=10.2214/ajr.138.3.523 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7039270 }} </ref><ref name="pmid6976726">{{cite journal| author=Pawar S, Kay CJ, Gonzalez R, Taylor KJ, Rosenfield AT| title=Sonography of splenic abscess. | journal=AJR Am J Roentgenol | year= 1982 | volume= 138 | issue= 2 | pages= 259-62 | pmid=6976726 | doi=10.2214/ajr.138.2.259 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6976726 }} </ref>

'''Advantages''' 
* Emergency radiography with high sensitivity (75-100%)<ref name="pmid9403539">{{cite journal| author=Phillips GS, Radosevich MD, Lipsett PA| title=Splenic abscess: another look at an old disease. | journal=Arch Surg | year= 1997 | volume= 132 | issue= 12 | pages= 1331-5; discussion 1335-6 | pmid=9403539 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9403539 }} </ref><ref name="pmid8161087">{{cite journal| author=Paris S, Weiss SM, Ayers WH, Clarke LE| title=Splenic abscess. | journal=Am Surg | year= 1994 | volume= 60 | issue= 5 | pages= 358-61 | pmid=8161087 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8161087 }} </ref>
* Non invasive
* Cost effective
* Determine the size of the spleen, size of the abscess, its location and [[echogenicity]]
[[File:Splenic abscess ultrasound.jpg|500px]][[File:Multiple splenic abscesses ultrasound.jpg|500px]]

====CT images====
Computerised tomography with contrast is both diagnostic and therapeutic test of choice for splenic abscess.<ref name="pmid2589597">{{cite journal| author=Faught WE, Gilbertson JJ, Nelson EW| title=Splenic abscess: presentation, treatment options, and results. | journal=Am J Surg | year= 1989 | volume= 158 | issue= 6 | pages= 612-4 | pmid=2589597 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2589597 }} </ref><ref name="pmid11206904">{{cite journal| author=Green BT| title=Splenic abscess: report of six cases and review of the literature. | journal=Am Surg | year= 2001 | volume= 67 | issue= 1 | pages= 80-5 | pmid=11206904 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11206904 }} </ref>
 '''Advantages'''
* High [[sensitivity]] (88-100%)
* Can differentiate unolocular and multilocular abscesses
* Can identify the contents of abscess
* Can determine the density index of abscess.
* Can differentiate splenic abscess from [[Splenic cyst|splenic cysts]] and [[Splenic hemangioma|splenic hematomas]]
* More precise and accurate than ultrasonography, in identifying the location of abscess in relation to other internal organs during per-cutaneous drainage.
* It is superior to all other diagnostic tests for splenic abscess.
|valign=top|
Scintigraphic studies include [[technetium-99m]] liver and spleen scans, [[gallium]] scans, and [[indium]] scans. Splenic scan is diagnostic modality to identify abscesses which relies upon splenic uptake of the [[Technetium-99m|radionuclide 99m technetium]] which shows abscess as a negative or filling defect.

'''Advantages'''
* High [[specificity]]: If patient showing high suspicion of splenic abscess and scan supports the diagnosis, then [[splenectomy]] can be performed.
'''Disadvantages:'''
* Scan can not identifie or visualize incurable small abscesses.<ref name="pmid4550054">{{cite journal| author=Gadacz T, Way LW, Dunphy JE| title=Changing clinical spectrum of splenic abscess. | journal=Am J Surg | year= 1974 | volume= 128 | issue= 2 | pages= 182-7 | pmid=4550054 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4550054 }} </ref>
* Less sensitive: If the scan shows negative or equivocal results for splenci abscess but clinical suspicion remains, an arteriogram should be ordered.
[[File:Splenic abscess CT images.gif|500px]]

===Other Imaging Studies===
====Scintigraphic studies====
Scintigraphic studies include [[technetium-99m]] liver and spleen scans, [[gallium]] scans, and [[indium]] scans. Splenic scan is diagnostic modality to identify abscesses which relies upon splenic uptake of the [[Technetium-99m|radionuclide 99m technetium]] which shows abscess as a negative or filling defect.

'''Advantages'''
* High [[specificity]]: If patient showing high suspicion of splenic abscess and scan supports the diagnosis, then [[splenectomy]] can be performed.
'''Disadvantages:'''
* Scan can not identifie or visualize incurable small abscesses.<ref name="pmid4550054">{{cite journal| author=Gadacz T, Way LW, Dunphy JE| title=Changing clinical spectrum of splenic abscess. | journal=Am J Surg | year= 1974 | volume= 128 | issue= 2 | pages= 182-7 | pmid=4550054 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4550054 }} </ref>
* Less sensitive: If the scan shows negative or equivocal results for splenci abscess but clinical suspicion remains, an arteriogram should be ordered.
====Arteriography====
Arteriography is the technique that involves injection of contrast material through a catheter passed retrograde into the [[splenic artery]] followed by rapid exposure of sequential x-ray films which shows abscesses as filling defects in the spleen.

'''Advantages:'''

More reliable and precise than splenic scan in diagnosing small abscesses.

'''Disadvantages:'''
* Invasive technique

==Treatment==
===Medical Therapy===
Antibiotic regimen should start before the procedure and continue until 7 days after the procedure. Diagnostic needle aspiration is very important in the management with antibiotics as blood culture may not be the best correlate as abscess culture. Anitbiotic of choice depends on the organism, but aggressive and early surgical intervention of splenic abscess should be encouraged especially when the risk factors are present. High suspicion of splenic abscess with history of risk factors, broad-spectrum empirical antibiotic therapy should be initiated <ref name="pmid14139921">{{cite journal| author=ZATZKIN HR, DRAZAN AD, IRWIN GA| title=ROENTGENOGRAPHIC DIAGNOSIS OF SPLENIC ABSCESS. | journal=Am J Roentgenol Radium Ther Nucl Med | year= 1964 | volume= 91 | issue= | pages= 896-9 | pmid=14139921 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14139921 }} </ref> Empiric antibiotic should cover [[Streptococcus|streptococci]], [[Staphylococcus aureus|staphylococci]], and [[Gram-negative bacteria|aerobic gram-negative rods]] such as [[Vancomycin]] or [[oxacillin]] plus an [[aminoglycoside]], a third- or fourth-generation [[cephalosporin]], [[fluoroquinolone]], or [[carbapenem]]. If culture shows fungi as causative organism, start [[Amphotericin B]] immediately and continue for 6-24 weeks and during the procedure [[amphotericin B]] should be administered directly into the abscess.<ref name="pmid6385895">{{cite journal| author=Johnson JD, Raff MJ| title=Fungal splenic abscess. | journal=Arch Intern Med | year= 1984 | volume= 144 | issue= 10 | pages= 1987-93 | pmid=6385895 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6385895 }} </ref>

===Surgery===
Treatment of splenic abscess depends on etiology. In bacterial abscesses, [[splenectomy]] combined with post-operative antibiotic therapy is the most appropriate treatment of choice with least mortality rate when compared to percutaneous drainage or antimicrobial therapy.<ref name="pmid16489650">{{cite journal| author=Chang KC, Chuah SK, Changchien CS, Tsai TL, Lu SN, Chiu YC et al.| title=Clinical characteristics and prognostic factors of splenic abscess: a review of 67 cases in a single medical center of Taiwan. | journal=World J Gastroenterol | year= 2006 | volume= 12 | issue= 3 | pages= 460-4 | pmid=16489650 | doi= | pmc=4066069 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16489650 }} </ref>
====Percutaneous Drainage====
Percutaneous drainage is the initial tretament of choice for splenic abscess, even though [[Splenectomy|splenectom]]<nowiki/>y is the definitive treatment because of increased risk of infections in splenectomised patient.<ref name="pmid17143953">{{cite journal| author=Zerem E, Bergsland J| title=Ultrasound guided percutaneous treatment for splenic abscesses: the significance in treatment of critically ill patients. | journal=World J Gastroenterol | year= 2006 | volume= 12 | issue= 45 | pages= 7341-5 | pmid=17143953 | doi= | pmc=4087495 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17143953 }} </ref><ref name="pmid16410091">{{cite journal| author=Choudhury S R, Rajiv C, Pitamber S, Akshay S, Dharmendra S| title=Management of splenic abscess in children by percutaneous drainage. | journal=J Pediatr Surg | year= 2006 | volume= 41 | issue= 1 | pages= e53-6 | pmid=16410091 | doi=10.1016/j.jpedsurg.2005.10.085 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16410091 }} </ref> It is genereally done under the guidance of imaging studies such as [[ultrasound]] or [[computerised tomography]] and under the guidence of imaging efficy of percuteneous drainage is equivalent to [[splenectomy]].<ref name="pmid3521422">{{cite journal| author=Teich S, Oliver GC, Canter JW| title=The early diagnosis of splenic abscess. | journal=Am Surg | year= 1986 | volume= 52 | issue= 6 | pages= 303-7 | pmid=3521422 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3521422 }} </ref><ref name="pmid1450832">{{cite journal| author=Hadas-Halpren I, Hiller N, Dolberg M| title=Percutaneous drainage of splenic abscesses: an effective and safe procedure. | journal=Br J Radiol | year= 1992 | volume= 65 | issue= 779 | pages= 968-70 | pmid=1450832 | doi=10.1259/0007-1285-65-779-968 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1450832 }} </ref>
* First line of treatment for splenic abscess
* Safe and effective than surgery in both unilocular and bilocular abscesses, especially in peripherally located abscesses.
* Preferred in critically ill patient and patients unfit for general anesthesia
'''Advantages'''
* Preserves spleen. So, it become the the treatment of choice in children to prevent post-splenectomy [[septicemia]]<ref name="pmid14530888">{{cite journal| author=Kang M, Saxena AK, Gulati M, Suri S| title=Ultrasound-guided percutaneous catheter drainage of splenic abscess. | journal=Pediatr Radiol | year= 2004 | volume= 34 | issue= 3 | pages= 271-3 | pmid=14530888 | doi=10.1007/s00247-003-1068-5 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14530888 }} </ref>
* No abdominal spillage of abscess contents
* Less expensive, high acceptance rate and less operative risk
'''Complications'''
* Splenic [[haemorrhage]]
* Injury to other abdominal organs
* [[Septicemia]]
* [[Empyema]]
* [[Pneumothorax]]
* [[Fistula|Fistula formation]]
* [[Deep vein thrombosis]]
'''Contraindications or limitations'''
* Multiple or septated abscesses<ref name="pmid3977590">{{cite journal| author=Gerzof SG, Johnson WC, Robbins AH, Nabseth DC| title=Expanded criteria for percutaneous abscess drainage. | journal=Arch Surg | year= 1985 | volume= 120 | issue= 2 | pages= 227-32 | pmid=3977590 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3977590 }} </ref><ref name="pmid9403539">{{cite journal| author=Phillips GS, Radosevich MD, Lipsett PA| title=Splenic abscess: another look at an old disease. | journal=Arch Surg | year= 1997 | volume= 132 | issue= 12 | pages= 1331-5; discussion 1335-6 | pmid=9403539 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9403539 }} </ref><ref name="pmid8343056">{{cite journal| author=Ho HS, Wisner DH| title=Splenic abscess in the intensive care unit. | journal=Arch Surg | year= 1993 | volume= 128 | issue= 8 | pages= 842-6; discussion 846-8 | pmid=8343056 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8343056 }} </ref>
* Anatomically inaccessible for drainage such as upper pole or hilar of the spleen,
* Uncontrolled [[coagulopathies]]
* [[Ascites]]
* Simultaneous surgical procedure required of other indications such as [[subphrenic abscess]]
* Abscess [[perforation]] or bleeding
* Refractoriness to abscess-content drainage
* Secondary infected [[Splenic hemangioma|spleen hematoma]]
====Splenectomy====
Splenectomy is the most effective and definitive treatment of choice for splenic abscess. splenectomy can be performed either from left subcostal incision or from midline epigastric entry.
 '''Advantages'''
* Definitive treatment for splenic abscess
* Treatment of choice if more than 2 abscesses are present
* Patients with failed percutaneous drainage
* Patient with recurrent abscesses
'''Disadvantages'''
* Splenecetomisesd patients are more prone to infections especially catalase positive bacteria such as [[Streptococcus pneumoniae]].
* Mortality rate varies between 0-20% <ref name="pmid11206904">{{cite journal| author=Green BT| title=Splenic abscess: report of six cases and review of the literature. | journal=Am Surg | year= 2001 | volume= 67 | issue= 1 | pages= 80-5 | pmid=11206904 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11206904 }} </ref>
* Extended duration operation time, larger volume of intra-operative blood loss
* Longer duration of hospital stay than percutaneous drainage procedure
'''Complications'''
* [[Lung infection]]
* Wound infection
* [[Septicemia]]
* [[Paralytic ileus]]
* [[Deep vein thrombosis]]

==Prevention==
===Primary Prevention===
Primary prevention for splenic abscess can prevent in specific cases especially patients who are at high risk such as [[Immunocompromised|immunocompromised patients]] (e.g. recipients of [[Renal transplantation|renal transplants]] or patients on [[immunosuppressive drugs]] for other reasons).
* In transplant patients best way to prevent splenic abscess is by [[splenectomy]], where as in patients with other immunocompromised states it can be achieved by proper care, early detection and aggressive treatment of minor infections.<ref name="pmid4550054">{{cite journal| author=Gadacz T, Way LW, Dunphy JE| title=Changing clinical spectrum of splenic abscess. | journal=Am J Surg | year= 1974 | volume= 128 | issue= 2 | pages= 182-7 | pmid=4550054 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4550054 }} </ref>
* Avoid [[Intravenous drug use|intravenous drug abuse]]

==References==
{{reflist|2}}

[[Category:Hematology]]
[[Category:Gastroenterology]]
[[Category:Infectious disease]]

{{WS}}
{{WH}}

Splenic abscess

2017-03-21T15:21:17Z

Venkata Sivakrishna Kumar Pulivarthi: /* Pathological Findings */

__NOTOC__
[[File:Splenic abscess.jpg|right|200px|thumb|Splenic infarction complicated with splenic abscess]]
{{SI}}
{{CMG}}; {{AE}}{{VSKP}}

{{SK}}Abscess of spleen

==Overview==
Splenic abscess is an uncommon and lifethreatening condition. Clinical presentation, etiological factors, natural history, treatment and prognosis depends on whether the abscess was solitary or multiple.<ref name="pmid4550054">{{cite journal| author=Gadacz T, Way LW, Dunphy JE| title=Changing clinical spectrum of splenic abscess. | journal=Am J Surg | year= 1974 | volume= 128 | issue= 2 | pages= 182-7 | pmid=4550054 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4550054 }} </ref> It is always fatal if left untreated. Most commonly associated with [[Immunodeficiency|immunodeficient]] patients especially, [[Hematological|hematological disorders]] such as [[leukemia]], [[sickle cell disease]] etc. Diagnostic needle aspiration is very important in the management with antibiotics as blood culture may not be the best correlate as abscess culture. Anitbiotic of choice depends on the organism, but aggressive and early surgical intervention of splenic abscess should be encouraged especially when the risk factors are present. High suspicion of splenic abscess with history of risk factors, broad-spectrum empirical antibiotic therapy should be initiated <ref name="pmid14139921">{{cite journal| author=ZATZKIN HR, DRAZAN AD, IRWIN GA| title=ROENTGENOGRAPHIC DIAGNOSIS OF SPLENIC ABSCESS. | journal=Am J Roentgenol Radium Ther Nucl Med | year= 1964 | volume= 91 | issue= | pages= 896-9 | pmid=14139921 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14139921 }} </ref>

==Definition==
Splenic abscess is defined as any infectious [[suppurative]] process involving identifiable macroscopic filling defects either in the [[Parenchyma|parenchym]]<nowiki/>a of the [[spleen]] or in the subcapsular space.<ref name="pmid3300398">{{cite journal| author=Nelken N, Ignatius J, Skinner M, Christensen N| title=Changing clinical spectrum of splenic abscess. A multicenter study and review of the literature. | journal=Am J Surg | year= 1987 | volume= 154 | issue= 1 | pages= 27-34 | pmid=3300398 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3300398 }} </ref>
==Historical Perspective==
* Since the times of Hippocrates, splenic abscess has been reported several times and he described the natural history and prognosis of splenic abscess.<ref name="pmid17865957">{{cite journal| author=Billings AE| title=ABSCESS OF THE SPLEEN. | journal=Ann Surg | year= 1928 | volume= 88 | issue= 3 | pages= 416-28 | pmid=17865957 | doi= | pmc=1398901 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17865957 }} </ref>
* In the early days of 20th century, splenic abscess most commonly caused by typhoid and then followed by malaria.<ref name="pmid17863403">{{cite journal| author=Elting AW| title=ABSCESS OF THE SPLEEN. | journal=Ann Surg | year= 1915 | volume= 62 | issue= 2 | pages= 182-92 | pmid=17863403 | doi= | pmc=1406707 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17863403 }} </ref>
* Ooi et al. described significant etiological differences such increase in the percentage of [[abscess]] cases due to [[Anaerobic|anaerobics]] as compared to [[aerobics]] (7 vs 18-28%), [[fungi]] (1 vs 18-41%) as well as [[Mycobacterium tuberculosis|Mycobacterium tuberculosi]]<nowiki/>s (0.8 vs. 14%) in the second half of 20th century.<ref name="pmid9240961">{{cite journal| author=Ooi LL, Leong SS| title=Splenic abscesses from 1987 to 1995. | journal=Am J Surg | year= 1997 | volume= 174 | issue= 1 | pages= 87-93 | pmid=9240961 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9240961 }} </ref>

==Classification==
{| border="1"
!colspan="1" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF|Classification by Mechanism of pathogenesis}}
!colspan="1" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF|Classification by Etiology}}
!colspan="1" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF|Classification by Pathological Findings}}
|-
|valign=top|
Splenic abscess is classified traditionally by ''Chun and colleagues'' based on the predisposing causes as follows:<ref name="pmid6986009">{{cite journal| author=Chun CH, Raff MJ, Contreras L, Varghese R, Waterman N, Daffner R et al.| title=Splenic abscess. | journal=Medicine (Baltimore) | year= 1980 | volume= 59 | issue= 1 | pages= 50-65 | pmid=6986009 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6986009 }} </ref><ref name="pmid4550054">{{cite journal| author=Gadacz T, Way LW, Dunphy JE| title=Changing clinical spectrum of splenic abscess. | journal=Am J Surg | year= 1974 | volume= 128 | issue= 2 | pages= 182-7 | pmid=4550054 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4550054 }} </ref><ref name="pmid9403539">{{cite journal| author=Phillips GS, Radosevich MD, Lipsett PA| title=Splenic abscess: another look at an old disease. | journal=Arch Surg | year= 1997 | volume= 132 | issue= 12 | pages= 1331-5; discussion 1335-6 | pmid=9403539 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9403539 }} </ref>
* '''Hematogenous or Metastatic infection:''' Seen in [[endocarditis]]
* '''Embolic phenomenon:''' splenic abscess developed as consequence of cellular [[embolism]] in [[hemoglobinopathies]] such as [[Sickle-cell disease|sickle cell disease]]
* '''Contagious infection:''' Splenic abscesses can develop through continuity of infection from primary sources which are anatomically close (e.g. [[Subphrenic abscess|subphrenic abscesses]])
* '''Splenic trauma:''' secondary infections may developed due to splenic trauma
* '''Depressed immune defenses:''' [[chemotherapy]]-induced abscesses developed particularily in [[Leukemia|leukemias]]
|valign=top|
Classification of splenic abscesses based on the etiological factors is as follows:<ref name="pmid9240961">{{cite journal| author=Ooi LL, Leong SS| title=Splenic abscesses from 1987 to 1995. | journal=Am J Surg | year= 1997 | volume= 174 | issue= 1 | pages= 87-93 | pmid=9240961 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9240961 }} </ref>
* Mono-microbial [[abscess]]
* Poly-microbial [[abscess]] (~10-15%)
* Sterile [[abscess]] (~30%)
|valign=top|
Lawhorne and Zuidema classified splenic abscees based on pathological findings as follows:<ref name="pmid1273753">{{cite journal| author=Lawhorne TW, Zuidema GD| title=Splenic abscess. | journal=Surgery | year= 1976 | volume= 79 | issue= 6 | pages= 686-9 | pmid=1273753 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1273753 }} </ref>
* Unilocular abscess
* Bilocular abscess
|}

==Pathophysiology==
{{Family tree/start}}
{{Family tree | | | | | A01 | | | | A02 | | | | A03 | | | | A04 | | | | | | A05 | | | | |A01='''Hematogenous'''|A02='''Splenic infarction'''|A03='''Immunodeficiency'''|A04='''Splenic Trauma'''|A05='''Contiguous'''}}
{{Family tree | | | | | |!| | | | | |`|-|-|v|-|-|'| |,|-|-|-|^|-|-|-|.| | | |!| | | | | |}}
{{Family tree | | | | | B01 | | | | | | | B02 | | | B03 | | | | | | B04 | | B05 | | | | |B01='''Septic focus'''|B02='''Superinfection'''|B03='''Hematoma'''|B04='''Bacteremia'''|B05='''Direct extension'''}}
{{Family tree | | | | | |!| | | | | | | | |!| | | | |`|-|-|-|v|-|-|-|'| | | |!| | | | | |}}
{{Family tree | | | | | C01 | | | | | | | |!| | | | | | | | |!| | | | | | | |!| | | | | |C01='''Bacteremia'''}}
{{Family tree | | | | | |`|-|-|-|-|-|-|-|-|^|-|-|-|-|v|-|-|-|^|-|-|-|-|-|-|-|'| | | | | |}}
{{Family tree | | | | | | | | | | | | | | | | | | | D01 | | | | | | | | | | | | | | | | |D01='''Splenic abscess'''}}
{{Family tree/end}}
Splenic abscess can result from various sources such as:<ref name="pmid17143953">{{cite journal| author=Zerem E, Bergsland J| title=Ultrasound guided percutaneous treatment for splenic abscesses: the significance in treatment of critically ill patients. | journal=World J Gastroenterol | year= 2006 | volume= 12 | issue= 45 | pages= 7341-5 | pmid=17143953 | doi= | pmc=4087495 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17143953 }} </ref>
{| border="2" cellpadding="4" cellspacing="0" style="margin: 1em 1em 1em 0; background: #f9f9f9; border: 1px #aaa solid; border-collapse: collapse;
!colspan="1" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF| '''Pathogenic Mechanism'''}}
!colspan="1" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF| '''Description'''}}
|-
!Hematogenous Dissemination
|
* Hematogenous Dissemination or arterial dissemination is the most common mode of infection that results in splenic abscess.<ref name="pmid4550054">{{cite journal| author=Gadacz T, Way LW, Dunphy JE| title=Changing clinical spectrum of splenic abscess. | journal=Am J Surg | year= 1974 | volume= 128 | issue= 2 | pages= 182-7 | pmid=4550054 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4550054 }} </ref>
* It is a metastatic infection through hematologic seeding from distant infections such as [[infective endocarditis]], purulent teeth-related infections and [[urinary tract infections]]
* Most common organism involved is [[Staphylococcus aureus|Staphylococcs aureus]]
* Often results in multiple [[abscesses]
|-
!Secondary infection of splenic infarction
|
* [[Embolic]] or [[thrombotic]] non-infectious events due to red cell abnormalities such as [[hemolytic]] and [[Sickle-cell disease|sickle cell anemia]] causes [[ischemia]] followed by [[superinfection]] of [[emboli]] which tend to obstruct free blood flow and oxygen delivery to the spleen on the microscopic level.
|-
!Contiguous spread of bacteria
|
* It is a mode of infection spread to the spleen from anatomically neighboring structures such as stomach or large bowel [[perforation]], infected [[pancreatic cyst]], perisplenic or [[Subphrenic abscess|subpleuric abscess]].
* Can cause either solitory or multiple [[abscesses]]<ref name="pmid3300398">{{cite journal| author=Nelken N, Ignatius J, Skinner M, Christensen N| title=Changing clinical spectrum of splenic abscess. A multicenter study and review of the literature. | journal=Am J Surg | year= 1987 | volume= 154 | issue= 1 | pages= 27-34 | pmid=3300398 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3300398 }} </ref>
|-
! Trauma
|
* secondary infections may developed due to splenic trauma during any intra-abdominal procedures.<ref name="pmid9240961">{{cite journal| author=Ooi LL, Leong SS| title=Splenic abscesses from 1987 to 1995. | journal=Am J Surg | year= 1997 | volume= 174 | issue= 1 | pages= 87-93 | pmid=9240961 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9240961 }} </ref>
|-
! Immunodeficiency
|
* It is major factor involved in the course of splenic abscess especially if the causative organism is [[fungi]] or any other atypical organism.
|}

=== Gross Findings ===
'''Solitary splenic abscess'''
* Enlarged spleen with due to large solitary abscesses with thick wall around the abscess to prevent dissemination is seen
'''Multiple splenic abscess'''
* At the time of [[autopsy]], spleen present as large and soft, and pus extruded organ from the cut surface.

=== Microscopic Findings ===
'''Solitary splenic abscess'''
* Microscopically the abscess consist of [[necrotic tissue]] with a fibrous wall surrounded by [[inflammatory]] cell infiltration.
'''Multiple splenic abscess'''
* Multiple microscopically visible foci of infection riddled homogeneously throughout the spleen
* Abscesses are filled with [[polymorphonuclear leukocytes]] which were scattered throughout the [[parenchyma]], intermixed with other foci of microinfarction and [[coagulation necrosis]]

==Causes==
Spleenic abscess is caused mostly by monomicrobial but some times it can be caused by polymicrobial agents. [[Bacteria]] is more common than other microbial agents such as [[fungi]], [[protozoa]] which can cause splenic abscess in [[Immunocompromised|immunocompromised patients]].
=== Common causes ===
Common causes of splenic abscess includes:<ref name="pmid3300398">{{cite journal| author=Nelken N, Ignatius J, Skinner M, Christensen N| title=Changing clinical spectrum of splenic abscess. A multicenter study and review of the literature. | journal=Am J Surg | year= 1987 | volume= 154 | issue= 1 | pages= 27-34 | pmid=3300398 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3300398 }} </ref> Aerobes are the most predominant organisms causing splenic abscess in 50% of cases.<ref name="pmid3300398">{{cite journal| author=Nelken N, Ignatius J, Skinner M, Christensen N| title=Changing clinical spectrum of splenic abscess. A multicenter study and review of the literature. | journal=Am J Surg | year= 1987 | volume= 154 | issue= 1 | pages= 27-34 | pmid=3300398 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3300398 }} </ref><ref name="pmid8343056">{{cite journal| author=Ho HS, Wisner DH| title=Splenic abscess in the intensive care unit. | journal=Arch Surg | year= 1993 | volume= 128 | issue= 8 | pages= 842-6; discussion 846-8 | pmid=8343056 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8343056 }} </ref>
{| border="1"
!colspan="1" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF|Aerobes}}
!colspan="1" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF|Anaerobes}}
!colspan="1" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF|Fungal}}
!colspan="1" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF|Parasite}}
|-
|valign=top|
* [[Staphylococcus|Staphylococcus species]]
* [[Streptococcus|Streptococcal species]]
* [[Salmonella|Salmonella species]]
* [[Escherichia coli]]
* [[Klebsiella pneumoniae]]
* [[Pseudomonas aeruginosa]]
* [[Enterococcus|Enterococcus species]]
* [[Mycobacterium]]
|valign=top|
* [[Bacteroides]]
* [[Actinomyces]]
* [[Propionibacteriaceae|Propionibacteriums species]]
* [[Clostridium]]
* [[Fusobacterium]]
|valign=top|
* [[Candida albicans]]
* [[Candida tropicalis]]
* [[Aspergillus]]
|valign=top|
* [[Entamoeba histolytica]]
|}

=== '''Less common causes''' ===
{{columns-list|3|
*[[Aureobasidium pullulans]]
*[[Bacillus cereus]]
*[[Brucella]]
*[[Citrobacter freundii]]
*[[Cryptococcus neoformans]]
*[[Diphtheria|Diphtheroides]]
*[[Echinococcus]]
*[[Enterobacter]]
*[[Malaria]]
*[[Nocardia]]
*[[Proteus mirabilis]]
*[[Schistosomiasis]]
*[[Shigella]]
*[[Staphylococcus epidermidis]]
*[[Streptococcus pneumonia]]
*[[Streptococcus pyogenes]]
*[[Vibrio cholerae]]
}}

==Differentiating {{PAGENAME}} from Other Diseases==
Splenic abscess should be differented from other causes of left upper quadrent pain:<ref name="pmid23204694">{{cite journal| author=Sreekar H, Saraf V, Pangi AC, Sreeharsha H, Reddy R, Kamat G| title=A retrospective study of 75 cases of splenic abscess. | journal=Indian J Surg | year= 2011 | volume= 73 | issue= 6 | pages= 398-402 | pmid=23204694 | doi=10.1007/s12262-011-0370-y | pmc=3236272 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23204694 }} </ref>
* [[Splenic cyst|Splenic cysts]]
* [[Splenic infarct]]
* [[Splenic hemangioma|Splenic hematomas]]
* [[Subphrenic abscess]]

==Epidemiology and Demographics==
===Incidence===
Incidence of spelenic abscess varies between 0.1% to 0.7% based on population based autopsy studies.<ref name="pmid6986009">{{cite journal| author=Chun CH, Raff MJ, Contreras L, Varghese R, Waterman N, Daffner R et al.| title=Splenic abscess. | journal=Medicine (Baltimore) | year= 1980 | volume= 59 | issue= 1 | pages= 50-65 | pmid=6986009 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6986009 }} </ref><ref name="pmid3892934">{{cite journal| author=Gadacz TR| title=Splenic abscess. | journal=World J Surg | year= 1985 | volume= 9 | issue= 3 | pages= 410-5 | pmid=3892934 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3892934 }} </ref> Incidence of splenic abscess due to hematogenous spread is gradually declining due to increased antibiotic use, but incidence due to fungal infection is increasing due to aggressive chemotherapeutic methods.<ref name="pmid3518659">{{cite journal| author=Helton WS, Carrico CJ, Zaveruha PA, Schaller R| title=Diagnosis and treatment of splenic fungal abscesses in the immune-suppressed patient. | journal=Arch Surg | year= 1986 | volume= 121 | issue= 5 | pages= 580-6 | pmid=3518659 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3518659 }} </ref><ref name="pmid6503858">{{cite journal| author=Linker CA, DeGregorio MW, Ries CA| title=Computerized tomography in the diagnosis of systemic candidiasis in patients with acute leukemia. | journal=Med Pediatr Oncol | year= 1984 | volume= 12 | issue= 6 | pages= 380-5 | pmid=6503858 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6503858 }} </ref>
===Prevalence===
Prevalence of splenic abscess is increasing gradually due to increased risk factors and increased imaging modalities that can diagnose more accurately.<ref name="pmid15287600">{{cite journal| author=Farres H, Felsher J, Banbury M, Brody F| title=Management of splenic abscess in a critically ill patient. | journal=Surg Laparosc Endosc Percutan Tech | year= 2004 | volume= 14 | issue= 2 | pages= 49-52 | pmid=15287600 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15287600 }} </ref>
===Case Fatality Rate===
Splenic abscesses are associate with increased morbidity and mortality. If left untreated, mortality is definite (100%).<ref name="pmid3300398">{{cite journal| author=Nelken N, Ignatius J, Skinner M, Christensen N| title=Changing clinical spectrum of splenic abscess. A multicenter study and review of the literature. | journal=Am J Surg | year= 1987 | volume= 154 | issue= 1 | pages= 27-34 | pmid=3300398 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3300398 }} </ref> Mortality rate also varies with treatment of choice such as splenectomy, percutaneous drainage, anti microbial therapy carries 8%, 29%, 20% of mortality rate respectively.<ref name="pmid16489650">{{cite journal| author=Chang KC, Chuah SK, Changchien CS, Tsai TL, Lu SN, Chiu YC et al.| title=Clinical characteristics and prognostic factors of splenic abscess: a review of 67 cases in a single medical center of Taiwan. | journal=World J Gastroenterol | year= 2006 | volume= 12 | issue= 3 | pages= 460-4 | pmid=16489650 | doi= | pmc=4066069 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16489650 }} </ref>

===Age===
Splenic abscess shows bimodal distribution in age of the patients, with peak incidence seen in thirties and sixties.<ref name="pmid3300398">{{cite journal| author=Nelken N, Ignatius J, Skinner M, Christensen N| title=Changing clinical spectrum of splenic abscess. A multicenter study and review of the literature. | journal=Am J Surg | year= 1987 | volume= 154 | issue= 1 | pages= 27-34 | pmid=3300398 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3300398 }} </ref> First peak of age group is people < 40 years of age who are immunosuppressed or intravenous drug abusers, who commonly present multilocular abscesses. Second peak of age group patients > 70 years with diabetes or nonendocardic septic focus and commonly develop a unilocular abscess.

===Gender===
Splenic abscess is more predominant in male compared to female (~2 folds).<ref name="pmid3300398">{{cite journal| author=Nelken N, Ignatius J, Skinner M, Christensen N| title=Changing clinical spectrum of splenic abscess. A multicenter study and review of the literature. | journal=Am J Surg | year= 1987 | volume= 154 | issue= 1 | pages= 27-34 | pmid=3300398 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3300398 }} </ref><ref name="pmid6986009">{{cite journal| author=Chun CH, Raff MJ, Contreras L, Varghese R, Waterman N, Daffner R et al.| title=Splenic abscess. | journal=Medicine (Baltimore) | year= 1980 | volume= 59 | issue= 1 | pages= 50-65 | pmid=6986009 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6986009 }} </ref><ref name="pmid6834894">{{cite journal| author=Linos DA, Nagorney DM, McIlrath DC| title=Splenic abscess--the importance of early diagnosis. | journal=Mayo Clin Proc | year= 1983 | volume= 58 | issue= 4 | pages= 261-4 | pmid=6834894 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6834894 }} </ref>

===Developing Countries===
In Africa, splenic abscess is common due to prevalence of hemoglobinopathies such as sickle cell disease, which is a common risk factor for this disease.<ref name="pmid4744723">{{cite journal| author=Kolawole TM, Bohrer SP| title=Splenic abscess and the gene for hemoglobin S. | journal=Am J Roentgenol Radium Ther Nucl Med | year= 1973 | volume= 119 | issue= 1 | pages= 175-89 | pmid=4744723 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4744723 }} </ref>

==Risk Factors==
Spleen abscess often co-exists with several risk factors, but the major one is the patient’s immunodeficiency. Common risk factors of splenic abscess include:<ref name="pmid23204694">{{cite journal| author=Sreekar H, Saraf V, Pangi AC, Sreeharsha H, Reddy R, Kamat G| title=A retrospective study of 75 cases of splenic abscess. | journal=Indian J Surg | year= 2011 | volume= 73 | issue= 6 | pages= 398-402 | pmid=23204694 | doi=10.1007/s12262-011-0370-y | pmc=3236272 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23204694 }} </ref>
{| border="1"
!colspan="1" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF|Infectious risk factors}}
!colspan="1" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF|Non infectious risk factors}}
|-
|valign=top|
* [[Endocarditis]]
* [[Urinary tract infection]]
* [[Immunocompromised]] conditions such as [[AIDS]]<ref name="pmid7362937">{{cite journal| author=Simson JN| title=Solitary abscess of the spleen. | journal=Br J Surg | year= 1980 | volume= 67 | issue= 2 | pages= 106-10 | pmid=7362937 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7362937 }} </ref>
* [[Intensive care unit|Intensive care unit patients]]
* [[Pulmonary tuberculosis]]
* [[Appendicitis]]
* [[Pneumonia]]
* [[Brucellosis]]
* [[Lung abscess]]
* [[Malaria]]
* [[Diverticulitis]]
* [[Amebiasis]]
* [[Sepsis|Septic syndrome]]
|valign=top|
* [[Diabetes mellitus]]
* Concomitant [[Liver disease|parenchymal liver disease]] such as [[cirrhosis]]
* [[Hemoglobinopathies]]
* [[Malignancies]]
* [[Trauma]]
* Pre-existing splenic pathology such as [[Splenic cyst|splenic cysts]], [[hemangiomas]].<ref name="pmid9240961">{{cite journal| author=Ooi LL, Leong SS| title=Splenic abscesses from 1987 to 1995. | journal=Am J Surg | year= 1997 | volume= 174 | issue= 1 | pages= 87-93 | pmid=9240961 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9240961 }} </ref>
|}

==Screening==
No specific screening test for splenic abscess.

==Natural History, Complications and Prognosis==
===Natural History===
Splenic abscess is a rare cause of abdominal abscesss, but life-threatening. Because of it's rarity, splenic abscess usually diagnosed at the late stages or after the onset of complications.<ref name="pmid4550054">{{cite journal| author=Gadacz T, Way LW, Dunphy JE| title=Changing clinical spectrum of splenic abscess. | journal=Am J Surg | year= 1974 | volume= 128 | issue= 2 | pages= 182-7 | pmid=4550054 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4550054 }} </ref> Solitory abscess present with delayed onset of presentation with history of trauma, [[sepsis]], or adjacent organ disease with [[Fever|feve]]<nowiki/>r, abdominal pain, nausea and vomiting where as multiple splenic abscess most commonly present with generalized [[sepsis]] because of an ineradicable septic focus remote from the [[spleen]]. Early diagnosis, prompt treatment can prevent complications.<ref name="pmid4550054">{{cite journal| author=Gadacz T, Way LW, Dunphy JE| title=Changing clinical spectrum of splenic abscess. | journal=Am J Surg | year= 1974 | volume= 128 | issue= 2 | pages= 182-7 | pmid=4550054 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4550054 }} </ref> Mortality rate is very high if left untreated.

===Complications===
{| border="1"
!colspan="1" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF|Life threatening complications}}
!colspan="1" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF|Common complications}}
!colspan="1" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF|Less common complications}}
|-
|valign=top|
* [[Septic shock]]
* [[Splenic rupture]] and [[peritonitis]]<ref name="pmid12107789">{{cite journal| author=Balasubramanian SP, Mojjada PR, Bose SM| title=Ruptured staphylococcal splenic abscess resulting in peritonitis: report of a case. | journal=Surg Today | year= 2002 | volume= 32 | issue= 6 | pages= 566-7 | pmid=12107789 | doi=10.1007/s005950200100 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12107789 }} </ref>
|valign=top|
* Bacterial sepsis or [[septicemia]]
* Respiratory complications such as [[Pneumonia|post operative pneumonia]]<ref name="pmid23204694">{{cite journal| author=Sreekar H, Saraf V, Pangi AC, Sreeharsha H, Reddy R, Kamat G| title=A retrospective study of 75 cases of splenic abscess. | journal=Indian J Surg | year= 2011 | volume= 73 | issue= 6 | pages= 398-402 | pmid=23204694 | doi=10.1007/s12262-011-0370-y | pmc=3236272 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23204694 }} </ref>
* [[Fistula]] formation with [[abscess]]<ref name="pmid15855993">{{cite journal| author=Nikolaidis N, Giouleme O, Gkisakis D, Grammatikos N| title=Posttraumatic splenic abscess with gastrosplenic fistula. | journal=Gastrointest Endosc | year= 2005 | volume= 61 | issue= 6 | pages= 771-2 | pmid=15855993 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15855993 }} </ref>
|valign=top|
* Wound infection
* [[Paralytic ileus]]
* [[Deep vein thrombosis]]
* [[Meningitis]]
|}

===Prognosis===
Prognosis of splenic abscess depends on the time of diagnosis and treatment. Delay in the management can lead to [[splenic rupture]] followed by spilling into [[peritoneal cavity]] or an adjacent organ which can lead to [[septicemia]] and death in severe cases.

==Association==
Splenic abscess is commonly associate with:<ref name="pmid23204694">{{cite journal| author=Sreekar H, Saraf V, Pangi AC, Sreeharsha H, Reddy R, Kamat G| title=A retrospective study of 75 cases of splenic abscess. | journal=Indian J Surg | year= 2011 | volume= 73 | issue= 6 | pages= 398-402 | pmid=23204694 | doi=10.1007/s12262-011-0370-y | pmc=3236272 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23204694 }} </ref>
* [[Liver disease|Paranchymal liver disease]]
* [[Pancreatitis]]
* [[Pleural effusion]]
* [[Renal cysts]]
* [[Ovarian cysts]]
* [[Lymphadenopathy|Abdominal lymphadenopathy]]
==Diagnosis==
Splenic abscess commonly present with a triad of symptoms include [[fever]], [[Nausea and vomiting|nausea, vomiting]] and [[abdominal pain]] along with palpable spleen on examination. Early diagnosis with imaging studies and prompt drainage is required to reduce morbidity and mortality. Presence of [[fever]], left upper abdominal pain, [[leukocytosis]] and radiologic evidence shows pathology in the left [[chest X-ray]] especially in [[immunocompromised]] patients are the indications for high suspicion of splenic abscess.

===History and Symptoms===
Common symptoms of splenic abscess include:<ref name="pmid3300398">{{cite journal| author=Nelken N, Ignatius J, Skinner M, Christensen N| title=Changing clinical spectrum of splenic abscess. A multicenter study and review of the literature. | journal=Am J Surg | year= 1987 | volume= 154 | issue= 1 | pages= 27-34 | pmid=3300398 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3300398 }} </ref><ref name="pmid9240961">{{cite journal| author=Ooi LL, Leong SS| title=Splenic abscesses from 1987 to 1995. | journal=Am J Surg | year= 1997 | volume= 174 | issue= 1 | pages= 87-93 | pmid=9240961 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9240961 }} </ref>
* [[Fever]]
* [[Left upper quadrant abdominal pain|Abdominal pain localized in the left upper quadrant]] or mesogastrium
* [[Nausea and vomiting]]
* Constitutional symptoms such as [[fatigue]], loss of body weight, sweat and chills
Other symptoms include:<ref name="pmid4550054">{{cite journal| author=Gadacz T, Way LW, Dunphy JE| title=Changing clinical spectrum of splenic abscess. | journal=Am J Surg | year= 1974 | volume= 128 | issue= 2 | pages= 182-7 | pmid=4550054 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4550054 }} </ref>
* [[Referred pain]] in the left shoulder
* [[Confusion]]
* Pain in the left lower hemithorax
* [[Cough]]

===Physical Examination Findings===
===Appearance===
Patient with splenic abscess appear ill appearing and [[diaphoretic]]
===Vital signs===
* [[Fever|High-grade fever]]
* [[Tachycardia]]
If patient present with sepsis:
* [[Hypotension]]
* [[Tachycardia]]
* Increased [[capillary refill time]]
Signs of sepsis indicate that splenic abscess is most likely due to bacterial cause than fungal source.<ref name="pmid3300398">{{cite journal| author=Nelken N, Ignatius J, Skinner M, Christensen N| title=Changing clinical spectrum of splenic abscess. A multicenter study and review of the literature. | journal=Am J Surg | year= 1987 | volume= 154 | issue= 1 | pages= 27-34 | pmid=3300398 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3300398 }} </ref>

===Heart===
* New onset [[Heart murmur|murmur]] may be present
===Lungs===
* Left sided pleural effusion may be present with signs of:
** Decreased [[breath sounds]] on left side
** Dullness to percussion on left side
** Absent [[tactile fremitus]] on left side
** [[Friction rub]] over the left chest

===Abdomen ===
'''Palpation'''
* Tender [[splenomegaly]]
* Palpable spleen or abdominal mass
'''Auscultation'''
* [[Friction rub]] over the spleen<ref name="pmid4550054">{{cite journal| author=Gadacz T, Way LW, Dunphy JE| title=Changing clinical spectrum of splenic abscess. | journal=Am J Surg | year= 1974 | volume= 128 | issue= 2 | pages= 182-7 | pmid=4550054 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4550054 }} </ref>

===Laboratory Tests===
===Blood Tests===
Blood tests such [[leukocytosis]] are increased but not significant in the diagnosis of splenic abscess because these tests may not be appropriate in immunocompromised patients.
* CBC with differential
* [[Erythrocyte Sedimentation Rate|Erythrocyte sedimentation rate]] ([[Erythrocyte sedimentation rate|ESR]])
* '''Microbiological tests:''' In solitary abscesses blood culture is not sensitive in the initial stages when as in multiple abscesses it is helpful in prompt diagnosis and early treatment.<ref name="pmid4550054">{{cite journal| author=Gadacz T, Way LW, Dunphy JE| title=Changing clinical spectrum of splenic abscess. | journal=Am J Surg | year= 1974 | volume= 128 | issue= 2 | pages= 182-7 | pmid=4550054 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4550054 }} </ref>
** [[Gram staining|Gram stain]]
** Bacterial culture
** Abscess culture
* '''Mycological tests'''
** [[KOH test]]
** Fungal culture

===Diagnostic Evaluation of Splenic abscess===
{{Family tree/start}}
{{Family tree | | | | | | | | | | | | | | | | A01 | | | | | | | | | | | | |A01= '''Suspicion of splenic abscess''' (Patients with [[immunodeficiency|immunodeficiency disorders]], [[fever]], changes in [[chest X-ray]], [[abdominal pain]]) }}
{{Family tree | | | | | | | | | | | | | | | | |!| | | | | | | | | | | | | |}}
{{Family tree | | | | | | | | | | | | | | | | B01 | | | | | | | | | | | | |B01= '''Blood culture'''}}
{{Family tree | | | | | | | | | | | | | | | | |!| | | | | | | | | | | | | |}}
{{Family tree | | | | | | | | | | | | | | | | C01 | | | | | | | | | | | | |C01='''Patient with [[immunodeficiency|immunodeficiency disorders]]?'''}}
{{Family tree | | | | | | | |,|-|-|-|-|-|-|-|-|^|-|-|-|-|-|-|-|-|.| | | | |}}
{{Family tree | | | | | | | D01 | | | | | | | | | | | | | | | | D02 | | | |D01='''If immunodeficent patient''' Initiate wide spectrum antibiotics + antifungal medication|D02='''If [[immunocompetent]] patient''' Initiate wide spectrum antibiotics}}
{{Family tree | | | | | | | |`|-|-|-|-|-|-|-|-|v|-|-|-|-|-|-|-|-|'| | | | |}}
{{Family tree | | | | | | | | | | | | | | | | E01 |-|-| E02 | | | | | | | |E01=[[Ultrasound]] of abdominal cavity, [[CT scan]] with contrast|E02=If imaging shows negative or equivocal with high clinical '''suspicion of splenic abscess''' }}
{{Family tree | | | | | | | | | | | | | | | | |!| | | | |!| | | | | | | | |}}
{{Family tree | | | | | | | | | | | | | | | | |!| | | | E03 | | | | | | | |E03='''Arteriography'''}}
{{Family tree | | | | | | | |,|-|-|-|-|-|-|-|-|^|-|-|-|-|^|-|-|-|.| | | | |}}
{{Family tree | | | | | | | G01 | | | | | | | | | | | | | | | | G02 | | | |G01='''Presence of indications for minimally invasive procedures''' |G02='''Absence of indications for minimally invasive procedures'''}}
{{Family tree | | | | | | | |!| | | | | | | | | | | | | | | | | |!| | | | |}}
{{Family tree | | | | | | | G03 | | | | | | | | | | | | | | | | |!| | | | |G03=Aspiration or abscess drainage under US or CT guidance}}
{{Family tree | | |,|-|-|-|-|^|-|-|-|-|-|-|-|.| | | | | | | | | |!| | | | |}}
{{Family tree | | H01 | | | | | | | | | | | H02 | | | | | | | | |!| | | | |H01=Abscess cavity content culture, modification of antibiotic therapy according to culture results; Prolonged antibiotic therapy|H02=If ineffective drainage or recurrent abscess}}
{{Family tree | | | | | | | | | | | | | | | |`|-|-|-|-|v|-|-|-|-|'| | | | |}}
{{Family tree | | | | | | | | | | | | | | | | | | | | I01 | | | | | | | | |I01='''[[Spleenectomy]] or Open abscess drainage'''}}
{{Family tree | | | | | | | | | | | | | | | | | | | | |!| | | | | | | | | |}}
{{Family tree | | | | | | | | | | | | | | | | | | | | J01 | | | | | | | | |J01=Abscess cavity content culture, modification of antibiotic therapy according to culture results; Prolonged antibiotic therapy}}
{{Family tree/end}}

===Imaging Findings===
As the clinical features of splenic absecess are non specific and vague such as abdominal pain, fever and vomiting, that makes diagnosis is challenging and relied on imaging modalities. Imaging studies such as [[ultrasound]], [[computerized tomography]] made the diagnosis early and more accurate that reduces morbidity and mortality.<ref name="pmid12185032">{{cite journal| author=Thanos L, Dailiana T, Papaioannou G, Nikita A, Koutrouvelis H, Kelekis DA| title=Percutaneous CT-guided drainage of splenic abscess. | journal=AJR Am J Roentgenol | year= 2002 | volume= 179 | issue= 3 | pages= 629-32 | pmid=12185032 | doi=10.2214/ajr.179.3.1790629 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12185032 }} </ref>

====X-ray====
'''Advantages'''
* High [[sensitivity]]
* Directly points to pathological changes
* It is the first line of examination for patients suspected of an ongoing infection
* Can determine [[phrenic]]/ [[Diaphragmatic Elevation|diaphragmatic dome]] positioning and air-fluid level in the left [[hypochondrium]]
Common '''chest x- ray''' findings includes:
* Elevated and immobile left [[diaphragm]]
* Ipsilateral [[pleural effusion]]
* [[Atelectasis|Atelectalic]] and inflammatory changes in interior lung lobe
Common '''abdominal x- ray''' findings includes:
* Shift of the stomach and colon by a soft tissue mass( splenic abscess) which is more rectangular than in other causes of splenomegaly
* Increased air-fluid levels with extra alimentary gas collection in the left upper quadrant<ref name="pmid14139921">{{cite journal| author=ZATZKIN HR, DRAZAN AD, IRWIN GA| title=ROENTGENOGRAPHIC DIAGNOSIS OF SPLENIC ABSCESS. | journal=Am J Roentgenol Radium Ther Nucl Med | year= 1964 | volume= 91 | issue= | pages= 896-9 | pmid=14139921 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14139921 }} </ref>
[[File:Splenic abscess chest x-ray.jpg|500px]]

====Ultrasound====
Ultrasound shows lesions of mixed echogenicity i.e anechoic central zone with a surrounding hyperechoic area.<ref name="pmid7039270">{{cite journal| author=Ralls PW, Quinn MF, Colletti P, Lapin SA, Halls J| title=Sonography of pyogenic splenic abscess. | journal=AJR Am J Roentgenol | year= 1982 | volume= 138 | issue= 3 | pages= 523-5 | pmid=7039270 | doi=10.2214/ajr.138.3.523 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7039270 }} </ref><ref name="pmid6976726">{{cite journal| author=Pawar S, Kay CJ, Gonzalez R, Taylor KJ, Rosenfield AT| title=Sonography of splenic abscess. | journal=AJR Am J Roentgenol | year= 1982 | volume= 138 | issue= 2 | pages= 259-62 | pmid=6976726 | doi=10.2214/ajr.138.2.259 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6976726 }} </ref>

'''Advantages''' 
* Emergency radiography with high sensitivity (75-100%)<ref name="pmid9403539">{{cite journal| author=Phillips GS, Radosevich MD, Lipsett PA| title=Splenic abscess: another look at an old disease. | journal=Arch Surg | year= 1997 | volume= 132 | issue= 12 | pages= 1331-5; discussion 1335-6 | pmid=9403539 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9403539 }} </ref><ref name="pmid8161087">{{cite journal| author=Paris S, Weiss SM, Ayers WH, Clarke LE| title=Splenic abscess. | journal=Am Surg | year= 1994 | volume= 60 | issue= 5 | pages= 358-61 | pmid=8161087 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8161087 }} </ref>
* Non invasive
* Cost effective
* Determine the size of the spleen, size of the abscess, its location and [[echogenicity]]
[[File:Splenic abscess ultrasound.jpg|500px]][[File:Multiple splenic abscesses ultrasound.jpg|500px]]

====CT images====
Computerised tomography with contrast is both diagnostic and therapeutic test of choice for splenic abscess.<ref name="pmid2589597">{{cite journal| author=Faught WE, Gilbertson JJ, Nelson EW| title=Splenic abscess: presentation, treatment options, and results. | journal=Am J Surg | year= 1989 | volume= 158 | issue= 6 | pages= 612-4 | pmid=2589597 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2589597 }} </ref><ref name="pmid11206904">{{cite journal| author=Green BT| title=Splenic abscess: report of six cases and review of the literature. | journal=Am Surg | year= 2001 | volume= 67 | issue= 1 | pages= 80-5 | pmid=11206904 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11206904 }} </ref>
 '''Advantages'''
* High [[sensitivity]] (88-100%)
* Can differentiate unolocular and multilocular abscesses
* Can identify the contents of abscess
* Can determine the density index of abscess.
* Can differentiate splenic abscess from [[Splenic cyst|splenic cysts]] and [[Splenic hemangioma|splenic hematomas]]
* More precise and accurate than ultrasonography, in identifying the location of abscess in relation to other internal organs during per-cutaneous drainage.
* It is superior to all other diagnostic tests for splenic abscess.
|valign=top|
Scintigraphic studies include [[technetium-99m]] liver and spleen scans, [[gallium]] scans, and [[indium]] scans. Splenic scan is diagnostic modality to identify abscesses which relies upon splenic uptake of the [[Technetium-99m|radionuclide 99m technetium]] which shows abscess as a negative or filling defect.

'''Advantages'''
* High [[specificity]]: If patient showing high suspicion of splenic abscess and scan supports the diagnosis, then [[splenectomy]] can be performed.
'''Disadvantages:'''
* Scan can not identifie or visualize incurable small abscesses.<ref name="pmid4550054">{{cite journal| author=Gadacz T, Way LW, Dunphy JE| title=Changing clinical spectrum of splenic abscess. | journal=Am J Surg | year= 1974 | volume= 128 | issue= 2 | pages= 182-7 | pmid=4550054 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4550054 }} </ref>
* Less sensitive: If the scan shows negative or equivocal results for splenci abscess but clinical suspicion remains, an arteriogram should be ordered.
[[File:Splenic abscess CT images.gif|500px]]

===Other Imaging Studies===
====Scintigraphic studies====
Scintigraphic studies include [[technetium-99m]] liver and spleen scans, [[gallium]] scans, and [[indium]] scans. Splenic scan is diagnostic modality to identify abscesses which relies upon splenic uptake of the [[Technetium-99m|radionuclide 99m technetium]] which shows abscess as a negative or filling defect.

'''Advantages'''
* High [[specificity]]: If patient showing high suspicion of splenic abscess and scan supports the diagnosis, then [[splenectomy]] can be performed.
'''Disadvantages:'''
* Scan can not identifie or visualize incurable small abscesses.<ref name="pmid4550054">{{cite journal| author=Gadacz T, Way LW, Dunphy JE| title=Changing clinical spectrum of splenic abscess. | journal=Am J Surg | year= 1974 | volume= 128 | issue= 2 | pages= 182-7 | pmid=4550054 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4550054 }} </ref>
* Less sensitive: If the scan shows negative or equivocal results for splenci abscess but clinical suspicion remains, an arteriogram should be ordered.
====Arteriography====
Arteriography is the technique that involves injection of contrast material through a catheter passed retrograde into the [[splenic artery]] followed by rapid exposure of sequential x-ray films which shows abscesses as filling defects in the spleen.

'''Advantages:'''

More reliable and precise than splenic scan in diagnosing small abscesses.

'''Disadvantages:'''
* Invasive technique

==Treatment==
===Medical Therapy===
Antibiotic regimen should start before the procedure and continue until 7 days after the procedure. Diagnostic needle aspiration is very important in the management with antibiotics as blood culture may not be the best correlate as abscess culture. Anitbiotic of choice depends on the organism, but aggressive and early surgical intervention of splenic abscess should be encouraged especially when the risk factors are present. High suspicion of splenic abscess with history of risk factors, broad-spectrum empirical antibiotic therapy should be initiated <ref name="pmid14139921">{{cite journal| author=ZATZKIN HR, DRAZAN AD, IRWIN GA| title=ROENTGENOGRAPHIC DIAGNOSIS OF SPLENIC ABSCESS. | journal=Am J Roentgenol Radium Ther Nucl Med | year= 1964 | volume= 91 | issue= | pages= 896-9 | pmid=14139921 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14139921 }} </ref> Empiric antibiotic should cover [[Streptococcus|streptococci]], [[Staphylococcus aureus|staphylococci]], and [[Gram-negative bacteria|aerobic gram-negative rods]] such as [[Vancomycin]] or [[oxacillin]] plus an [[aminoglycoside]], a third- or fourth-generation [[cephalosporin]], [[fluoroquinolone]], or [[carbapenem]]. If culture shows fungi as causative organism, start [[Amphotericin B]] immediately and continue for 6-24 weeks and during the procedure [[amphotericin B]] should be administered directly into the abscess.<ref name="pmid6385895">{{cite journal| author=Johnson JD, Raff MJ| title=Fungal splenic abscess. | journal=Arch Intern Med | year= 1984 | volume= 144 | issue= 10 | pages= 1987-93 | pmid=6385895 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6385895 }} </ref>

===Surgery===
Treatment of splenic abscess depends on etiology. In bacterial abscesses, [[splenectomy]] combined with post-operative antibiotic therapy is the most appropriate treatment of choice with least mortality rate when compared to percutaneous drainage or antimicrobial therapy.<ref name="pmid16489650">{{cite journal| author=Chang KC, Chuah SK, Changchien CS, Tsai TL, Lu SN, Chiu YC et al.| title=Clinical characteristics and prognostic factors of splenic abscess: a review of 67 cases in a single medical center of Taiwan. | journal=World J Gastroenterol | year= 2006 | volume= 12 | issue= 3 | pages= 460-4 | pmid=16489650 | doi= | pmc=4066069 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16489650 }} </ref>
====Percutaneous Drainage====
Percutaneous drainage is the initial tretament of choice for splenic abscess, even though [[Splenectomy|splenectom]]<nowiki/>y is the definitive treatment because of increased risk of infections in splenectomised patient.<ref name="pmid17143953">{{cite journal| author=Zerem E, Bergsland J| title=Ultrasound guided percutaneous treatment for splenic abscesses: the significance in treatment of critically ill patients. | journal=World J Gastroenterol | year= 2006 | volume= 12 | issue= 45 | pages= 7341-5 | pmid=17143953 | doi= | pmc=4087495 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17143953 }} </ref><ref name="pmid16410091">{{cite journal| author=Choudhury S R, Rajiv C, Pitamber S, Akshay S, Dharmendra S| title=Management of splenic abscess in children by percutaneous drainage. | journal=J Pediatr Surg | year= 2006 | volume= 41 | issue= 1 | pages= e53-6 | pmid=16410091 | doi=10.1016/j.jpedsurg.2005.10.085 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16410091 }} </ref> It is genereally done under the guidance of imaging studies such as [[ultrasound]] or [[computerised tomography]] and under the guidence of imaging efficy of percuteneous drainage is equivalent to [[splenectomy]].<ref name="pmid3521422">{{cite journal| author=Teich S, Oliver GC, Canter JW| title=The early diagnosis of splenic abscess. | journal=Am Surg | year= 1986 | volume= 52 | issue= 6 | pages= 303-7 | pmid=3521422 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3521422 }} </ref><ref name="pmid1450832">{{cite journal| author=Hadas-Halpren I, Hiller N, Dolberg M| title=Percutaneous drainage of splenic abscesses: an effective and safe procedure. | journal=Br J Radiol | year= 1992 | volume= 65 | issue= 779 | pages= 968-70 | pmid=1450832 | doi=10.1259/0007-1285-65-779-968 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1450832 }} </ref>
* First line of treatment for splenic abscess
* Safe and effective than surgery in both unilocular and bilocular abscesses, especially in peripherally located abscesses.
* Preferred in critically ill patient and patients unfit for general anesthesia
'''Advantages'''
* Preserves spleen. So, it become the the treatment of choice in children to prevent post-splenectomy [[septicemia]]<ref name="pmid14530888">{{cite journal| author=Kang M, Saxena AK, Gulati M, Suri S| title=Ultrasound-guided percutaneous catheter drainage of splenic abscess. | journal=Pediatr Radiol | year= 2004 | volume= 34 | issue= 3 | pages= 271-3 | pmid=14530888 | doi=10.1007/s00247-003-1068-5 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14530888 }} </ref>
* No abdominal spillage of abscess contents
* Less expensive, high acceptance rate and less operative risk
'''Complications'''
* Splenic [[haemorrhage]]
* Injury to other abdominal organs
* [[Septicemia]]
* [[Empyema]]
* [[Pneumothorax]]
* [[Fistula|Fistula formation]]
* [[Deep vein thrombosis]]
'''Contraindications or limitations'''
* Multiple or septated abscesses<ref name="pmid3977590">{{cite journal| author=Gerzof SG, Johnson WC, Robbins AH, Nabseth DC| title=Expanded criteria for percutaneous abscess drainage. | journal=Arch Surg | year= 1985 | volume= 120 | issue= 2 | pages= 227-32 | pmid=3977590 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3977590 }} </ref><ref name="pmid9403539">{{cite journal| author=Phillips GS, Radosevich MD, Lipsett PA| title=Splenic abscess: another look at an old disease. | journal=Arch Surg | year= 1997 | volume= 132 | issue= 12 | pages= 1331-5; discussion 1335-6 | pmid=9403539 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9403539 }} </ref><ref name="pmid8343056">{{cite journal| author=Ho HS, Wisner DH| title=Splenic abscess in the intensive care unit. | journal=Arch Surg | year= 1993 | volume= 128 | issue= 8 | pages= 842-6; discussion 846-8 | pmid=8343056 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8343056 }} </ref>
* Anatomically inaccessible for drainage such as upper pole or hilar of the spleen,
* Uncontrolled [[coagulopathies]]
* [[Ascites]]
* Simultaneous surgical procedure required of other indications such as [[subphrenic abscess]]
* Abscess [[perforation]] or bleeding
* Refractoriness to abscess-content drainage
* Secondary infected [[Splenic hemangioma|spleen hematoma]]
====Splenectomy====
Splenectomy is the most effective and definitive treatment of choice for splenic abscess. splenectomy can be performed either from left subcostal incision or from midline epigastric entry.
 '''Advantages'''
* Definitive treatment for splenic abscess
* Treatment of choice if more than 2 abscesses are present
* Patients with failed percutaneous drainage
* Patient with recurrent abscesses
'''Disadvantages'''
* Splenecetomisesd patients are more prone to infections especially catalase positive bacteria such as [[Streptococcus pneumoniae]].
* Mortality rate varies between 0-20% <ref name="pmid11206904">{{cite journal| author=Green BT| title=Splenic abscess: report of six cases and review of the literature. | journal=Am Surg | year= 2001 | volume= 67 | issue= 1 | pages= 80-5 | pmid=11206904 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11206904 }} </ref>
* Extended duration operation time, larger volume of intra-operative blood loss
* Longer duration of hospital stay than percutaneous drainage procedure
'''Complications'''
* [[Lung infection]]
* Wound infection
* [[Septicemia]]
* [[Paralytic ileus]]
* [[Deep vein thrombosis]]

==Prevention==
===Primary Prevention===
Primary prevention for splenic abscess can prevent in specific cases especially patients who are at high risk such as [[Immunocompromised|immunocompromised patients]] (e.g. recipients of [[Renal transplantation|renal transplants]] or patients on [[immunosuppressive drugs]] for other reasons).
* In transplant patients best way to prevent splenic abscess is by [[splenectomy]], where as in patients with other immunocompromised states it can be achieved by proper care, early detection and aggressive treatment of minor infections.<ref name="pmid4550054">{{cite journal| author=Gadacz T, Way LW, Dunphy JE| title=Changing clinical spectrum of splenic abscess. | journal=Am J Surg | year= 1974 | volume= 128 | issue= 2 | pages= 182-7 | pmid=4550054 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4550054 }} </ref>
* Avoid [[Intravenous drug use|intravenous drug abuse]]

==References==
{{reflist|2}}

[[Category:Hematology]]
[[Category:Gastroenterology]]
[[Category:Infectious disease]]

{{WS}}
{{WH}}

Splenic abscess

2017-03-21T14:59:35Z

Venkata Sivakrishna Kumar Pulivarthi: /* Pathophysiology */

__NOTOC__
[[File:Splenic abscess.jpg|right|200px|thumb|Splenic infarction complicated with splenic abscess]]
{{SI}}
{{CMG}}; {{AE}}{{VSKP}}

{{SK}}Abscess of spleen

==Overview==
Splenic abscess is an uncommon and lifethreatening condition. Clinical presentation, etiological factors, natural history, treatment and prognosis depends on whether the abscess was solitary or multiple.<ref name="pmid4550054">{{cite journal| author=Gadacz T, Way LW, Dunphy JE| title=Changing clinical spectrum of splenic abscess. | journal=Am J Surg | year= 1974 | volume= 128 | issue= 2 | pages= 182-7 | pmid=4550054 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4550054 }} </ref> It is always fatal if left untreated. Most commonly associated with [[Immunodeficiency|immunodeficient]] patients especially, [[Hematological|hematological disorders]] such as [[leukemia]], [[sickle cell disease]] etc. Diagnostic needle aspiration is very important in the management with antibiotics as blood culture may not be the best correlate as abscess culture. Anitbiotic of choice depends on the organism, but aggressive and early surgical intervention of splenic abscess should be encouraged especially when the risk factors are present. High suspicion of splenic abscess with history of risk factors, broad-spectrum empirical antibiotic therapy should be initiated <ref name="pmid14139921">{{cite journal| author=ZATZKIN HR, DRAZAN AD, IRWIN GA| title=ROENTGENOGRAPHIC DIAGNOSIS OF SPLENIC ABSCESS. | journal=Am J Roentgenol Radium Ther Nucl Med | year= 1964 | volume= 91 | issue= | pages= 896-9 | pmid=14139921 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14139921 }} </ref>

==Definition==
Splenic abscess is defined as any infectious [[suppurative]] process involving identifiable macroscopic filling defects either in the [[Parenchyma|parenchym]]<nowiki/>a of the [[spleen]] or in the subcapsular space.<ref name="pmid3300398">{{cite journal| author=Nelken N, Ignatius J, Skinner M, Christensen N| title=Changing clinical spectrum of splenic abscess. A multicenter study and review of the literature. | journal=Am J Surg | year= 1987 | volume= 154 | issue= 1 | pages= 27-34 | pmid=3300398 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3300398 }} </ref>
==Historical Perspective==
* Since the times of Hippocrates, splenic abscess has been reported several times and he described the natural history and prognosis of splenic abscess.<ref name="pmid17865957">{{cite journal| author=Billings AE| title=ABSCESS OF THE SPLEEN. | journal=Ann Surg | year= 1928 | volume= 88 | issue= 3 | pages= 416-28 | pmid=17865957 | doi= | pmc=1398901 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17865957 }} </ref>
* In the early days of 20th century, splenic abscess most commonly caused by typhoid and then followed by malaria.<ref name="pmid17863403">{{cite journal| author=Elting AW| title=ABSCESS OF THE SPLEEN. | journal=Ann Surg | year= 1915 | volume= 62 | issue= 2 | pages= 182-92 | pmid=17863403 | doi= | pmc=1406707 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17863403 }} </ref>
* Ooi et al. described significant etiological differences such increase in the percentage of [[abscess]] cases due to [[Anaerobic|anaerobics]] as compared to [[aerobics]] (7 vs 18-28%), [[fungi]] (1 vs 18-41%) as well as [[Mycobacterium tuberculosis|Mycobacterium tuberculosi]]<nowiki/>s (0.8 vs. 14%) in the second half of 20th century.<ref name="pmid9240961">{{cite journal| author=Ooi LL, Leong SS| title=Splenic abscesses from 1987 to 1995. | journal=Am J Surg | year= 1997 | volume= 174 | issue= 1 | pages= 87-93 | pmid=9240961 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9240961 }} </ref>

==Classification==
{| border="1"
!colspan="1" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF|Classification by Mechanism of pathogenesis}}
!colspan="1" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF|Classification by Etiology}}
!colspan="1" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF|Classification by Pathological Findings}}
|-
|valign=top|
Splenic abscess is classified traditionally by ''Chun and colleagues'' based on the predisposing causes as follows:<ref name="pmid6986009">{{cite journal| author=Chun CH, Raff MJ, Contreras L, Varghese R, Waterman N, Daffner R et al.| title=Splenic abscess. | journal=Medicine (Baltimore) | year= 1980 | volume= 59 | issue= 1 | pages= 50-65 | pmid=6986009 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6986009 }} </ref><ref name="pmid4550054">{{cite journal| author=Gadacz T, Way LW, Dunphy JE| title=Changing clinical spectrum of splenic abscess. | journal=Am J Surg | year= 1974 | volume= 128 | issue= 2 | pages= 182-7 | pmid=4550054 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4550054 }} </ref><ref name="pmid9403539">{{cite journal| author=Phillips GS, Radosevich MD, Lipsett PA| title=Splenic abscess: another look at an old disease. | journal=Arch Surg | year= 1997 | volume= 132 | issue= 12 | pages= 1331-5; discussion 1335-6 | pmid=9403539 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9403539 }} </ref>
* '''Hematogenous or Metastatic infection:''' Seen in [[endocarditis]]
* '''Embolic phenomenon:''' splenic abscess developed as consequence of cellular [[embolism]] in [[hemoglobinopathies]] such as [[Sickle-cell disease|sickle cell disease]]
* '''Contagious infection:''' Splenic abscesses can develop through continuity of infection from primary sources which are anatomically close (e.g. [[Subphrenic abscess|subphrenic abscesses]])
* '''Splenic trauma:''' secondary infections may developed due to splenic trauma
* '''Depressed immune defenses:''' [[chemotherapy]]-induced abscesses developed particularily in [[Leukemia|leukemias]]
|valign=top|
Classification of splenic abscesses based on the etiological factors is as follows:<ref name="pmid9240961">{{cite journal| author=Ooi LL, Leong SS| title=Splenic abscesses from 1987 to 1995. | journal=Am J Surg | year= 1997 | volume= 174 | issue= 1 | pages= 87-93 | pmid=9240961 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9240961 }} </ref>
* Mono-microbial [[abscess]]
* Poly-microbial [[abscess]] (~10-15%)
* Sterile [[abscess]] (~30%)
|valign=top|
Lawhorne and Zuidema classified splenic abscees based on pathological findings as follows:<ref name="pmid1273753">{{cite journal| author=Lawhorne TW, Zuidema GD| title=Splenic abscess. | journal=Surgery | year= 1976 | volume= 79 | issue= 6 | pages= 686-9 | pmid=1273753 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1273753 }} </ref>
* Unilocular abscess
* Bilocular abscess
|}

==Pathophysiology==
{{Family tree/start}}
{{Family tree | | | | | A01 | | | | A02 | | | | A03 | | | | A04 | | | | | | A05 | | | | |A01='''Hematogenous'''|A02='''Splenic infarction'''|A03='''Immunodeficiency'''|A04='''Splenic Trauma'''|A05='''Contiguous'''}}
{{Family tree | | | | | |!| | | | | |`|-|-|v|-|-|'| |,|-|-|-|^|-|-|-|.| | | |!| | | | | |}}
{{Family tree | | | | | B01 | | | | | | | B02 | | | B03 | | | | | | B04 | | B05 | | | | |B01='''Septic focus'''|B02='''Superinfection'''|B03='''Hematoma'''|B04='''Bacteremia'''|B05='''Direct extension'''}}
{{Family tree | | | | | |!| | | | | | | | |!| | | | |`|-|-|-|v|-|-|-|'| | | |!| | | | | |}}
{{Family tree | | | | | C01 | | | | | | | |!| | | | | | | | |!| | | | | | | |!| | | | | |C01='''Bacteremia'''}}
{{Family tree | | | | | |`|-|-|-|-|-|-|-|-|^|-|-|-|-|v|-|-|-|^|-|-|-|-|-|-|-|'| | | | | |}}
{{Family tree | | | | | | | | | | | | | | | | | | | D01 | | | | | | | | | | | | | | | | |D01='''Splenic abscess'''}}
{{Family tree/end}}
Splenic abscess can result from various sources such as:<ref name="pmid17143953">{{cite journal| author=Zerem E, Bergsland J| title=Ultrasound guided percutaneous treatment for splenic abscesses: the significance in treatment of critically ill patients. | journal=World J Gastroenterol | year= 2006 | volume= 12 | issue= 45 | pages= 7341-5 | pmid=17143953 | doi= | pmc=4087495 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17143953 }} </ref>
{| border="2" cellpadding="4" cellspacing="0" style="margin: 1em 1em 1em 0; background: #f9f9f9; border: 1px #aaa solid; border-collapse: collapse;
!colspan="1" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF| '''Pathogenic Mechanism'''}}
!colspan="1" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF| '''Description'''}}
|-
!Hematogenous Dissemination
|
* Hematogenous Dissemination or arterial dissemination is the most common mode of infection that results in splenic abscess.<ref name="pmid4550054">{{cite journal| author=Gadacz T, Way LW, Dunphy JE| title=Changing clinical spectrum of splenic abscess. | journal=Am J Surg | year= 1974 | volume= 128 | issue= 2 | pages= 182-7 | pmid=4550054 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4550054 }} </ref>
* It is a metastatic infection through hematologic seeding from distant infections such as [[infective endocarditis]], purulent teeth-related infections and [[urinary tract infections]]
* Most common organism involved is [[Staphylococcus aureus|Staphylococcs aureus]]
* Often results in multiple [[abscesses]
|-
!Secondary infection of splenic infarction
|
* [[Embolic]] or [[thrombotic]] non-infectious events due to red cell abnormalities such as [[hemolytic]] and [[Sickle-cell disease|sickle cell anemia]] causes [[ischemia]] followed by [[superinfection]] of [[emboli]] which tend to obstruct free blood flow and oxygen delivery to the spleen on the microscopic level.
|-
!Contiguous spread of bacteria
|
* It is a mode of infection spread to the spleen from anatomically neighboring structures such as stomach or large bowel [[perforation]], infected [[pancreatic cyst]], perisplenic or [[Subphrenic abscess|subpleuric abscess]].
* Can cause either solitory or multiple [[abscesses]]<ref name="pmid3300398">{{cite journal| author=Nelken N, Ignatius J, Skinner M, Christensen N| title=Changing clinical spectrum of splenic abscess. A multicenter study and review of the literature. | journal=Am J Surg | year= 1987 | volume= 154 | issue= 1 | pages= 27-34 | pmid=3300398 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3300398 }} </ref>
|-
! Trauma
|
* secondary infections may developed due to splenic trauma during any intra-abdominal procedures.<ref name="pmid9240961">{{cite journal| author=Ooi LL, Leong SS| title=Splenic abscesses from 1987 to 1995. | journal=Am J Surg | year= 1997 | volume= 174 | issue= 1 | pages= 87-93 | pmid=9240961 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9240961 }} </ref>
|-
! Immunodeficiency
|
* It is major factor involved in the course of splenic abscess especially if the causative organism is [[fungi]] or any other atypical organism.
|}

=== Pathological Findings ===
{| border="1"
|+
!colspan="1" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF|Solitary splenic abscess}}
!colspan="1" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF|Multiple splenic abscesses}}
|-
|'''Gross findings:'''
* Enlarged spleen with due to large solitary abscesses with thick wall around the abscess to prevent dissemination is seen
'''Microscopic findings:'''
* Microscopically the abscess consist of [[necrotic tissue]] with a fibrous wall surrounded by [[inflammatory]] cell infiltration.
|'''Gross findings:'''
* At the time of [[autopsy]], spleen present as large and soft, and pus extruded organ from the cut surface.
'''Microscopic findings:'''
* Multiple microscopically visible foci of infection riddled homogeneously throughout the spleen
* Abscesses are filled with [[polymorphonuclear leukocytes]] which were scattered throughout the [[parenchyma]], intermixed with other foci of microinfarction and [[coagulation necrosis]]
|}

==Causes==
Spleenic abscess is caused mostly by monomicrobial but some times it can be caused by polymicrobial agents. [[Bacteria]] is more common than other microbial agents such as [[fungi]], [[protozoa]] which can cause splenic abscess in [[Immunocompromised|immunocompromised patients]].
=== Common causes ===
Common causes of splenic abscess includes:<ref name="pmid3300398">{{cite journal| author=Nelken N, Ignatius J, Skinner M, Christensen N| title=Changing clinical spectrum of splenic abscess. A multicenter study and review of the literature. | journal=Am J Surg | year= 1987 | volume= 154 | issue= 1 | pages= 27-34 | pmid=3300398 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3300398 }} </ref> Aerobes are the most predominant organisms causing splenic abscess in 50% of cases.<ref name="pmid3300398">{{cite journal| author=Nelken N, Ignatius J, Skinner M, Christensen N| title=Changing clinical spectrum of splenic abscess. A multicenter study and review of the literature. | journal=Am J Surg | year= 1987 | volume= 154 | issue= 1 | pages= 27-34 | pmid=3300398 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3300398 }} </ref><ref name="pmid8343056">{{cite journal| author=Ho HS, Wisner DH| title=Splenic abscess in the intensive care unit. | journal=Arch Surg | year= 1993 | volume= 128 | issue= 8 | pages= 842-6; discussion 846-8 | pmid=8343056 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8343056 }} </ref>
{| border="1"
!colspan="1" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF|Aerobes}}
!colspan="1" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF|Anaerobes}}
!colspan="1" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF|Fungal}}
!colspan="1" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF|Parasite}}
|-
|valign=top|
* [[Staphylococcus|Staphylococcus species]]
* [[Streptococcus|Streptococcal species]]
* [[Salmonella|Salmonella species]]
* [[Escherichia coli]]
* [[Klebsiella pneumoniae]]
* [[Pseudomonas aeruginosa]]
* [[Enterococcus|Enterococcus species]]
* [[Mycobacterium]]
|valign=top|
* [[Bacteroides]]
* [[Actinomyces]]
* [[Propionibacteriaceae|Propionibacteriums species]]
* [[Clostridium]]
* [[Fusobacterium]]
|valign=top|
* [[Candida albicans]]
* [[Candida tropicalis]]
* [[Aspergillus]]
|valign=top|
* [[Entamoeba histolytica]]
|}

=== '''Less common causes''' ===
{{columns-list|3|
*[[Aureobasidium pullulans]]
*[[Bacillus cereus]]
*[[Brucella]]
*[[Citrobacter freundii]]
*[[Cryptococcus neoformans]]
*[[Diphtheria|Diphtheroides]]
*[[Echinococcus]]
*[[Enterobacter]]
*[[Malaria]]
*[[Nocardia]]
*[[Proteus mirabilis]]
*[[Schistosomiasis]]
*[[Shigella]]
*[[Staphylococcus epidermidis]]
*[[Streptococcus pneumonia]]
*[[Streptococcus pyogenes]]
*[[Vibrio cholerae]]
}}

==Differentiating {{PAGENAME}} from Other Diseases==
Splenic abscess should be differented from other causes of left upper quadrent pain:<ref name="pmid23204694">{{cite journal| author=Sreekar H, Saraf V, Pangi AC, Sreeharsha H, Reddy R, Kamat G| title=A retrospective study of 75 cases of splenic abscess. | journal=Indian J Surg | year= 2011 | volume= 73 | issue= 6 | pages= 398-402 | pmid=23204694 | doi=10.1007/s12262-011-0370-y | pmc=3236272 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23204694 }} </ref>
* [[Splenic cyst|Splenic cysts]]
* [[Splenic infarct]]
* [[Splenic hemangioma|Splenic hematomas]]
* [[Subphrenic abscess]]

==Epidemiology and Demographics==
===Incidence===
Incidence of spelenic abscess varies between 0.1% to 0.7% based on population based autopsy studies.<ref name="pmid6986009">{{cite journal| author=Chun CH, Raff MJ, Contreras L, Varghese R, Waterman N, Daffner R et al.| title=Splenic abscess. | journal=Medicine (Baltimore) | year= 1980 | volume= 59 | issue= 1 | pages= 50-65 | pmid=6986009 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6986009 }} </ref><ref name="pmid3892934">{{cite journal| author=Gadacz TR| title=Splenic abscess. | journal=World J Surg | year= 1985 | volume= 9 | issue= 3 | pages= 410-5 | pmid=3892934 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3892934 }} </ref> Incidence of splenic abscess due to hematogenous spread is gradually declining due to increased antibiotic use, but incidence due to fungal infection is increasing due to aggressive chemotherapeutic methods.<ref name="pmid3518659">{{cite journal| author=Helton WS, Carrico CJ, Zaveruha PA, Schaller R| title=Diagnosis and treatment of splenic fungal abscesses in the immune-suppressed patient. | journal=Arch Surg | year= 1986 | volume= 121 | issue= 5 | pages= 580-6 | pmid=3518659 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3518659 }} </ref><ref name="pmid6503858">{{cite journal| author=Linker CA, DeGregorio MW, Ries CA| title=Computerized tomography in the diagnosis of systemic candidiasis in patients with acute leukemia. | journal=Med Pediatr Oncol | year= 1984 | volume= 12 | issue= 6 | pages= 380-5 | pmid=6503858 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6503858 }} </ref>
===Prevalence===
Prevalence of splenic abscess is increasing gradually due to increased risk factors and increased imaging modalities that can diagnose more accurately.<ref name="pmid15287600">{{cite journal| author=Farres H, Felsher J, Banbury M, Brody F| title=Management of splenic abscess in a critically ill patient. | journal=Surg Laparosc Endosc Percutan Tech | year= 2004 | volume= 14 | issue= 2 | pages= 49-52 | pmid=15287600 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15287600 }} </ref>
===Case Fatality Rate===
Splenic abscesses are associate with increased morbidity and mortality. If left untreated, mortality is definite (100%).<ref name="pmid3300398">{{cite journal| author=Nelken N, Ignatius J, Skinner M, Christensen N| title=Changing clinical spectrum of splenic abscess. A multicenter study and review of the literature. | journal=Am J Surg | year= 1987 | volume= 154 | issue= 1 | pages= 27-34 | pmid=3300398 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3300398 }} </ref> Mortality rate also varies with treatment of choice such as splenectomy, percutaneous drainage, anti microbial therapy carries 8%, 29%, 20% of mortality rate respectively.<ref name="pmid16489650">{{cite journal| author=Chang KC, Chuah SK, Changchien CS, Tsai TL, Lu SN, Chiu YC et al.| title=Clinical characteristics and prognostic factors of splenic abscess: a review of 67 cases in a single medical center of Taiwan. | journal=World J Gastroenterol | year= 2006 | volume= 12 | issue= 3 | pages= 460-4 | pmid=16489650 | doi= | pmc=4066069 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16489650 }} </ref>

===Age===
Splenic abscess shows bimodal distribution in age of the patients, with peak incidence seen in thirties and sixties.<ref name="pmid3300398">{{cite journal| author=Nelken N, Ignatius J, Skinner M, Christensen N| title=Changing clinical spectrum of splenic abscess. A multicenter study and review of the literature. | journal=Am J Surg | year= 1987 | volume= 154 | issue= 1 | pages= 27-34 | pmid=3300398 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3300398 }} </ref> First peak of age group is people < 40 years of age who are immunosuppressed or intravenous drug abusers, who commonly present multilocular abscesses. Second peak of age group patients > 70 years with diabetes or nonendocardic septic focus and commonly develop a unilocular abscess.

===Gender===
Splenic abscess is more predominant in male compared to female (~2 folds).<ref name="pmid3300398">{{cite journal| author=Nelken N, Ignatius J, Skinner M, Christensen N| title=Changing clinical spectrum of splenic abscess. A multicenter study and review of the literature. | journal=Am J Surg | year= 1987 | volume= 154 | issue= 1 | pages= 27-34 | pmid=3300398 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3300398 }} </ref><ref name="pmid6986009">{{cite journal| author=Chun CH, Raff MJ, Contreras L, Varghese R, Waterman N, Daffner R et al.| title=Splenic abscess. | journal=Medicine (Baltimore) | year= 1980 | volume= 59 | issue= 1 | pages= 50-65 | pmid=6986009 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6986009 }} </ref><ref name="pmid6834894">{{cite journal| author=Linos DA, Nagorney DM, McIlrath DC| title=Splenic abscess--the importance of early diagnosis. | journal=Mayo Clin Proc | year= 1983 | volume= 58 | issue= 4 | pages= 261-4 | pmid=6834894 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6834894 }} </ref>

===Developing Countries===
In Africa, splenic abscess is common due to prevalence of hemoglobinopathies such as sickle cell disease, which is a common risk factor for this disease.<ref name="pmid4744723">{{cite journal| author=Kolawole TM, Bohrer SP| title=Splenic abscess and the gene for hemoglobin S. | journal=Am J Roentgenol Radium Ther Nucl Med | year= 1973 | volume= 119 | issue= 1 | pages= 175-89 | pmid=4744723 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4744723 }} </ref>

==Risk Factors==
Spleen abscess often co-exists with several risk factors, but the major one is the patient’s immunodeficiency. Common risk factors of splenic abscess include:<ref name="pmid23204694">{{cite journal| author=Sreekar H, Saraf V, Pangi AC, Sreeharsha H, Reddy R, Kamat G| title=A retrospective study of 75 cases of splenic abscess. | journal=Indian J Surg | year= 2011 | volume= 73 | issue= 6 | pages= 398-402 | pmid=23204694 | doi=10.1007/s12262-011-0370-y | pmc=3236272 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23204694 }} </ref>
{| border="1"
!colspan="1" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF|Infectious risk factors}}
!colspan="1" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF|Non infectious risk factors}}
|-
|valign=top|
* [[Endocarditis]]
* [[Urinary tract infection]]
* [[Immunocompromised]] conditions such as [[AIDS]]<ref name="pmid7362937">{{cite journal| author=Simson JN| title=Solitary abscess of the spleen. | journal=Br J Surg | year= 1980 | volume= 67 | issue= 2 | pages= 106-10 | pmid=7362937 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7362937 }} </ref>
* [[Intensive care unit|Intensive care unit patients]]
* [[Pulmonary tuberculosis]]
* [[Appendicitis]]
* [[Pneumonia]]
* [[Brucellosis]]
* [[Lung abscess]]
* [[Malaria]]
* [[Diverticulitis]]
* [[Amebiasis]]
* [[Sepsis|Septic syndrome]]
|valign=top|
* [[Diabetes mellitus]]
* Concomitant [[Liver disease|parenchymal liver disease]] such as [[cirrhosis]]
* [[Hemoglobinopathies]]
* [[Malignancies]]
* [[Trauma]]
* Pre-existing splenic pathology such as [[Splenic cyst|splenic cysts]], [[hemangiomas]].<ref name="pmid9240961">{{cite journal| author=Ooi LL, Leong SS| title=Splenic abscesses from 1987 to 1995. | journal=Am J Surg | year= 1997 | volume= 174 | issue= 1 | pages= 87-93 | pmid=9240961 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9240961 }} </ref>
|}

==Screening==
No specific screening test for splenic abscess.

==Natural History, Complications and Prognosis==
===Natural History===
Splenic abscess is a rare cause of abdominal abscesss, but life-threatening. Because of it's rarity, splenic abscess usually diagnosed at the late stages or after the onset of complications.<ref name="pmid4550054">{{cite journal| author=Gadacz T, Way LW, Dunphy JE| title=Changing clinical spectrum of splenic abscess. | journal=Am J Surg | year= 1974 | volume= 128 | issue= 2 | pages= 182-7 | pmid=4550054 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4550054 }} </ref> Solitory abscess present with delayed onset of presentation with history of trauma, [[sepsis]], or adjacent organ disease with [[Fever|feve]]<nowiki/>r, abdominal pain, nausea and vomiting where as multiple splenic abscess most commonly present with generalized [[sepsis]] because of an ineradicable septic focus remote from the [[spleen]]. Early diagnosis, prompt treatment can prevent complications.<ref name="pmid4550054">{{cite journal| author=Gadacz T, Way LW, Dunphy JE| title=Changing clinical spectrum of splenic abscess. | journal=Am J Surg | year= 1974 | volume= 128 | issue= 2 | pages= 182-7 | pmid=4550054 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4550054 }} </ref> Mortality rate is very high if left untreated.

===Complications===
{| border="1"
!colspan="1" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF|Life threatening complications}}
!colspan="1" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF|Common complications}}
!colspan="1" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF|Less common complications}}
|-
|valign=top|
* [[Septic shock]]
* [[Splenic rupture]] and [[peritonitis]]<ref name="pmid12107789">{{cite journal| author=Balasubramanian SP, Mojjada PR, Bose SM| title=Ruptured staphylococcal splenic abscess resulting in peritonitis: report of a case. | journal=Surg Today | year= 2002 | volume= 32 | issue= 6 | pages= 566-7 | pmid=12107789 | doi=10.1007/s005950200100 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12107789 }} </ref>
|valign=top|
* Bacterial sepsis or [[septicemia]]
* Respiratory complications such as [[Pneumonia|post operative pneumonia]]<ref name="pmid23204694">{{cite journal| author=Sreekar H, Saraf V, Pangi AC, Sreeharsha H, Reddy R, Kamat G| title=A retrospective study of 75 cases of splenic abscess. | journal=Indian J Surg | year= 2011 | volume= 73 | issue= 6 | pages= 398-402 | pmid=23204694 | doi=10.1007/s12262-011-0370-y | pmc=3236272 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23204694 }} </ref>
* [[Fistula]] formation with [[abscess]]<ref name="pmid15855993">{{cite journal| author=Nikolaidis N, Giouleme O, Gkisakis D, Grammatikos N| title=Posttraumatic splenic abscess with gastrosplenic fistula. | journal=Gastrointest Endosc | year= 2005 | volume= 61 | issue= 6 | pages= 771-2 | pmid=15855993 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15855993 }} </ref>
|valign=top|
* Wound infection
* [[Paralytic ileus]]
* [[Deep vein thrombosis]]
* [[Meningitis]]
|}

===Prognosis===
Prognosis of splenic abscess depends on the time of diagnosis and treatment. Delay in the management can lead to [[splenic rupture]] followed by spilling into [[peritoneal cavity]] or an adjacent organ which can lead to [[septicemia]] and death in severe cases.

==Association==
Splenic abscess is commonly associate with:<ref name="pmid23204694">{{cite journal| author=Sreekar H, Saraf V, Pangi AC, Sreeharsha H, Reddy R, Kamat G| title=A retrospective study of 75 cases of splenic abscess. | journal=Indian J Surg | year= 2011 | volume= 73 | issue= 6 | pages= 398-402 | pmid=23204694 | doi=10.1007/s12262-011-0370-y | pmc=3236272 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23204694 }} </ref>
* [[Liver disease|Paranchymal liver disease]]
* [[Pancreatitis]]
* [[Pleural effusion]]
* [[Renal cysts]]
* [[Ovarian cysts]]
* [[Lymphadenopathy|Abdominal lymphadenopathy]]
==Diagnosis==
Splenic abscess commonly present with a triad of symptoms include [[fever]], [[Nausea and vomiting|nausea, vomiting]] and [[abdominal pain]] along with palpable spleen on examination. Early diagnosis with imaging studies and prompt drainage is required to reduce morbidity and mortality. Presence of [[fever]], left upper abdominal pain, [[leukocytosis]] and radiologic evidence shows pathology in the left [[chest X-ray]] especially in [[immunocompromised]] patients are the indications for high suspicion of splenic abscess.

===History and Symptoms===
Common symptoms of splenic abscess include:<ref name="pmid3300398">{{cite journal| author=Nelken N, Ignatius J, Skinner M, Christensen N| title=Changing clinical spectrum of splenic abscess. A multicenter study and review of the literature. | journal=Am J Surg | year= 1987 | volume= 154 | issue= 1 | pages= 27-34 | pmid=3300398 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3300398 }} </ref><ref name="pmid9240961">{{cite journal| author=Ooi LL, Leong SS| title=Splenic abscesses from 1987 to 1995. | journal=Am J Surg | year= 1997 | volume= 174 | issue= 1 | pages= 87-93 | pmid=9240961 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9240961 }} </ref>
* [[Fever]]
* [[Left upper quadrant abdominal pain|Abdominal pain localized in the left upper quadrant]] or mesogastrium
* [[Nausea and vomiting]]
* Constitutional symptoms such as [[fatigue]], loss of body weight, sweat and chills
Other symptoms include:<ref name="pmid4550054">{{cite journal| author=Gadacz T, Way LW, Dunphy JE| title=Changing clinical spectrum of splenic abscess. | journal=Am J Surg | year= 1974 | volume= 128 | issue= 2 | pages= 182-7 | pmid=4550054 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4550054 }} </ref>
* [[Referred pain]] in the left shoulder
* [[Confusion]]
* Pain in the left lower hemithorax
* [[Cough]]

===Physical Examination Findings===
===Appearance===
Patient with splenic abscess appear ill appearing and [[diaphoretic]]
===Vital signs===
* [[Fever|High-grade fever]]
* [[Tachycardia]]
If patient present with sepsis:
* [[Hypotension]]
* [[Tachycardia]]
* Increased [[capillary refill time]]
Signs of sepsis indicate that splenic abscess is most likely due to bacterial cause than fungal source.<ref name="pmid3300398">{{cite journal| author=Nelken N, Ignatius J, Skinner M, Christensen N| title=Changing clinical spectrum of splenic abscess. A multicenter study and review of the literature. | journal=Am J Surg | year= 1987 | volume= 154 | issue= 1 | pages= 27-34 | pmid=3300398 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3300398 }} </ref>

===Heart===
* New onset [[Heart murmur|murmur]] may be present
===Lungs===
* Left sided pleural effusion may be present with signs of:
** Decreased [[breath sounds]] on left side
** Dullness to percussion on left side
** Absent [[tactile fremitus]] on left side
** [[Friction rub]] over the left chest

===Abdomen ===
'''Palpation'''
* Tender [[splenomegaly]]
* Palpable spleen or abdominal mass
'''Auscultation'''
* [[Friction rub]] over the spleen<ref name="pmid4550054">{{cite journal| author=Gadacz T, Way LW, Dunphy JE| title=Changing clinical spectrum of splenic abscess. | journal=Am J Surg | year= 1974 | volume= 128 | issue= 2 | pages= 182-7 | pmid=4550054 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4550054 }} </ref>

===Laboratory Tests===
===Blood Tests===
Blood tests such [[leukocytosis]] are increased but not significant in the diagnosis of splenic abscess because these tests may not be appropriate in immunocompromised patients.
* CBC with differential
* [[Erythrocyte Sedimentation Rate|Erythrocyte sedimentation rate]] ([[Erythrocyte sedimentation rate|ESR]])
* '''Microbiological tests:''' In solitary abscesses blood culture is not sensitive in the initial stages when as in multiple abscesses it is helpful in prompt diagnosis and early treatment.<ref name="pmid4550054">{{cite journal| author=Gadacz T, Way LW, Dunphy JE| title=Changing clinical spectrum of splenic abscess. | journal=Am J Surg | year= 1974 | volume= 128 | issue= 2 | pages= 182-7 | pmid=4550054 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4550054 }} </ref>
** [[Gram staining|Gram stain]]
** Bacterial culture
** Abscess culture
* '''Mycological tests'''
** [[KOH test]]
** Fungal culture

===Diagnostic Evaluation of Splenic abscess===
{{Family tree/start}}
{{Family tree | | | | | | | | | | | | | | | | A01 | | | | | | | | | | | | |A01= '''Suspicion of splenic abscess''' (Patients with [[immunodeficiency|immunodeficiency disorders]], [[fever]], changes in [[chest X-ray]], [[abdominal pain]]) }}
{{Family tree | | | | | | | | | | | | | | | | |!| | | | | | | | | | | | | |}}
{{Family tree | | | | | | | | | | | | | | | | B01 | | | | | | | | | | | | |B01= '''Blood culture'''}}
{{Family tree | | | | | | | | | | | | | | | | |!| | | | | | | | | | | | | |}}
{{Family tree | | | | | | | | | | | | | | | | C01 | | | | | | | | | | | | |C01='''Patient with [[immunodeficiency|immunodeficiency disorders]]?'''}}
{{Family tree | | | | | | | |,|-|-|-|-|-|-|-|-|^|-|-|-|-|-|-|-|-|.| | | | |}}
{{Family tree | | | | | | | D01 | | | | | | | | | | | | | | | | D02 | | | |D01='''If immunodeficent patient''' Initiate wide spectrum antibiotics + antifungal medication|D02='''If [[immunocompetent]] patient''' Initiate wide spectrum antibiotics}}
{{Family tree | | | | | | | |`|-|-|-|-|-|-|-|-|v|-|-|-|-|-|-|-|-|'| | | | |}}
{{Family tree | | | | | | | | | | | | | | | | E01 |-|-| E02 | | | | | | | |E01=[[Ultrasound]] of abdominal cavity, [[CT scan]] with contrast|E02=If imaging shows negative or equivocal with high clinical '''suspicion of splenic abscess''' }}
{{Family tree | | | | | | | | | | | | | | | | |!| | | | |!| | | | | | | | |}}
{{Family tree | | | | | | | | | | | | | | | | |!| | | | E03 | | | | | | | |E03='''Arteriography'''}}
{{Family tree | | | | | | | |,|-|-|-|-|-|-|-|-|^|-|-|-|-|^|-|-|-|.| | | | |}}
{{Family tree | | | | | | | G01 | | | | | | | | | | | | | | | | G02 | | | |G01='''Presence of indications for minimally invasive procedures''' |G02='''Absence of indications for minimally invasive procedures'''}}
{{Family tree | | | | | | | |!| | | | | | | | | | | | | | | | | |!| | | | |}}
{{Family tree | | | | | | | G03 | | | | | | | | | | | | | | | | |!| | | | |G03=Aspiration or abscess drainage under US or CT guidance}}
{{Family tree | | |,|-|-|-|-|^|-|-|-|-|-|-|-|.| | | | | | | | | |!| | | | |}}
{{Family tree | | H01 | | | | | | | | | | | H02 | | | | | | | | |!| | | | |H01=Abscess cavity content culture, modification of antibiotic therapy according to culture results; Prolonged antibiotic therapy|H02=If ineffective drainage or recurrent abscess}}
{{Family tree | | | | | | | | | | | | | | | |`|-|-|-|-|v|-|-|-|-|'| | | | |}}
{{Family tree | | | | | | | | | | | | | | | | | | | | I01 | | | | | | | | |I01='''[[Spleenectomy]] or Open abscess drainage'''}}
{{Family tree | | | | | | | | | | | | | | | | | | | | |!| | | | | | | | | |}}
{{Family tree | | | | | | | | | | | | | | | | | | | | J01 | | | | | | | | |J01=Abscess cavity content culture, modification of antibiotic therapy according to culture results; Prolonged antibiotic therapy}}
{{Family tree/end}}

===Imaging Findings===
As the clinical features of splenic absecess are non specific and vague such as abdominal pain, fever and vomiting, that makes diagnosis is challenging and relied on imaging modalities. Imaging studies such as [[ultrasound]], [[computerized tomography]] made the diagnosis early and more accurate that reduces morbidity and mortality.<ref name="pmid12185032">{{cite journal| author=Thanos L, Dailiana T, Papaioannou G, Nikita A, Koutrouvelis H, Kelekis DA| title=Percutaneous CT-guided drainage of splenic abscess. | journal=AJR Am J Roentgenol | year= 2002 | volume= 179 | issue= 3 | pages= 629-32 | pmid=12185032 | doi=10.2214/ajr.179.3.1790629 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12185032 }} </ref>

====X-ray====
'''Advantages'''
* High [[sensitivity]]
* Directly points to pathological changes
* It is the first line of examination for patients suspected of an ongoing infection
* Can determine [[phrenic]]/ [[Diaphragmatic Elevation|diaphragmatic dome]] positioning and air-fluid level in the left [[hypochondrium]]
Common '''chest x- ray''' findings includes:
* Elevated and immobile left [[diaphragm]]
* Ipsilateral [[pleural effusion]]
* [[Atelectasis|Atelectalic]] and inflammatory changes in interior lung lobe
Common '''abdominal x- ray''' findings includes:
* Shift of the stomach and colon by a soft tissue mass( splenic abscess) which is more rectangular than in other causes of splenomegaly
* Increased air-fluid levels with extra alimentary gas collection in the left upper quadrant<ref name="pmid14139921">{{cite journal| author=ZATZKIN HR, DRAZAN AD, IRWIN GA| title=ROENTGENOGRAPHIC DIAGNOSIS OF SPLENIC ABSCESS. | journal=Am J Roentgenol Radium Ther Nucl Med | year= 1964 | volume= 91 | issue= | pages= 896-9 | pmid=14139921 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14139921 }} </ref>
[[File:Splenic abscess chest x-ray.jpg|500px]]

====Ultrasound====
Ultrasound shows lesions of mixed echogenicity i.e anechoic central zone with a surrounding hyperechoic area.<ref name="pmid7039270">{{cite journal| author=Ralls PW, Quinn MF, Colletti P, Lapin SA, Halls J| title=Sonography of pyogenic splenic abscess. | journal=AJR Am J Roentgenol | year= 1982 | volume= 138 | issue= 3 | pages= 523-5 | pmid=7039270 | doi=10.2214/ajr.138.3.523 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7039270 }} </ref><ref name="pmid6976726">{{cite journal| author=Pawar S, Kay CJ, Gonzalez R, Taylor KJ, Rosenfield AT| title=Sonography of splenic abscess. | journal=AJR Am J Roentgenol | year= 1982 | volume= 138 | issue= 2 | pages= 259-62 | pmid=6976726 | doi=10.2214/ajr.138.2.259 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6976726 }} </ref>

'''Advantages''' 
* Emergency radiography with high sensitivity (75-100%)<ref name="pmid9403539">{{cite journal| author=Phillips GS, Radosevich MD, Lipsett PA| title=Splenic abscess: another look at an old disease. | journal=Arch Surg | year= 1997 | volume= 132 | issue= 12 | pages= 1331-5; discussion 1335-6 | pmid=9403539 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9403539 }} </ref><ref name="pmid8161087">{{cite journal| author=Paris S, Weiss SM, Ayers WH, Clarke LE| title=Splenic abscess. | journal=Am Surg | year= 1994 | volume= 60 | issue= 5 | pages= 358-61 | pmid=8161087 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8161087 }} </ref>
* Non invasive
* Cost effective
* Determine the size of the spleen, size of the abscess, its location and [[echogenicity]]
[[File:Splenic abscess ultrasound.jpg|500px]][[File:Multiple splenic abscesses ultrasound.jpg|500px]]

====CT images====
Computerised tomography with contrast is both diagnostic and therapeutic test of choice for splenic abscess.<ref name="pmid2589597">{{cite journal| author=Faught WE, Gilbertson JJ, Nelson EW| title=Splenic abscess: presentation, treatment options, and results. | journal=Am J Surg | year= 1989 | volume= 158 | issue= 6 | pages= 612-4 | pmid=2589597 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2589597 }} </ref><ref name="pmid11206904">{{cite journal| author=Green BT| title=Splenic abscess: report of six cases and review of the literature. | journal=Am Surg | year= 2001 | volume= 67 | issue= 1 | pages= 80-5 | pmid=11206904 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11206904 }} </ref>
 '''Advantages'''
* High [[sensitivity]] (88-100%)
* Can differentiate unolocular and multilocular abscesses
* Can identify the contents of abscess
* Can determine the density index of abscess.
* Can differentiate splenic abscess from [[Splenic cyst|splenic cysts]] and [[Splenic hemangioma|splenic hematomas]]
* More precise and accurate than ultrasonography, in identifying the location of abscess in relation to other internal organs during per-cutaneous drainage.
* It is superior to all other diagnostic tests for splenic abscess.
|valign=top|
Scintigraphic studies include [[technetium-99m]] liver and spleen scans, [[gallium]] scans, and [[indium]] scans. Splenic scan is diagnostic modality to identify abscesses which relies upon splenic uptake of the [[Technetium-99m|radionuclide 99m technetium]] which shows abscess as a negative or filling defect.

'''Advantages'''
* High [[specificity]]: If patient showing high suspicion of splenic abscess and scan supports the diagnosis, then [[splenectomy]] can be performed.
'''Disadvantages:'''
* Scan can not identifie or visualize incurable small abscesses.<ref name="pmid4550054">{{cite journal| author=Gadacz T, Way LW, Dunphy JE| title=Changing clinical spectrum of splenic abscess. | journal=Am J Surg | year= 1974 | volume= 128 | issue= 2 | pages= 182-7 | pmid=4550054 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4550054 }} </ref>
* Less sensitive: If the scan shows negative or equivocal results for splenci abscess but clinical suspicion remains, an arteriogram should be ordered.
[[File:Splenic abscess CT images.gif|500px]]

===Other Imaging Studies===
====Scintigraphic studies====
Scintigraphic studies include [[technetium-99m]] liver and spleen scans, [[gallium]] scans, and [[indium]] scans. Splenic scan is diagnostic modality to identify abscesses which relies upon splenic uptake of the [[Technetium-99m|radionuclide 99m technetium]] which shows abscess as a negative or filling defect.

'''Advantages'''
* High [[specificity]]: If patient showing high suspicion of splenic abscess and scan supports the diagnosis, then [[splenectomy]] can be performed.
'''Disadvantages:'''
* Scan can not identifie or visualize incurable small abscesses.<ref name="pmid4550054">{{cite journal| author=Gadacz T, Way LW, Dunphy JE| title=Changing clinical spectrum of splenic abscess. | journal=Am J Surg | year= 1974 | volume= 128 | issue= 2 | pages= 182-7 | pmid=4550054 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4550054 }} </ref>
* Less sensitive: If the scan shows negative or equivocal results for splenci abscess but clinical suspicion remains, an arteriogram should be ordered.
====Arteriography====
Arteriography is the technique that involves injection of contrast material through a catheter passed retrograde into the [[splenic artery]] followed by rapid exposure of sequential x-ray films which shows abscesses as filling defects in the spleen.

'''Advantages:'''

More reliable and precise than splenic scan in diagnosing small abscesses.

'''Disadvantages:'''
* Invasive technique

==Treatment==
===Medical Therapy===
Antibiotic regimen should start before the procedure and continue until 7 days after the procedure. Diagnostic needle aspiration is very important in the management with antibiotics as blood culture may not be the best correlate as abscess culture. Anitbiotic of choice depends on the organism, but aggressive and early surgical intervention of splenic abscess should be encouraged especially when the risk factors are present. High suspicion of splenic abscess with history of risk factors, broad-spectrum empirical antibiotic therapy should be initiated <ref name="pmid14139921">{{cite journal| author=ZATZKIN HR, DRAZAN AD, IRWIN GA| title=ROENTGENOGRAPHIC DIAGNOSIS OF SPLENIC ABSCESS. | journal=Am J Roentgenol Radium Ther Nucl Med | year= 1964 | volume= 91 | issue= | pages= 896-9 | pmid=14139921 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14139921 }} </ref> Empiric antibiotic should cover [[Streptococcus|streptococci]], [[Staphylococcus aureus|staphylococci]], and [[Gram-negative bacteria|aerobic gram-negative rods]] such as [[Vancomycin]] or [[oxacillin]] plus an [[aminoglycoside]], a third- or fourth-generation [[cephalosporin]], [[fluoroquinolone]], or [[carbapenem]]. If culture shows fungi as causative organism, start [[Amphotericin B]] immediately and continue for 6-24 weeks and during the procedure [[amphotericin B]] should be administered directly into the abscess.<ref name="pmid6385895">{{cite journal| author=Johnson JD, Raff MJ| title=Fungal splenic abscess. | journal=Arch Intern Med | year= 1984 | volume= 144 | issue= 10 | pages= 1987-93 | pmid=6385895 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6385895 }} </ref>

===Surgery===
Treatment of splenic abscess depends on etiology. In bacterial abscesses, [[splenectomy]] combined with post-operative antibiotic therapy is the most appropriate treatment of choice with least mortality rate when compared to percutaneous drainage or antimicrobial therapy.<ref name="pmid16489650">{{cite journal| author=Chang KC, Chuah SK, Changchien CS, Tsai TL, Lu SN, Chiu YC et al.| title=Clinical characteristics and prognostic factors of splenic abscess: a review of 67 cases in a single medical center of Taiwan. | journal=World J Gastroenterol | year= 2006 | volume= 12 | issue= 3 | pages= 460-4 | pmid=16489650 | doi= | pmc=4066069 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16489650 }} </ref>
====Percutaneous Drainage====
Percutaneous drainage is the initial tretament of choice for splenic abscess, even though [[Splenectomy|splenectom]]<nowiki/>y is the definitive treatment because of increased risk of infections in splenectomised patient.<ref name="pmid17143953">{{cite journal| author=Zerem E, Bergsland J| title=Ultrasound guided percutaneous treatment for splenic abscesses: the significance in treatment of critically ill patients. | journal=World J Gastroenterol | year= 2006 | volume= 12 | issue= 45 | pages= 7341-5 | pmid=17143953 | doi= | pmc=4087495 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17143953 }} </ref><ref name="pmid16410091">{{cite journal| author=Choudhury S R, Rajiv C, Pitamber S, Akshay S, Dharmendra S| title=Management of splenic abscess in children by percutaneous drainage. | journal=J Pediatr Surg | year= 2006 | volume= 41 | issue= 1 | pages= e53-6 | pmid=16410091 | doi=10.1016/j.jpedsurg.2005.10.085 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16410091 }} </ref> It is genereally done under the guidance of imaging studies such as [[ultrasound]] or [[computerised tomography]] and under the guidence of imaging efficy of percuteneous drainage is equivalent to [[splenectomy]].<ref name="pmid3521422">{{cite journal| author=Teich S, Oliver GC, Canter JW| title=The early diagnosis of splenic abscess. | journal=Am Surg | year= 1986 | volume= 52 | issue= 6 | pages= 303-7 | pmid=3521422 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3521422 }} </ref><ref name="pmid1450832">{{cite journal| author=Hadas-Halpren I, Hiller N, Dolberg M| title=Percutaneous drainage of splenic abscesses: an effective and safe procedure. | journal=Br J Radiol | year= 1992 | volume= 65 | issue= 779 | pages= 968-70 | pmid=1450832 | doi=10.1259/0007-1285-65-779-968 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1450832 }} </ref>
* First line of treatment for splenic abscess
* Safe and effective than surgery in both unilocular and bilocular abscesses, especially in peripherally located abscesses.
* Preferred in critically ill patient and patients unfit for general anesthesia
'''Advantages'''
* Preserves spleen. So, it become the the treatment of choice in children to prevent post-splenectomy [[septicemia]]<ref name="pmid14530888">{{cite journal| author=Kang M, Saxena AK, Gulati M, Suri S| title=Ultrasound-guided percutaneous catheter drainage of splenic abscess. | journal=Pediatr Radiol | year= 2004 | volume= 34 | issue= 3 | pages= 271-3 | pmid=14530888 | doi=10.1007/s00247-003-1068-5 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14530888 }} </ref>
* No abdominal spillage of abscess contents
* Less expensive, high acceptance rate and less operative risk
'''Complications'''
* Splenic [[haemorrhage]]
* Injury to other abdominal organs
* [[Septicemia]]
* [[Empyema]]
* [[Pneumothorax]]
* [[Fistula|Fistula formation]]
* [[Deep vein thrombosis]]
'''Contraindications or limitations'''
* Multiple or septated abscesses<ref name="pmid3977590">{{cite journal| author=Gerzof SG, Johnson WC, Robbins AH, Nabseth DC| title=Expanded criteria for percutaneous abscess drainage. | journal=Arch Surg | year= 1985 | volume= 120 | issue= 2 | pages= 227-32 | pmid=3977590 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3977590 }} </ref><ref name="pmid9403539">{{cite journal| author=Phillips GS, Radosevich MD, Lipsett PA| title=Splenic abscess: another look at an old disease. | journal=Arch Surg | year= 1997 | volume= 132 | issue= 12 | pages= 1331-5; discussion 1335-6 | pmid=9403539 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9403539 }} </ref><ref name="pmid8343056">{{cite journal| author=Ho HS, Wisner DH| title=Splenic abscess in the intensive care unit. | journal=Arch Surg | year= 1993 | volume= 128 | issue= 8 | pages= 842-6; discussion 846-8 | pmid=8343056 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8343056 }} </ref>
* Anatomically inaccessible for drainage such as upper pole or hilar of the spleen,
* Uncontrolled [[coagulopathies]]
* [[Ascites]]
* Simultaneous surgical procedure required of other indications such as [[subphrenic abscess]]
* Abscess [[perforation]] or bleeding
* Refractoriness to abscess-content drainage
* Secondary infected [[Splenic hemangioma|spleen hematoma]]
====Splenectomy====
Splenectomy is the most effective and definitive treatment of choice for splenic abscess. splenectomy can be performed either from left subcostal incision or from midline epigastric entry.
 '''Advantages'''
* Definitive treatment for splenic abscess
* Treatment of choice if more than 2 abscesses are present
* Patients with failed percutaneous drainage
* Patient with recurrent abscesses
'''Disadvantages'''
* Splenecetomisesd patients are more prone to infections especially catalase positive bacteria such as [[Streptococcus pneumoniae]].
* Mortality rate varies between 0-20% <ref name="pmid11206904">{{cite journal| author=Green BT| title=Splenic abscess: report of six cases and review of the literature. | journal=Am Surg | year= 2001 | volume= 67 | issue= 1 | pages= 80-5 | pmid=11206904 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11206904 }} </ref>
* Extended duration operation time, larger volume of intra-operative blood loss
* Longer duration of hospital stay than percutaneous drainage procedure
'''Complications'''
* [[Lung infection]]
* Wound infection
* [[Septicemia]]
* [[Paralytic ileus]]
* [[Deep vein thrombosis]]

==Prevention==
===Primary Prevention===
Primary prevention for splenic abscess can prevent in specific cases especially patients who are at high risk such as [[Immunocompromised|immunocompromised patients]] (e.g. recipients of [[Renal transplantation|renal transplants]] or patients on [[immunosuppressive drugs]] for other reasons).
* In transplant patients best way to prevent splenic abscess is by [[splenectomy]], where as in patients with other immunocompromised states it can be achieved by proper care, early detection and aggressive treatment of minor infections.<ref name="pmid4550054">{{cite journal| author=Gadacz T, Way LW, Dunphy JE| title=Changing clinical spectrum of splenic abscess. | journal=Am J Surg | year= 1974 | volume= 128 | issue= 2 | pages= 182-7 | pmid=4550054 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4550054 }} </ref>
* Avoid [[Intravenous drug use|intravenous drug abuse]]

==References==
{{reflist|2}}

[[Category:Hematology]]
[[Category:Gastroenterology]]
[[Category:Infectious disease]]

{{WS}}
{{WH}}

Leptospirosis

2017-03-20T22:26:02Z

Venkata Sivakrishna Kumar Pulivarthi: /* Treatment */

__NOTOC__
{{Leptospirosis}}

{{CMG}};{{AE}}{{VSKP}}

{{About1|Leptospira}}
'''For patient information on this page, click [[Leptospirosis (patient information)|here]]'''

{{SK}} Cane cutter's fever; Harvest fever; Infection due to Leptospira; Japanese autumnal fever; Queensland fever; Rice-field worker's disease; Seven day fever; Spirochaetal jaundice; Mud fever; Swamp fever; Cane field fever; Fort Bragg fever; Tibial fever; Haemorrhagic jaundice; Spirochetosis; Canicola fever; Rat Catcher’s yellows disease; Swineherds disease

==[[Leptospirosis overview|Overview]]==

==[[Leptospirosis historical perspective|Historical Perspective]]==

==[[Leptospirosis classification|Classification]]==

==[[Leptospirosis pathophysiology|Pathophysiology]]==

==[[Leptospirosis causes|Causes]]==

==[[Leptospirosis differential diagnosis|Differentiating Leptospirosis from other Diseases]]==

==[[Leptospirosis epidemiology and demographics|Epidemiology and Demographics]]==

==[[Leptospirosis risk factors|Risk Factors]]==

==[[Leptospirosis natural history, complications and prognosis|Natural History, Complications and Prognosis]]==

==Diagnosis==
[[Leptospirosis history and symptoms| History and Symptoms]] | [[Leptospirosis physical examination | Physical Examination]] | [[Leptospirosis laboratory findings|Laboratory Findings]] | [[Leptospirosis other imaging findings|Other Imaging Findings]] | [[Leptospirosis other diagnostic studies|Other Diagnostic Studies]] | [[Leptospirosis criteria]]

==Treatment==
[[Leptospirosis medical therapy|Medical Therapy]] | [[Leptospirosis primary prevention|Primary Prevention]] | [[Leptospirosis cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Leptospirosis future or investigational therapies|Future or Investigational Therapies]]

==Case Studies==
[[Leptospirosis case study one|Case#1]]

==Related Chapters==
* [[Leptospira]]

==External links==
* [http://www.leptospirosis.org/ The Leptospirosis Information Center]
* [http://www.cdc.gov/ncidod/dbmd/diseaseinfo/leptospirosis_g.htm U.S. Disease Control and Prevention Center page on Leptospirosis]
* [http://www.leptonet.net/ www.leptonet.net - the Leptospirosis information portal]
* [http://www.med.monash.edu.au/microbiology/staff/adler/ils.html International Leptospirosis Society page]
*[http://www.jpgmonline.com/showbackissue.asp?issn=0022-3859;year=2005;volume=51;issue=4;month=October-December;year=2005;volume=51;issue=3 A Symposium on Leptospirosis: Collection of peer-reviewed articles from The Journal of Postgraduate Medicine]
*[http://www.leptoinfo.com leptoinfo.com - A website for Dog Owners and Veterinary Professionals dedicated to sharing information on Leptospirosis in Canada]

[[Category:Bacterial diseases]]
[[Category:Zoonoses]]
[[Category:Rat carried diseases]]
[[Category:Disease]]
[[Category:Infectious disease]]

{{WikiDoc Help Menu}}
{{WikiDoc Sources}}
{{jb1}}

Leptospirosis

2017-03-20T22:25:14Z

Venkata Sivakrishna Kumar Pulivarthi: /* Diagnosis */

__NOTOC__
{{Leptospirosis}}

{{CMG}};{{AE}}{{VSKP}}

{{About1|Leptospira}}
'''For patient information on this page, click [[Leptospirosis (patient information)|here]]'''

{{SK}} Cane cutter's fever; Harvest fever; Infection due to Leptospira; Japanese autumnal fever; Queensland fever; Rice-field worker's disease; Seven day fever; Spirochaetal jaundice; Mud fever; Swamp fever; Cane field fever; Fort Bragg fever; Tibial fever; Haemorrhagic jaundice; Spirochetosis; Canicola fever; Rat Catcher’s yellows disease; Swineherds disease

==[[Leptospirosis overview|Overview]]==

==[[Leptospirosis historical perspective|Historical Perspective]]==

==[[Leptospirosis classification|Classification]]==

==[[Leptospirosis pathophysiology|Pathophysiology]]==

==[[Leptospirosis causes|Causes]]==

==[[Leptospirosis differential diagnosis|Differentiating Leptospirosis from other Diseases]]==

==[[Leptospirosis epidemiology and demographics|Epidemiology and Demographics]]==

==[[Leptospirosis risk factors|Risk Factors]]==

==[[Leptospirosis natural history, complications and prognosis|Natural History, Complications and Prognosis]]==

==Diagnosis==
[[Leptospirosis history and symptoms| History and Symptoms]] | [[Leptospirosis physical examination | Physical Examination]] | [[Leptospirosis laboratory findings|Laboratory Findings]] | [[Leptospirosis other imaging findings|Other Imaging Findings]]

==Treatment==
[[Leptospirosis medical therapy|Medical Therapy]] | [[Leptospirosis primary prevention|Primary Prevention]] | [[Leptospirosis secondary prevention|Secondary Prevention]] | [[Leptospirosis cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Leptospirosis future or investigational therapies|Future or Investigational Therapies]]

==Case Studies==
[[Leptospirosis case study one|Case#1]]

==Related Chapters==
* [[Leptospira]]

==External links==
* [http://www.leptospirosis.org/ The Leptospirosis Information Center]
* [http://www.cdc.gov/ncidod/dbmd/diseaseinfo/leptospirosis_g.htm U.S. Disease Control and Prevention Center page on Leptospirosis]
* [http://www.leptonet.net/ www.leptonet.net - the Leptospirosis information portal]
* [http://www.med.monash.edu.au/microbiology/staff/adler/ils.html International Leptospirosis Society page]
*[http://www.jpgmonline.com/showbackissue.asp?issn=0022-3859;year=2005;volume=51;issue=4;month=October-December;year=2005;volume=51;issue=3 A Symposium on Leptospirosis: Collection of peer-reviewed articles from The Journal of Postgraduate Medicine]
*[http://www.leptoinfo.com leptoinfo.com - A website for Dog Owners and Veterinary Professionals dedicated to sharing information on Leptospirosis in Canada]

[[Category:Bacterial diseases]]
[[Category:Zoonoses]]
[[Category:Rat carried diseases]]
[[Category:Disease]]
[[Category:Infectious disease]]

{{WikiDoc Help Menu}}
{{WikiDoc Sources}}
{{jb1}}

Leptospirosis physical examination

2017-03-20T22:23:32Z

Venkata Sivakrishna Kumar Pulivarthi: /* Neck */

__NOTOC__
{{Leptospirosis}}
{{CMG}};{{AE}}{{VSKP}}
==Overview==
Physical examination findings of leptospirosis depends upon the severity of the disease. In the early days of the disease, patient may show signs of upper respiratory tract infections, later findings varies with the severity of the disease, immune status of the host and the organ system involved.

==Physical Examination Findings==
=== Appearance of the Patient ===
* Patient present with [[irritability]] and [[restlessness]].

=== Vital Signs ===
* [[Hypotension]] and circulatory collapse.
* [[Tachypnea]]
* [[Tachycardia]]

=== Skin ===
* [[Macular]], [[maculopapular]] [[erythematous]] skin eruptions are seen in the [[face]] and [[trunk]].<ref name="pmid14902167">{{cite journal| author=BEESON PB, HANKEY DD| title=Leptospiral meningitis. | journal=AMA Arch Intern Med | year= 1952 | volume= 89 | issue= 4 | pages= 575-83 | pmid=14902167 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14902167 }} </ref>
* [[Purpura]] due to [[thrombocytopenia]].
<gallery>File:Leptospirosis rash.jpg</gallery>

=== HEENT ===
* Icteric [[sclera]] is seen in patients with icteric leptospirosis
* Conjunctival suffusion: a charecterestic finding seen in patients with anicteric leptosirosis. Usually bilaeral and involving palpebral [[conjunctiva]].<ref name="Budihal2014">{{cite journal|last1=Budihal|first1=Suman Veerappa|title=Leptospirosis Diagnosis: Competancy of Various Laboratory Tests|journal=JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH|year=2014|issn=2249782X|doi=10.7860/JCDR/2014/6593.3950}}</ref>
* Conjunctival hemorrhages: may be unilateral or bilateral.<ref name="pmid1224630">{{cite journal| author=King SD, Urquhart AE| title=Laboratory investigations on four cases of leptospiral meningitis in Jamaica. | journal=West Indian Med J | year= 1975 | volume= 24 | issue= 4 | pages= 196-201 | pmid=1224630 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1224630 }} </ref>
<gallery>File:Leptospirosis eye.jpg</gallery>

=== Lungs ===
* [[Crepitations]] common in basal regions

=== Abdomen ===
* [[Right upper quadrant]] [[Tenderness (medicine)|tenderness]]<ref name="pmid9071036">{{cite journal| author=Silva MV, Camargo ED, Batista L, Vaz AJ, Ferreira AW, Barbosa PR| title=Application of anti-leptospira ELISA-IgM for the etiologic elucidation of meningitis. | journal=Rev Inst Med Trop Sao Paulo | year= 1996 | volume= 38 | issue= 2 | pages= 153-6 | pmid=9071036 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9071036 }} </ref>

* [[Hepatomegaly]]

=== Genitourinary ===

=== Extremities ===
* [[Edema]] of the [[extremities]]
* [[Cool extremities|cold clammy extremities]]

=== Neuromuscular ===
Signs of [[meningitis]] such as [[neck stiffness]], [[nuchal rigidity]] are present.

Other signs include:
* [[Nystagmus]]
* [[Spasticity]]

==References==
{{reflist|2}}

[[Category:Infectious disease]]
[[Category:Diseases]]

Leptospirosis (patient information)

2017-03-10T17:37:51Z

Venkata Sivakrishna Kumar Pulivarthi: /* What causes Leptospirosis? */

__NOTOC__
{{Template:Leptospirosis (patient information)}}

'''For the WikiDoc page for this topic, click [[Leptospirosis|here]]'''

{{CMG}}

==Overview==

Leptospirosis is an infection that occurs when you come in contact with ''[[Leptospira]]'' bacteria.

==What are the symptoms of Leptospirosis?==

Symptoms can take 2 to 26 days (average 10 days) to develop, and may include:

:* [[Dry cough]]
:* [[Fever]]
:* [[Headache]]
:* [[Muscle pain]]
:* [[Nausea]], [[vomiting]], and [[diarrhea]]
:* [[Shaking chills]]

Less common symptoms include:

:* [[Abdominal pain]]
:* Abnormal lung sounds
:* [[Bone pain]]
:* [[Conjunctivitis]]
:* Enlarged lymph glands
:* [[Enlarged spleen]] or liver
:* [[Joint aches]]
:* [[Muscle rigidity]]
:* Muscle tenderness
:* [[Skin rash]]
:* [[Sore throat]]

==What causes Leptospirosis?==

The Leptospira bacteria can be found in fresh water that has been contaminated by animal urine. The infection occurs in warmer climates.

Leptospirosis is not spread from person to person, except in vary rare cases. It occasionally spreads through sexual intercourse, breast milk, or from a mother to her unborn child.

Risk factors include:

:* Occupational exposure -- farmers, ranchers, slaughterhouse workers, trappers, veterinarians, loggers, sewer workers, rice field workers, and military personnel
:* Recreational activities -- fresh water swimming, canoeing, kayaking, and trail biking in warm areas
:* Household exposure -- pet dogs, domesticated livestock, rainwater catchment systems, and infected rodents

Leptospirosis is rare in the continental United States. Hawaii has the highest number of cases in the United States. Recent out break of leptospirosis is reported in Bronx, New York and found 3 cases in the months January and February, 2017.

==Who is at highest risk?==

Outbreaks of leptospirosis are usually caused by exposure to water contaminated with the urine of infected animals. Many different kinds of animals carry the bacterium; they may become sick but sometimes have no symptoms. Leptospira organisms have been found in cattle, pigs, horses, dogs, rodents, and wild animals. Humans become infected through contact with water, food, or soil containing urine from these infected animals. This may happen by swallowing contaminated food or water or through skin contact, especially with mucosal surfaces, such as the eyes or nose, or with broken skin. The disease is not known to be spread from person to person.

==Diagnosis==

==When to seek urgent medical care?==

Contact your health care provider if you have any symptoms of, or risk factors for, leptospirosis.

==Treatment options==

Medications to treat leptospirosis include:

:* [[Ampicillin]]
:* [[Azithromycin]]
:* [[Ceftriaxone]]
:* [[Doxycycline]]
:* [[Penicillin]]

Complicated or serious cases may need supportive care or treatment in a hospital intensive care unit (ICU).

==Where to find medical care for Leptospirosis?==

1-800-CDC-INFO (1-800-262-4636)/TTY 1-888-232-6348 or

visit the website at http://www.cdc.gov/leptospirosis/

==Prevention==

The risk of acquiring leptospirosis can be greatly reduced by not swimming or wading in water that might be contaminated with animal urine.
Protective clothing or footwear should be worn by those exposed to contaminated water or soil because of their job or recreational activities.

==What to expect (Outlook/Prognosis)?==

The outlook is generally good. However, a complicated case can be life threatening if it is not treated promptly.

==Possible complications==

* [[Jarisch-Herxheimer]] reaction when penicillin is given
* [[Meningitis]]
* Severe [[bleeding]]

==Sources==

http://www.cdc.gov/leptospirosis/resources/index.html

http://www.nlm.nih.gov/medlineplus/ency/article/001376.htm

[[Category:Patient information]]

Leptospirosis epidemiology and demographics

2017-03-10T17:36:46Z

Venkata Sivakrishna Kumar Pulivarthi: /* Developed Countries */

__NOTOC__
{{Leptospirosis}}

{{CMG}};{{AE}}{{VSKP}}

==Overview==

Leptospirosis occurs worldwide but is most common in temperate or tropical climates. It is an occupational hazard for many people who work outdoors or with animals, for example, farmers, sewer workers, veterinarians, fish workers, dairy farmers, or military personnel. It is a recreational hazard for campers or those who participate in outdoor sports in contaminated areas and has been associated with swimming, wading, and whitewater rafting in contaminated lakes and rivers. The incidence is also increasing among urban children. Epidemiology of human leptospirosis is complex and dynamic, due to the interaction of pathogen, host, animal reservoir, and environment. With the increase in urban population, occupational and recreational exposure to surface water and climatic changes results in increase in prevalence of leptospirosis recently.

==Epidemiology and Demographics==
Leptospirosis caused by pathogenic Leptospira species have been found worldwide, except in Antarctica. It is most common in warm, humid environments and in the areas with a high disease incidence in humans include the Caribbean and Latin America, Oceania and parts of Asia. During the past few decades, leptospirosis has become seriously neglected, especially in countries of temperate regions. The main reasons for this situation are probably: 1) a relatively less number of cases noted in the temperate climate zone 2) well established, quite effective methods of therapy and prevention of the disease 3) seemingly well-determined epidemiologic situation concerning the disease.<ref name="pmid21414083">{{cite journal| author=Hartskeerl RA, Collares-Pereira M, Ellis WA| title=Emergence, control and re-emerging leptospirosis: dynamics of infection in the changing world. | journal=Clin Microbiol Infect | year= 2011 | volume= 17 | issue= 4 | pages= 494-501 | pmid=21414083 | doi=10.1111/j.1469-0691.2011.03474.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21414083 }} </ref>
===Prevalence===
Leptospirosis, is a [[zoonotic]] emerging infectious disease with a worldwide distribution.<ref name="pmid11292640">{{cite journal| author=Levett PN| title=Leptospirosis. | journal=Clin Microbiol Rev | year= 2001 | volume= 14 | issue= 2 | pages= 296-326 | pmid=11292640 | doi=10.1128/CMR.14.2.296-326.2001 | pmc=88975 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11292640 }} </ref> Tropical climatic conditions are most favourable for survival of leptospires and the morbidity is high due to extreme weather events such as cyclones and floods occurring in recent years.<ref name="pmid20813388">{{cite journal| author=Lau CL, Smythe LD, Craig SB, Weinstein P| title=Climate change, flooding, urbanisation and leptospirosis: fuelling the fire? | journal=Trans R Soc Trop Med Hyg | year= 2010 | volume= 104 | issue= 10 | pages= 631-8 | pmid=20813388 | doi=10.1016/j.trstmh.2010.07.002 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20813388 }} </ref><ref name="pmid19208981">{{cite journal| author=Vijayachari P, Sugunan AP, Shriram AN| title=Leptospirosis: an emerging global public health problem. | journal=J Biosci | year= 2008 | volume= 33 | issue= 4 | pages= 557-69 | pmid=19208981 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19208981 }} </ref> Leptospirosis is particularly prevalent in wet tropical and subtropical regions as the pathogenic leptospires can survive longer in a warm and humid environment.

===Incidence===
Leptospirosis is an increasing public health problem worldwide, evidenced by markedly increasing incidence rates and multiple outbreaks allover the world. Even though multiple outbreaks has been reported, the true spread and incidence of leptospirosis remains unknown, as the availability of diagnostic tests, testing facilities and surveillance systems are highly variable and frequently absent. Incidence rate in temperate climate is in a range of ~0.1–1 per 100000 per year and it is ~10–100 per 100 000 in the humid tropical regions. In high-exposure risk groups and during outbreaks, the incidence may be >100 per 100000.<ref>{{cite book | last = LastName | first = FirstName | title = Human leptospirosis : guidance for diagnosis, surveillance and control | publisher = World Health Organization | location = Geneva | year = 2003 | isbn = 9241545895 }}</ref>

===Case Fatality Rate===
Higher morbidity due to leptospirosis is observed in regions with higher proportion of surface fresh waters such as lakes, rivers, developed canal systems.<ref name="pmid16022779">{{cite journal| author=Jansen A, Schöneberg I, Frank C, Alpers K, Schneider T, Stark K| title=Leptospirosis in Germany, 1962-2003. | journal=Emerg Infect Dis | year= 2005 | volume= 11 | issue= 7 | pages= 1048-54 | pmid=16022779 | doi=10.3201/eid1107.041172 | pmc=3371786 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16022779 }} </ref><ref name="pmid16298537">{{cite journal| author=Baranton G, Postic D| title=Trends in leptospirosis epidemiology in France. Sixty-six years of passive serological surveillance from 1920 to 2003. | journal=Int J Infect Dis | year= 2006 | volume= 10 | issue= 2 | pages= 162-70 | pmid=16298537 | doi=10.1016/j.ijid.2005.02.010 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16298537 }} </ref> Case fatality rate due to leptospirosis is > 10%, and > 500,000 cases of severe leptospirosis are reported each year. Worldwide case fatality rates range from 3%-50%.<ref name="Abela-RidderSikkema2010">{{cite journal|last1=Abela-Ridder|first1=Bernadette|last2=Sikkema|first2=Reina|last3=Hartskeerl|first3=Rudy A.|title=Estimating the burden of human leptospirosis|journal=International Journal of Antimicrobial Agents|volume=36|year=2010|pages=S5–S7|issn=09248579|doi=10.1016/j.ijantimicag.2010.06.012}}</ref>

===Age===
Leptospirosis has no age predilection, but more sever form of the disease is common in the age group of ≤ 5 years or ≥ 65 years.<ref name="pmid22843698">{{cite journal| author=Forbes AE, Zochowski WJ, Dubrey SW, Sivaprakasam V| title=Leptospirosis and Weil's disease in the UK. | journal=QJM | year= 2012 | volume= 105 | issue= 12 | pages= 1151-62 | pmid=22843698 | doi=10.1093/qjmed/hcs145 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22843698 }} </ref>

===Gender===
Leptospirosis has no gender predilection usually, but due to high occupational exposure in men lead to high risk of disease incidence in male than female.<ref>{{cite web |url=http://www.ncdc.gov.in/writereaddata/mainlinkfile/File558.pdf |title= Leptospirosis |last=prasad |first=jagadeesh |date= |website= |publisher= |access-date= |quote=}}</ref>

===Developed Countries===
Leptospirosis is a zoonotic disease with global distribution, commonly occurs in tropical and subtropical regions. In United States most reported cases are seen in Hawaii.<ref name="pmid7935317">{{cite journal| author=Centers for Disease Control and Prevention (CDC)| title=National notifiable diseases reporting--United States, 1994. | journal=MMWR Morb Mortal Wkly Rep | year= 1994 | volume= 43 | issue= 43 | pages= 800-1 | pmid=7935317 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7935317 }} </ref>
[[File:Global distribution of leptospirosis.jpg|500px]] Recent out break of leptospirosis is reported in Bronx, New York and found 3 cases in the months January and February, 2017.

{|
! colspan="2" |Water born outbreaks in United States
|-
!colspan="1" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF| '''Place of outbreak'''}}
!colspan="1" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF| '''Number of cases reported'''}}
|-
|Philadelphia, 1939
!7
|-
|Georgia, 1940
!35
|-
|Wyoming, 1942
!24
|-
|Alabama, 1950
!50
|-
|Georgia, 1952
!26
|-
|South Dakota, 1956
!3
|-
|Florida, 1958
!9
|-
|Iowa, 1959
!40
|-
|Washington, 1964
!61
|-
|Tennessee, 1975
!7
|-
|Missouri, 1985
!4
|-
|Kauai, Hawaii, 1987
!8
|-
|Illinois, 1991
!5
|-
|Kauai, Hawaii, 1992
!8
|-
|Illinois & Wisconsin,1998
!74
|}

===Developing Countries===
Leptospirosis is a neglected disease with a greatest burden on impoverished populations from developing countries and tropical regions.<ref name="pmid16148523">{{cite journal| author=McBride AJ, Athanazio DA, Reis MG, Ko AI| title=Leptospirosis. | journal=Curr Opin Infect Dis | year= 2005 | volume= 18 | issue= 5 | pages= 376-86 | pmid=16148523 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16148523 }} </ref> Most of the tropical regions are developing countries and there is higher risk of exposure to the human population from the infected animals such as livestock, domestic pets, or wild or feral animals. It is a major public health problem in many developing countries, such as Latin America and South-East Asia where the climate is more favorable for leptospires.<ref name="Picardeau2013">{{cite journal|last1=Picardeau|first1=M.|title=Diagnosis and epidemiology of leptospirosis|journal=Médecine et Maladies Infectieuses|volume=43|issue=1|year=2013|pages=1–9|issn=0399077X|doi=10.1016/j.medmal.2012.11.005}}</ref> 90% of deaths due to leptospirosis occur due to pulmonary hemorrhage and [[acute renal failure]].<ref>{{cite web |url=http://www.ncdc.gov.in/writereaddata/mainlinkfile/File558.pdf |title= Leptospirosis |last=prasad |first=jagadeesh |date= |website= |publisher= |access-date= |quote=}}</ref>

[[File:Leptospirosis geographical distribution.jpg|thumb|center|400px]]

==References==
{{Reflist|2}}

[[Category:Disease]]
[[Category:Infectious disease]]

Leptospirosis overview

2017-03-10T16:50:33Z

Venkata Sivakrishna Kumar Pulivarthi: /* Prevention */

__NOTOC__
[[File:Leptospira.png|right|200px]]
{{Leptospirosis}}

{{CMG}};{{AE}}{{VSKP}}

==Overview==

'''Leptospirosis''' is a [[zoonotic]] disease caused by ''[[Leptospira]] sps.'' that affects [[human]]s and a wide range of animals, including mammals, birds, amphibians, and reptiles.<ref name=Leptospirosis> Leptospirosis. Centers for Disease Control and Prevention (2015). https://www.cdc.gov/leptospirosis/ Accessed on July 28, 2016 </ref> Even though leptospirosis is relatively rare in human, it is one of the world's most common [[Zoonosis|zoonotic disease]]. The infection is commonly transmitted to humans by carriers such as rodents and other mammals through contaminated water sources by animal [[urine]] to come in contact with unhealed breaks in the [[skin]], [[eye]]s or with the [[mucous membrane]]s. Due to the ability of leptospire, the can survive for a prolonged period outside the animal host, especially in the environment favored by warm moist conditions with a neutral pH, which makes the disease more prevalent in tropical and sub-tropical regions. Outside of [[Tropics|tropical]] areas, leptospirosis cases have a relatively distinct seasonality with most of them occurring August-September/February-March.<ref name="NORD">Leptospirosis. National Organization for Rare Diseases (2015). http://rarediseases.org/rare-diseases/leptospirosis/ Accessed on July 28, 2016 </ref> Recently, with the improved health and safety methods in the work place, more infections are occurring due to recreational activities rather than occupational exposure.<ref name="pmid2786228">{{cite journal| author=Philipp R, Waitkins S, Caul O, Roome A, McMahon S, Enticott R| title=Leptospiral and hepatitis A antibodies amongst windsurfers and waterskiers in Bristol City Docks. | journal=Public Health | year= 1989 | volume= 103 | issue= 2 | pages= 123-9 | pmid=2786228 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2786228 }} </ref><ref name="pmid1490212">{{cite journal| author=Philipp R, King C, Hughes A| title=Understanding of Weil's disease among canoeists. | journal=Br J Sports Med | year= 1992 | volume= 26 | issue= 4 | pages= 223-7 | pmid=1490212 | doi= | pmc=1479000 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1490212 }} </ref> Animal body fluids such as [[urine]], [[semen]] and products of [[conception]] with pathogenic [[Leptospira|leptospires]], pose a potential risk to humans through prolonged excretion of bacteria.Other less common mechanisms of transmission include direct infection from animal urine, human to human spread, sexual transmission and via breast milk.<ref name="pmid20186328">{{cite journal| author=Ganoza CA, Matthias MA, Saito M, Cespedes M, Gotuzzo E, Vinetz JM| title=Asymptomatic renal colonization of humans in the peruvian Amazon by Leptospira. | journal=PLoS Negl Trop Dis | year= 2010 | volume= 4 | issue= 2 | pages= e612 | pmid=20186328 | doi=10.1371/journal.pntd.0000612 | pmc=2826405 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20186328 }} </ref><ref name="pmid14166972">{{cite journal| author=SPINU I, TOPCIU V et al.| title=[MAN AS A VIRAL RESERVOIR IN AN EPIDEMIC OF LEPTOSPIROSIS OCCURRING IN THE JUNGLE]. | journal=Arch Roum Pathol Exp Microbiol | year= 1963 | volume= 22 | issue= | pages= 1081-100 | pmid=14166972 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14166972 }} </ref><ref name="pmid987112">{{cite journal| author=Kiktenko VS, Balashov NG, Rodina VN| title=Leptospirosis infection through insemination of animals. | journal=J Hyg Epidemiol Microbiol Immunol | year= 1976 | volume= 21 | issue= 2 | pages= 207-13 | pmid=987112 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=987112 }} </ref>

== Historical Perspective ==
Adof Weil is the first physician described about the severe form of leptospirosis and the name [[Weil's disease]] is named after him in the year 1886. He also described the [[jaundice]] with [[splenomegaly]], [[renal failure]], [[skin rash]] and conjunctival suffusion.<ref name="pmid25388129">{{cite journal| author=Adler B| title=History of leptospirosis and leptospira. | journal=Curr Top Microbiol Immunol | year= 2015 | volume= 387 | issue= | pages= 1-9 | pmid=25388129 | doi=10.1007/978-3-662-45059-8_1 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25388129 }} </ref> Japanees scientists Kitamura and Hara named this disease as autumn fever and seven day disease in 1918.<ref name="Kobayashi2001">{{cite journal|last1=Kobayashi|first1=Yuzuru|title=Discovery of the causative organism of Weil's disease: historical view|journal=Journal of Infection and Chemotherapy|volume=7|issue=1|year=2001|pages=10–15|issn=1341321X|doi=10.1007/s101560170028}}</ref>

== Classification ==
Leptospirosis is classified into anicteric and icteric form of leptospirosis based on the clinical presentation.

== Pathophysiology ==
Pathological findings of leptospirosis are due to the development of the following:[[Leptospirosis pathophysiology|[12][13][14][15]]]
* [[Vasculitis]]
* [[Endothelial]] damage
* [[Inflammatory]] infiltrates composed of moncytic cells, [[plasma cells]], [[histiocytes]], and [[neutrophils]].

== Causes ==
Leptospirosis is caused by an infection with ''[[Leptospira]]''. Several species of Leptospira have identified and have been classified, genotypically, which include both pathogenic and saprophytic species. Among the pathogenic species, over 300 serovars have been identified by serotyping methods.<ref name="pmid22843698">{{cite journal| author=Forbes AE, Zochowski WJ, Dubrey SW, Sivaprakasam V| title=Leptospirosis and Weil's disease in the UK. | journal=QJM | year= 2012 | volume= 105 | issue= 12 | pages= 1151-62 | pmid=22843698 | doi=10.1093/qjmed/hcs145 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22843698 }} </ref>

== Differential Diagnosis ==
Leptospirosis must be differentiated from other diseases that cause fever, diarrhea, nausea and vomiting, such as ebola, typhoid fever, malaria, yellow fever, and other enteric bacterial infections. Moderate to severe leptospirosis must be differentiated from dengue fever.

== Epidemiology and Demographics==
Leptospirosis occurs worldwide but is most common in temperate or tropical climates. It is an occupational hazard for many people who work outdoors or with animals, for example, farmers, sewer workers, veterinarians, fish workers, dairy farmers, or military personnel. It is a recreational hazard for campers or those who participate in outdoor sports in contaminated areas and has been associated with swimming, wading, and whitewater rafting in contaminated lakes and rivers. The incidence is also increasing among urban children. Epidemiology of human leptospirosis is complex and dynamic, due to the interaction of pathogen, host, animal reservoir, and environment. With the increase in urban population, occupational and recreational exposure to surface water and climatic changes results in increase in prevalence of leptospirosis recently.

== Risk Factors ==
The risk of acquiring leptospirosis is associated with contact with animals, which made leptospirosis as an important occupational disease, especially affecting farmers, slaughterhouse workers, pet traders, veterinarians, rodent catchers and sewer workers who are in contact with mammalian species which acts as a natural carriers of leptospires.<ref name="pmid11292640">{{cite journal| author=Levett PN| title=Leptospirosis. | journal=Clin Microbiol Rev | year= 2001 | volume= 14 | issue= 2 | pages= 296-326 | pmid=11292640 | doi=10.1128/CMR.14.2.296-326.2001 | pmc=88975 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11292640 }} </ref> According to World health organization survey highest risk groups are subsistence farmers and people living in urban slums.<ref name="pmid16148523">{{cite journal| author=McBride AJ, Athanazio DA, Reis MG, Ko AI| title=Leptospirosis. | journal=Curr Opin Infect Dis | year= 2005 | volume= 18 | issue= 5 | pages= 376-86 | pmid=16148523 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16148523 }} </ref> Common risk factors in the development of leptospirosis include occupational exposure to animals, tropical or temperate climates, and water sports in contaminated lakes and rivers.

== Natural History, Complications & Prognosis ==
Leptospirosis is transported by the natural carriers such as feral, semi-domestic and farm and pet animals.<ref name="pmid11292640">{{cite journal| author=Levett PN| title=Leptospirosis. | journal=Clin Microbiol Rev | year= 2001 | volume= 14 | issue= 2 | pages= 296-326 | pmid=11292640 | doi=10.1128/CMR.14.2.296-326.2001 | pmc=88975 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11292640 }} </ref> Incubation period for leptospirosis varies between 3-20 days. The disease can cause wide range of symptoms from mild [[flu]]-like symptoms to severe disease with multi [[organ failure]] causing death. The first phase resolves and the patient is asymptomatic briefly before the second phase begins that is characterized by [[meningitis]], [[liver]] damage (causing [[jaundice]]), and [[renal failure]].<ref name="VCNA">{{cite journal|author=Heuter, Kerry J.,Langston, Cathy E.|title=Leptospirosis: A re-emerging zoonotic disease|journal=The Veterinary Clinics of North America|year=2003|volume=33|pages=791-807}}</ref> The disease leptospirosis is poorly known and unaware of its natural history is mainly due to the wide range of non specific symptoms, subclinical nature of the disease in animals, and non specific laboratory tests making the disease difficult to diagnose.<ref name="pmid16600656">{{cite journal| author=Vieira ML, Gama-Simões MJ, Collares-Pereira M| title=Human leptospirosis in Portugal: A retrospective study of eighteen years. | journal=Int J Infect Dis | year= 2006 | volume= 10 | issue= 5 | pages= 378-86 | pmid=16600656 | doi=10.1016/j.ijid.2005.07.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16600656 }} </ref> Outcome of the patient depends upon the pathogenic [[serovar]] and [[immunological]] status.

== Diagnosis ==
Clinical symptoms of leptospirosis are very wide, with mild anicteric presentation at one end to severe leptospirosis with severe [[jaundice]] and multiple organ involvement. Classic presentation of leptospirosis is a biphasic illness, and the onset of Symptoms within 2–30 days (incubation period) of exposure to the bacteria. Serious symptoms may manifest earlier on Days 4–6 of the illness depending on the type of pathogen and host immunological status.<ref>{{cite book | last = Faine | first = S | title = Guidelines for the control of leptospirosis | publisher = World Health Organization Obtainable from WHO Publication Centre USA | location = Geneva Albany, N.Y | year = 1982 | isbn = 924170067X }}</ref> As the clinical manifestations of the disease are non specific, the clinical diagnosis is difficult. The laboratory investigations for leptospirosis should be considered in patient with an abrupt onset of [[fever]], [[chills]], conjunctival suffusion, [[headache]], [[myalgia]] and [[jaundice]] with history of occupational exposure to infected animals or contaminated with animal urine.<ref>{{cite book | last = LastName | first = FirstName | title = Human leptospirosis : guidance for diagnosis, surveillance and control | publisher = World Health Organization | location = Geneva | year = 2003 | isbn = 9241545895 }}</ref> The diagnosis of leptospirosis is based upon clinical suspicion and lab findings, so lab tests should be considered in a patient with a history of contact with potentially infected animals, soil or surface waters contaminated by animal urine.<ref name="pmid22843698">{{cite journal| author=Forbes AE, Zochowski WJ, Dubrey SW, Sivaprakasam V| title=Leptospirosis and Weil's disease in the UK. | journal=QJM | year= 2012 | volume= 105 | issue= 12 | pages= 1151-62 | pmid=22843698 | doi=10.1093/qjmed/hcs145 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22843698 }} </ref> Leptospires can be found in [[blood]] and [[CSF]] for the first 7 to 10 days and then in the [[urine]]. Hence, in the early diagnosis, specimen of choice should be, [[blood]] or [[CSF]] for [[culture]]. From the second week onwards serological tests are useful in the diagnosis.

== Treatment ==
All patients with suspected leptospirosis require [[antimicrobial]] therapy. [[Antimicrobial drug|Antimicrobial]] therapy is the mainstay of therapy for Leptospirosis. Antimicrobial therapies include either [[penicillin]], [[ampicillin]], [[doxycycline]], or [[ceftriaxone]]. Patients with [[meningitis]] often require high-dose [[penicillin]], whereas patients with [[Weil's disease]] often require either [[azithromycin]] or [[doxycycline]]. Supportive measures include [[detoxification]] and normalization of electrolyte imbalances. [[Dialysis]] is reserved for patients with severe disease who fail antimicrobial therapy.

== Prevention ==
Leptospirosis can be prevented by avoiding the risk factors by practicing general measures, from contact with infected sources and animals. Also, it can be minimized by taking antibiotic prophylaxis in high risk group who will have occupational exposure with infected sources.

==References==
{{Reflist|2}}

[[Category:Disease]]
[[Category:Infectious disease]]

Leptospirosis primary prevention

2017-03-10T16:50:05Z

Venkata Sivakrishna Kumar Pulivarthi:

__NOTOC__
[[File:Work-boots.jpg|200px|right]]
{{Leptospirosis}}
{{CMG}};{{AE}}{{VSKP}}
==Overview==
Leptospirosis can be prevented by avoiding the risk factors by practicing general measures, from contact with infected sources and animals. Also, it can be minimized by taking antibiotic prophylaxis in high risk group who will have occupational exposure with infected sources.

==Primary Prevention==
===General measures===
General protective measures to be taken by risk groups as follows.
* Recreational activities :
** Protective clothing and appropriate shoes to protect from infection from contaminated sources such as animal urine.<ref name="pmid22843698">{{cite journal| author=Forbes AE, Zochowski WJ, Dubrey SW, Sivaprakasam V| title=Leptospirosis and Weil's disease in the UK. | journal=QJM | year= 2012 | volume= 105 | issue= 12 | pages= 1151-62 | pmid=22843698 | doi=10.1093/qjmed/hcs145 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22843698 }} </ref>
** Immediate washing or bathing after recreational activities if exposed to stagnant water or soil
* workers and farmers:<ref>{{cite web |url=http://www.hse.gov.uk/pubns/aise2.pdf |title=prevention of leptospirosis |author= |date= |website= |publisher= |access-date= |quote=}}</ref>
** Learning good animal husbandry techniques and using of personal protective equipment that minimize the risk of transmission
** Eradication or control of rodent population in the fields or working place

===Prophylaxis===
Prophylactic antibiotic for leptospirosis is needed for risk group who are unavoidably in contact with rodents or working in stagnant water and far from medical help such as disaster-zone aid workers, military personnel. Recommended drug of choice is [[doxycycline]] with a dose of 200mg weekly, starting 1 or 2 days before exposure and continuing until the high-risk situation resolve(maximum of not more than 8weeks).<ref name="pmid6363930">{{cite journal| author=Takafuji ET, Kirkpatrick JW, Miller RN, Karwacki JJ, Kelley PW, Gray MR et al.| title=An efficacy trial of doxycycline chemoprophylaxis against leptospirosis. | journal=N Engl J Med | year= 1984 | volume= 310 | issue= 8 | pages= 497-500 | pmid=6363930 | doi=10.1056/NEJM198402233100805 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6363930 }} </ref>

===Vaccines===
As the pathogenic serovars include wide variety of group, [[vaccine]] against leptospirosis is short lived and unprotective.<ref name="pmid16333195">{{cite journal| author=Koizumi N, Watanabe H| title=Leptospirosis vaccines: past, present, and future. | journal=J Postgrad Med | year= 2005 | volume= 51 | issue= 3 | pages= 210-4 | pmid=16333195 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16333195 }} </ref>

==References==
{{reflist|2}}

[[Category:Infectious disease]]
[[Category:Diseases]]

Template:Leptospirosis

2017-03-10T16:45:37Z

Venkata Sivakrishna Kumar Pulivarthi:

{| class="infobox bordered" style="width: 15em; text-align: left; font-size: 90%; background:AliceBlue"
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'''Leptospirosis Microchapters'''

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[[Leptospirosis|Home]]
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[[Leptospirosis (patient information)|Patient Information]]
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[[Leptospirosis overview|Overview]]
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[[Leptospirosis historical perspective|Historical Perspective]]
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[[Leptospirosis classification|Classification]]
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[[Leptospirosis pathophysiology|Pathophysiology]]
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[[Leptospirosis causes|Causes]]
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[[Leptospirosis differential diagnosis|Differentiating Leptospirosis from other Diseases]]
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[[Leptospirosis epidemiology and demographics|Epidemiology and Demographics]]
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[[Leptospirosis risk factors|Risk Factors]]
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[[Leptospirosis natural history, complications and prognosis|Natural History, Complications and Prognosis]]
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Diagnosis
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[[Leptospirosis history and symptoms|History and Symptoms]]
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[[Leptospirosis physical examination|Physical Examination]]
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[[Leptospirosis laboratory findings|Laboratory Findings]]
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[[Leptospirosis other imaging findings|Other Imaging Findings]]
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Treatment
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[[Leptospirosis medical therapy|Medical Therapy]]
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[[Leptospirosis surgery|Surgery]]
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[[Leptospirosis primary prevention|Primary Prevention]]
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[[Leptospirosis future or investigational therapies|Future or Investigational Therapies]]
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Case Studies
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[[Leptospirosis case study one|Case #1]]
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Leptospirosis overview

2017-03-10T16:43:38Z

Venkata Sivakrishna Kumar Pulivarthi: /* Pathophysiology */

__NOTOC__
[[File:Leptospira.png|right|200px]]
{{Leptospirosis}}

{{CMG}};{{AE}}{{VSKP}}

==Overview==

'''Leptospirosis''' is a [[zoonotic]] disease caused by ''[[Leptospira]] sps.'' that affects [[human]]s and a wide range of animals, including mammals, birds, amphibians, and reptiles.<ref name=Leptospirosis> Leptospirosis. Centers for Disease Control and Prevention (2015). https://www.cdc.gov/leptospirosis/ Accessed on July 28, 2016 </ref> Even though leptospirosis is relatively rare in human, it is one of the world's most common [[Zoonosis|zoonotic disease]]. The infection is commonly transmitted to humans by carriers such as rodents and other mammals through contaminated water sources by animal [[urine]] to come in contact with unhealed breaks in the [[skin]], [[eye]]s or with the [[mucous membrane]]s. Due to the ability of leptospire, the can survive for a prolonged period outside the animal host, especially in the environment favored by warm moist conditions with a neutral pH, which makes the disease more prevalent in tropical and sub-tropical regions. Outside of [[Tropics|tropical]] areas, leptospirosis cases have a relatively distinct seasonality with most of them occurring August-September/February-March.<ref name="NORD">Leptospirosis. National Organization for Rare Diseases (2015). http://rarediseases.org/rare-diseases/leptospirosis/ Accessed on July 28, 2016 </ref> Recently, with the improved health and safety methods in the work place, more infections are occurring due to recreational activities rather than occupational exposure.<ref name="pmid2786228">{{cite journal| author=Philipp R, Waitkins S, Caul O, Roome A, McMahon S, Enticott R| title=Leptospiral and hepatitis A antibodies amongst windsurfers and waterskiers in Bristol City Docks. | journal=Public Health | year= 1989 | volume= 103 | issue= 2 | pages= 123-9 | pmid=2786228 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2786228 }} </ref><ref name="pmid1490212">{{cite journal| author=Philipp R, King C, Hughes A| title=Understanding of Weil's disease among canoeists. | journal=Br J Sports Med | year= 1992 | volume= 26 | issue= 4 | pages= 223-7 | pmid=1490212 | doi= | pmc=1479000 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1490212 }} </ref> Animal body fluids such as [[urine]], [[semen]] and products of [[conception]] with pathogenic [[Leptospira|leptospires]], pose a potential risk to humans through prolonged excretion of bacteria.Other less common mechanisms of transmission include direct infection from animal urine, human to human spread, sexual transmission and via breast milk.<ref name="pmid20186328">{{cite journal| author=Ganoza CA, Matthias MA, Saito M, Cespedes M, Gotuzzo E, Vinetz JM| title=Asymptomatic renal colonization of humans in the peruvian Amazon by Leptospira. | journal=PLoS Negl Trop Dis | year= 2010 | volume= 4 | issue= 2 | pages= e612 | pmid=20186328 | doi=10.1371/journal.pntd.0000612 | pmc=2826405 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20186328 }} </ref><ref name="pmid14166972">{{cite journal| author=SPINU I, TOPCIU V et al.| title=[MAN AS A VIRAL RESERVOIR IN AN EPIDEMIC OF LEPTOSPIROSIS OCCURRING IN THE JUNGLE]. | journal=Arch Roum Pathol Exp Microbiol | year= 1963 | volume= 22 | issue= | pages= 1081-100 | pmid=14166972 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14166972 }} </ref><ref name="pmid987112">{{cite journal| author=Kiktenko VS, Balashov NG, Rodina VN| title=Leptospirosis infection through insemination of animals. | journal=J Hyg Epidemiol Microbiol Immunol | year= 1976 | volume= 21 | issue= 2 | pages= 207-13 | pmid=987112 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=987112 }} </ref>

== Historical Perspective ==
Adof Weil is the first physician described about the severe form of leptospirosis and the name [[Weil's disease]] is named after him in the year 1886. He also described the [[jaundice]] with [[splenomegaly]], [[renal failure]], [[skin rash]] and conjunctival suffusion.<ref name="pmid25388129">{{cite journal| author=Adler B| title=History of leptospirosis and leptospira. | journal=Curr Top Microbiol Immunol | year= 2015 | volume= 387 | issue= | pages= 1-9 | pmid=25388129 | doi=10.1007/978-3-662-45059-8_1 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25388129 }} </ref> Japanees scientists Kitamura and Hara named this disease as autumn fever and seven day disease in 1918.<ref name="Kobayashi2001">{{cite journal|last1=Kobayashi|first1=Yuzuru|title=Discovery of the causative organism of Weil's disease: historical view|journal=Journal of Infection and Chemotherapy|volume=7|issue=1|year=2001|pages=10–15|issn=1341321X|doi=10.1007/s101560170028}}</ref>

== Classification ==
Leptospirosis is classified into anicteric and icteric form of leptospirosis based on the clinical presentation.

== Pathophysiology ==
Pathological findings of leptospirosis are due to the development of the following:[[Leptospirosis pathophysiology|[12][13][14][15]]]
* [[Vasculitis]]
* [[Endothelial]] damage
* [[Inflammatory]] infiltrates composed of moncytic cells, [[plasma cells]], [[histiocytes]], and [[neutrophils]].

== Causes ==
Leptospirosis is caused by an infection with ''[[Leptospira]]''. Several species of Leptospira have identified and have been classified, genotypically, which include both pathogenic and saprophytic species. Among the pathogenic species, over 300 serovars have been identified by serotyping methods.<ref name="pmid22843698">{{cite journal| author=Forbes AE, Zochowski WJ, Dubrey SW, Sivaprakasam V| title=Leptospirosis and Weil's disease in the UK. | journal=QJM | year= 2012 | volume= 105 | issue= 12 | pages= 1151-62 | pmid=22843698 | doi=10.1093/qjmed/hcs145 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22843698 }} </ref>

== Differential Diagnosis ==
Leptospirosis must be differentiated from other diseases that cause fever, diarrhea, nausea and vomiting, such as ebola, typhoid fever, malaria, yellow fever, and other enteric bacterial infections. Moderate to severe leptospirosis must be differentiated from dengue fever.

== Epidemiology and Demographics==
Leptospirosis occurs worldwide but is most common in temperate or tropical climates. It is an occupational hazard for many people who work outdoors or with animals, for example, farmers, sewer workers, veterinarians, fish workers, dairy farmers, or military personnel. It is a recreational hazard for campers or those who participate in outdoor sports in contaminated areas and has been associated with swimming, wading, and whitewater rafting in contaminated lakes and rivers. The incidence is also increasing among urban children. Epidemiology of human leptospirosis is complex and dynamic, due to the interaction of pathogen, host, animal reservoir, and environment. With the increase in urban population, occupational and recreational exposure to surface water and climatic changes results in increase in prevalence of leptospirosis recently.

== Risk Factors ==
The risk of acquiring leptospirosis is associated with contact with animals, which made leptospirosis as an important occupational disease, especially affecting farmers, slaughterhouse workers, pet traders, veterinarians, rodent catchers and sewer workers who are in contact with mammalian species which acts as a natural carriers of leptospires.<ref name="pmid11292640">{{cite journal| author=Levett PN| title=Leptospirosis. | journal=Clin Microbiol Rev | year= 2001 | volume= 14 | issue= 2 | pages= 296-326 | pmid=11292640 | doi=10.1128/CMR.14.2.296-326.2001 | pmc=88975 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11292640 }} </ref> According to World health organization survey highest risk groups are subsistence farmers and people living in urban slums.<ref name="pmid16148523">{{cite journal| author=McBride AJ, Athanazio DA, Reis MG, Ko AI| title=Leptospirosis. | journal=Curr Opin Infect Dis | year= 2005 | volume= 18 | issue= 5 | pages= 376-86 | pmid=16148523 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16148523 }} </ref> Common risk factors in the development of leptospirosis include occupational exposure to animals, tropical or temperate climates, and water sports in contaminated lakes and rivers.

== Natural History, Complications & Prognosis ==
Leptospirosis is transported by the natural carriers such as feral, semi-domestic and farm and pet animals.<ref name="pmid11292640">{{cite journal| author=Levett PN| title=Leptospirosis. | journal=Clin Microbiol Rev | year= 2001 | volume= 14 | issue= 2 | pages= 296-326 | pmid=11292640 | doi=10.1128/CMR.14.2.296-326.2001 | pmc=88975 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11292640 }} </ref> Incubation period for leptospirosis varies between 3-20 days. The disease can cause wide range of symptoms from mild [[flu]]-like symptoms to severe disease with multi [[organ failure]] causing death. The first phase resolves and the patient is asymptomatic briefly before the second phase begins that is characterized by [[meningitis]], [[liver]] damage (causing [[jaundice]]), and [[renal failure]].<ref name="VCNA">{{cite journal|author=Heuter, Kerry J.,Langston, Cathy E.|title=Leptospirosis: A re-emerging zoonotic disease|journal=The Veterinary Clinics of North America|year=2003|volume=33|pages=791-807}}</ref> The disease leptospirosis is poorly known and unaware of its natural history is mainly due to the wide range of non specific symptoms, subclinical nature of the disease in animals, and non specific laboratory tests making the disease difficult to diagnose.<ref name="pmid16600656">{{cite journal| author=Vieira ML, Gama-Simões MJ, Collares-Pereira M| title=Human leptospirosis in Portugal: A retrospective study of eighteen years. | journal=Int J Infect Dis | year= 2006 | volume= 10 | issue= 5 | pages= 378-86 | pmid=16600656 | doi=10.1016/j.ijid.2005.07.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16600656 }} </ref> Outcome of the patient depends upon the pathogenic [[serovar]] and [[immunological]] status.

== Diagnosis ==
Clinical symptoms of leptospirosis are very wide, with mild anicteric presentation at one end to severe leptospirosis with severe [[jaundice]] and multiple organ involvement. Classic presentation of leptospirosis is a biphasic illness, and the onset of Symptoms within 2–30 days (incubation period) of exposure to the bacteria. Serious symptoms may manifest earlier on Days 4–6 of the illness depending on the type of pathogen and host immunological status.<ref>{{cite book | last = Faine | first = S | title = Guidelines for the control of leptospirosis | publisher = World Health Organization Obtainable from WHO Publication Centre USA | location = Geneva Albany, N.Y | year = 1982 | isbn = 924170067X }}</ref> As the clinical manifestations of the disease are non specific, the clinical diagnosis is difficult. The laboratory investigations for leptospirosis should be considered in patient with an abrupt onset of [[fever]], [[chills]], conjunctival suffusion, [[headache]], [[myalgia]] and [[jaundice]] with history of occupational exposure to infected animals or contaminated with animal urine.<ref>{{cite book | last = LastName | first = FirstName | title = Human leptospirosis : guidance for diagnosis, surveillance and control | publisher = World Health Organization | location = Geneva | year = 2003 | isbn = 9241545895 }}</ref> The diagnosis of leptospirosis is based upon clinical suspicion and lab findings, so lab tests should be considered in a patient with a history of contact with potentially infected animals, soil or surface waters contaminated by animal urine.<ref name="pmid22843698">{{cite journal| author=Forbes AE, Zochowski WJ, Dubrey SW, Sivaprakasam V| title=Leptospirosis and Weil's disease in the UK. | journal=QJM | year= 2012 | volume= 105 | issue= 12 | pages= 1151-62 | pmid=22843698 | doi=10.1093/qjmed/hcs145 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22843698 }} </ref> Leptospires can be found in [[blood]] and [[CSF]] for the first 7 to 10 days and then in the [[urine]]. Hence, in the early diagnosis, specimen of choice should be, [[blood]] or [[CSF]] for [[culture]]. From the second week onwards serological tests are useful in the diagnosis.

== Treatment ==
All patients with suspected leptospirosis require [[antimicrobial]] therapy. [[Antimicrobial drug|Antimicrobial]] therapy is the mainstay of therapy for Leptospirosis. Antimicrobial therapies include either [[penicillin]], [[ampicillin]], [[doxycycline]], or [[ceftriaxone]]. Patients with [[meningitis]] often require high-dose [[penicillin]], whereas patients with [[Weil's disease]] often require either [[azithromycin]] or [[doxycycline]]. Supportive measures include [[detoxification]] and normalization of electrolyte imbalances. [[Dialysis]] is reserved for patients with severe disease who fail antimicrobial therapy.

== Prevention ==

==References==
{{Reflist|2}}

[[Category:Disease]]
[[Category:Infectious disease]]

Leptospirosis pathophysiology

2017-03-10T16:41:01Z

Venkata Sivakrishna Kumar Pulivarthi: /* Gross Pathology */

__NOTOC__
[[File:Rat.jpg|right|200px]]
{{Leptospirosis}}
{{CMG}}; {{AE}}{{VSKP}}
==Overview==
Leptospires shed in the urine of animals to the environment from where humans are infected by incidental hosts. In Carriers these bacteria harbour in the [[renal tubules]] and can persist in soil or surface water and then transmits to human hosts via mucous membranes or abraded skin.<ref name="pmid13559904">{{cite journal| author=BABUDIERI B| title=Animal reservoirs of leptospires. | journal=Ann N Y Acad Sci | year= 1958 | volume= 70 | issue= 3 | pages= 393-413 | pmid=13559904 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=13559904 }} </ref><ref name="ForbesZochowski2012">{{cite journal|last1=Forbes|first1=A. E.|last2=Zochowski|first2=W. J.|last3=Dubrey|first3=S. W.|last4=Sivaprakasam|first4=V.|title=Leptospirosis and Weil's disease in the UK|journal=QJM|volume=105|issue=12|year=2012|pages=1151–1162|issn=1460-2725|doi=10.1093/qjmed/hcs145}}</ref> Pathogen transmit through various mechanisms such as broken skin, mucus membranes and the conjunctivae, exposure to contaminated water are at risk of contracting leptospirosis.<ref name="pmid22843698">{{cite journal| author=Forbes AE, Zochowski WJ, Dubrey SW, Sivaprakasam V| title=Leptospirosis and Weil's disease in the UK. | journal=QJM | year= 2012 | volume= 105 | issue= 12 | pages= 1151-62 | pmid=22843698 | doi=10.1093/qjmed/hcs145 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22843698 }} </ref>

==Pathogenesis==
The disease leptospirosis involves a spectrum of symptoms ranging from subclinical infection to a severe syndrome of multiorgan infection with high mortality and Weil’s disease represents only the most severe presentation. Severe leptospirosis is frequently caused by serovars of the icterohaemorrhagiae serogroup. The presentation of leptospirosis is biphasic, with the acute or septicemic phase lasting about a week, followed by the immune phase, characterized by antibody production and excretion of leptospires in the urine.<ref name="Levett2001">{{cite journal|last1=Levett|first1=P. N.|title=Leptospirosis|journal=Clinical Microbiology Reviews|volume=14|issue=2|year=2001|pages=296–326|issn=0893-8512|doi=10.1128/CMR.14.2.296-326.2001}}</ref>
[[File:Leptospirosis pathogenesis.jpg|center]]
=== Reservoirs ===
The major reservoir for leptospirosis is rat and small rodents that appear to harbour more virulent strains of the disease.<ref name="Picardeau2013">{{cite journal|last1=Picardeau|first1=M.|title=Diagnosis and epidemiology of leptospirosis|journal=Médecine et Maladies Infectieuses|volume=43|issue=1|year=2013|pages=1–9|issn=0399077X|doi=10.1016/j.medmal.2012.11.005}}</ref>
===Carriers===
Domestic animals such as dogs,cattle and pigs acts as potential carriers that increases the risk of leptospirosis in humans. These carriers are generally asymptomatic.<ref name="pmid19011247">{{cite journal| author=Gaudie CM, Featherstone CA, Phillips WS, McNaught R, Rhodes PM, Errington J et al.| title=Human Leptospira interrogans serogroup icterohaemorrhagiae infection (Weil's disease) acquired from pet rats. | journal=Vet Rec | year= 2008 | volume= 163 | issue= 20 | pages= 599-601 | pmid=19011247 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19011247 }} </ref><ref name="pmid19202179">{{cite journal| author=Strugnell BW, Featherstone C, Gent M, Lister P, Evans G, Okereke E et al.| title=Weil's disease associated with the adoption of a feral rat. | journal=Vet Rec | year= 2009 | volume= 164 | issue= 6 | pages= 186 | pmid=19202179 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19202179 }} </ref>

=== Modes of transmission ===
# Direct contact with urine or tissue of infected animal: Through skin abrasions, intact mucus membrane
# Indirect contact: Broken skin with infected soil, water or vegetation, Through ingestion of contaminated food and water
# Droplet infection: Inhalation of droplets of infected urine
Infection can occurs either by direct contact with the carrier’s urine or through indirect transmission via urine-contaminated environment. Infection due to direct transmission through direct oral intake of contaminated drinking water or food is very rare.<ref name="pmid3618584">{{cite journal| author=Cacciapuoti B, Ciceroni L, Maffei C, Di Stanislao F, Strusi P, Calegari L et al.| title=A waterborne outbreak of leptospirosis. | journal=Am J Epidemiol | year= 1987 | volume= 126 | issue= 3 | pages= 535-45 | pmid=3618584 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3618584 }} </ref> Pathogenic leptospires live in the renal system and the genital tracts of domestic animals which act as sites of persistence.<ref name="pmid4081333">{{cite journal| author=Ellis WA, O'Brien JJ, Cassells JA, Neill SD, Hanna J| title=Excretion of Leptospira interrogans serovar hardjo following calving or abortion. | journal=Res Vet Sci | year= 1985 | volume= 39 | issue= 3 | pages= 296-8 | pmid=4081333 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4081333 }} </ref><ref name="pmid3705357">{{cite journal| author=Ellis WA, McParland PJ, Bryson DG, Thiermann AB, Montgomery J| title=Isolation of leptospires from the genital tract and kidneys of aborted sows. | journal=Vet Rec | year= 1986 | volume= 118 | issue= 11 | pages= 294-5 | pmid=3705357 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3705357 }} </ref> Bacteria shed from the infected animals such as rodents and domesticat animals through urine. These animals may not show signs of disease, but humans shows signs of illness after contact with infected urine, or through contact with water, soil or food that has been contaminated and the outbreaks are associates with floodwaters. The major route of infection by leptospires is probably by transmission through indirect contact with leptospires secreted into the environment. Humans are considered dead end hosts, but sometimes they also act as carriers. Mammalian species (e.g. rodents, insectivores, dogs, pigs and cattle) act as the main carriers of the disease.<ref name="pmid20186328">{{cite journal| author=Ganoza CA, Matthias MA, Saito M, Cespedes M, Gotuzzo E, Vinetz JM| title=Asymptomatic renal colonization of humans in the peruvian Amazon by Leptospira. | journal=PLoS Negl Trop Dis | year= 2010 | volume= 4 | issue= 2 | pages= e612 | pmid=20186328 | doi=10.1371/journal.pntd.0000612 | pmc=2826405 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20186328 }} </ref>
Leptospires are excreted in urine into the environment, where they can survive for several months, depending on favourable environmental conditions such as humid and temperate areas. The pathogen may also be excreted in the products of abortion in mammalian animal species.<ref name="pmid4081333">{{cite journal| author=Ellis WA, O'Brien JJ, Cassells JA, Neill SD, Hanna J| title=Excretion of Leptospira interrogans serovar hardjo following calving or abortion. | journal=Res Vet Sci | year= 1985 | volume= 39 | issue= 3 | pages= 296-8 | pmid=4081333 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4081333 }} </ref>

Pathological findings of leptospirosis are due to the development of the following:<ref name="Budihal2014">{{cite journal|last1=Budihal|first1=Suman Veerappa|title=Leptospirosis Diagnosis: Competancy of Various Laboratory Tests|journal=JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH|year=2014|issn=2249782X|doi=10.7860/JCDR/2014/6593.3950}}</ref><ref name="pmid14902167">{{cite journal| author=BEESON PB, HANKEY DD| title=Leptospiral meningitis. | journal=AMA Arch Intern Med | year= 1952 | volume= 89 | issue= 4 | pages= 575-83 | pmid=14902167 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14902167 }} </ref><ref name="pmid1224630">{{cite journal| author=King SD, Urquhart AE| title=Laboratory investigations on four cases of leptospiral meningitis in Jamaica. | journal=West Indian Med J | year= 1975 | volume= 24 | issue= 4 | pages= 196-201 | pmid=1224630 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1224630 }} </ref><ref name="pmid9071036">{{cite journal| author=Silva MV, Camargo ED, Batista L, Vaz AJ, Ferreira AW, Barbosa PR| title=Application of anti-leptospira ELISA-IgM for the etiologic elucidation of meningitis. | journal=Rev Inst Med Trop Sao Paulo | year= 1996 | volume= 38 | issue= 2 | pages= 153-6 | pmid=9071036 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9071036 }} </ref>
* [[Vasculitis]]
* [[Endothelial]] damage
* [[Inflammatory]] infiltrates composed of moncytic cells, [[plasma cells]], [[histiocytes]], and [[neutrophils]].

{| border="0"
|-
|align=center| '''Leptospira'''
'''⬇'''

'''[[Toxin]] production'''

'''Type of toxin production depends on the serovar'''
* [[Hemolysin|Hemolysins]] are produced from several serovars such as serovars ballum, hardjo, pomona, and tarassovi which are [[Sphingomyelinase|sphingomyelinases]]
* Protein [[cytotoxins]] are produced by strains of serovars pomona and copenhageni
* [[Glycolipids|Glycolipoprotein]] fraction with [[Cytotoxicity|cytotoxic activity]] produced by serovar copenhageni
'''⬇'''

'''Damage to small [[blood vessels]]'''

'''⬇'''

'''[[Vasculitis]]'''

'''⬇'''

'''• Direct cytotoxic injury or Immunological injury 
• Fluid extavasation into the interstitial compartment due to [[vasculitis]]
'''

'''⬇'''

'''Acute renal injury and [[vascular]] injury to internal organs'''
|}

==Gross Pathology==
Gross findings of various organ systems are present as:<ref name="pmid13862141">{{cite journal| author=AREAN VM| title=The pathologic anatomy and pathogenesis of fatal human leptospirosis (Weil's disease). | journal=Am J Pathol | year= 1962 | volume= 40 | issue= | pages= 393-423 | pmid=13862141 | doi= | pmc=1949541 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=13862141 }} </ref>
* Extensive [[petechial hemorrhages]] are common.
* Discoloration of organs is seen in severe cases of icteric leptospirosis.

== Microscopic Pathology ==
===Liver===
* No significant structural destruction is seen<ref name="pmid13862141">{{cite journal| author=AREAN VM| title=The pathologic anatomy and pathogenesis of fatal human leptospirosis (Weil's disease). | journal=Am J Pathol | year= 1962 | volume= 40 | issue= | pages= 393-423 | pmid=13862141 | doi= | pmc=1949541 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=13862141 }} </ref><ref name="pmid4298629">{{cite journal| author=De Brito T, Machado MM, Montans SD, Hoshino S, Freymüller E| title=Liver biopsy in human leptospirosis: a light and electron microscopy study. | journal=Virchows Arch Pathol Anat Physiol Klin Med | year= 1967 | volume= 342 | issue= 1 | pages= 61-9 | pmid=4298629 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4298629 }} </ref>
* [[Intrahepatic cholestasis]] is seen in few cases
* [[Hypertrophy (medical)|Hypertrophy]] and [[hyperplasia]] of [[Kupffer cells]]
* Erythrophagocytosis
===Kidney===
* Common histopathological presentation in kidney includes [[interstitial nephritis]] with infiltration of [[neutrophils]] and [[Monocytes|monocytes.]]<ref name="pmid13862141">{{cite journal| author=AREAN VM| title=The pathologic anatomy and pathogenesis of fatal human leptospirosis (Weil's disease). | journal=Am J Pathol | year= 1962 | volume= 40 | issue= | pages= 393-423 | pmid=13862141 | doi= | pmc=1949541 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=13862141 }} </ref>
* Leptospires are seen in [[renal tubules]].
* Electron microscopy findings include:<ref name="pmid14072448">{{cite journal| author=PENNA D, DE BRITO T, PUPO AA, MACHADO MM, AYROZA PA, DE ALMEIDA SS| title=KIDNEY BIOPSY IN HUMAN LEPTOSPIROSIS. | journal=Am J Trop Med Hyg | year= 1963 | volume= 12 | issue= | pages= 896-901 | pmid=14072448 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14072448 }} </ref><ref name="SitprijaEvans1970">{{cite journal|last1=Sitprija|first1=Visith|last2=Evans|first2=Hilary|title=The kidney in human leptospirosis|journal=The American Journal of Medicine|volume=49|issue=6|year=1970|pages=780–788|issn=00029343|doi=10.1016/S0002-9343(70)80059-6}}</ref>

** Thickened tubular [[basement membrane]]
** Denuded tubular brush borders
** Mitochondrial depletion in tubular cells
* Glomerular destruction associated with [[proteinuria]] is seen in few cases.
===Heart===
Leptospirosis is associate with interstitial [[myocarditis]].<ref name="pmid3446572">{{cite journal| author=De Biase L, De Curtis G, Paparoni S, Sciarra D, Campa PP| title=Fatal leptospiral myocarditis. | journal=G Ital Cardiol | year= 1987 | volume= 17 | issue= 11 | pages= 992-4 | pmid=3446572 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3446572 }} </ref><ref name="BritoMorais2016">{{cite journal|last1=Brito|first1=T. De|last2=Morais|first2=C. F.|last3=Yasuda|first3=P. H.|last4=Lancellotti|first4=Carmen P.|last5=Hoshino-Shimizu|first5=Sumie|last6=Yamashiro|first6=E.|last7=Alves|first7=V. A. Ferreira|title=Cardiovascular involvement in human and experimental leptospirosis: Pathologic findings and immunohistochemical detection of leptospiral antigen|journal=Annals of Tropical Medicine & Parasitology|volume=81|issue=3|year=2016|pages=207–214|issn=0003-4983|doi=10.1080/00034983.1987.11812114}}</ref><ref name="pmid13464040">{{cite journal| author=AREAN VM| title=Leptospiral myocarditis. | journal=Lab Invest | year= 1957 | volume= 6 | issue= 5 | pages= 462-71 | pmid=13464040 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=13464040 }} </ref><ref name="pmid871034">{{cite journal| author=Ramachandran S, Perera MV| title=Cardiac and pulmonary involvement in leptospirosis. | journal=Trans R Soc Trop Med Hyg | year= 1977 | volume= 71 | issue= 1 | pages= 56-9 | pmid=871034 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=871034 }} </ref>
* Cellular infiltration predominantly with [[lymphocytes]] and [[plasma cells]].
* [[Petechial hemorrhages]] (epicardial hemorrhages are common)
* Epicardial infilteration of [[mononuclear cells]].
* [[Pericardial effusion]]
* coronary arteritis
===Lungs===
Common pulmonary presentation in leptospirosis are [[pulmonary congestion]] and [[hemorrhage]].<ref name="pmid13862141">{{cite journal| author=AREAN VM| title=The pathologic anatomy and pathogenesis of fatal human leptospirosis (Weil's disease). | journal=Am J Pathol | year= 1962 | volume= 40 | issue= | pages= 393-423 | pmid=13862141 | doi= | pmc=1949541 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=13862141 }} </ref><ref name="pmid871034">{{cite journal| author=Ramachandran S, Perera MV| title=Cardiac and pulmonary involvement in leptospirosis. | journal=Trans R Soc Trop Med Hyg | year= 1977 | volume= 71 | issue= 1 | pages= 56-9 | pmid=871034 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=871034 }} </ref><ref name="pmid9080878">{{cite journal| author=Nicodemo AC, Duarte MI, Alves VA, Takakura CF, Santos RT, Nicodemo EL| title=Lung lesions in human leptospirosis: microscopic, immunohistochemical, and ultrastructural features related to thrombocytopenia. | journal=Am J Trop Med Hyg | year= 1997 | volume= 56 | issue= 2 | pages= 181-7 | pmid=9080878 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9080878 }} </ref><ref name="pmid6790049">{{cite journal| author=Zaltzman M, Kallenbach JM, Goss GD, Lewis M, Zwi S, Gear JH| title=Adult respiratory distress syndrome in Leptospira canicola infection. | journal=Br Med J (Clin Res Ed) | year= 1981 | volume= 283 | issue= 6290 | pages= 519-20 | pmid=6790049 | doi= | pmc=1507945 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6790049 }} </ref>
* Alveolar infiltration by [[monocytes]] and [[neutrophils]].
* Hyaline membrane formation.
* Leptospires are seen within the [[endothelial cells]] in interalveolar septa, and also attached to capillary endothelial cells.
===Skeletal muscle===
* Focal [[necrosis]] of muscle fibers with infiltration of [[histiocytes]], [[neutrophils]], and [[plasma cells]].
===Brain===
* Perivascular cuffing is seen.

==References==
{{Reflist|2}}

Leptospirosis overview

2017-03-10T16:31:13Z

Venkata Sivakrishna Kumar Pulivarthi: /* Overview */

__NOTOC__
[[File:Leptospira.png|right|200px]]
{{Leptospirosis}}

{{CMG}};{{AE}}{{VSKP}}

==Overview==

'''Leptospirosis''' is a [[zoonotic]] disease caused by ''[[Leptospira]] sps.'' that affects [[human]]s and a wide range of animals, including mammals, birds, amphibians, and reptiles.<ref name=Leptospirosis> Leptospirosis. Centers for Disease Control and Prevention (2015). https://www.cdc.gov/leptospirosis/ Accessed on July 28, 2016 </ref> Even though leptospirosis is relatively rare in human, it is one of the world's most common [[Zoonosis|zoonotic disease]]. The infection is commonly transmitted to humans by carriers such as rodents and other mammals through contaminated water sources by animal [[urine]] to come in contact with unhealed breaks in the [[skin]], [[eye]]s or with the [[mucous membrane]]s. Due to the ability of leptospire, the can survive for a prolonged period outside the animal host, especially in the environment favored by warm moist conditions with a neutral pH, which makes the disease more prevalent in tropical and sub-tropical regions. Outside of [[Tropics|tropical]] areas, leptospirosis cases have a relatively distinct seasonality with most of them occurring August-September/February-March.<ref name="NORD">Leptospirosis. National Organization for Rare Diseases (2015). http://rarediseases.org/rare-diseases/leptospirosis/ Accessed on July 28, 2016 </ref> Recently, with the improved health and safety methods in the work place, more infections are occurring due to recreational activities rather than occupational exposure.<ref name="pmid2786228">{{cite journal| author=Philipp R, Waitkins S, Caul O, Roome A, McMahon S, Enticott R| title=Leptospiral and hepatitis A antibodies amongst windsurfers and waterskiers in Bristol City Docks. | journal=Public Health | year= 1989 | volume= 103 | issue= 2 | pages= 123-9 | pmid=2786228 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2786228 }} </ref><ref name="pmid1490212">{{cite journal| author=Philipp R, King C, Hughes A| title=Understanding of Weil's disease among canoeists. | journal=Br J Sports Med | year= 1992 | volume= 26 | issue= 4 | pages= 223-7 | pmid=1490212 | doi= | pmc=1479000 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1490212 }} </ref> Animal body fluids such as [[urine]], [[semen]] and products of [[conception]] with pathogenic [[Leptospira|leptospires]], pose a potential risk to humans through prolonged excretion of bacteria.Other less common mechanisms of transmission include direct infection from animal urine, human to human spread, sexual transmission and via breast milk.<ref name="pmid20186328">{{cite journal| author=Ganoza CA, Matthias MA, Saito M, Cespedes M, Gotuzzo E, Vinetz JM| title=Asymptomatic renal colonization of humans in the peruvian Amazon by Leptospira. | journal=PLoS Negl Trop Dis | year= 2010 | volume= 4 | issue= 2 | pages= e612 | pmid=20186328 | doi=10.1371/journal.pntd.0000612 | pmc=2826405 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20186328 }} </ref><ref name="pmid14166972">{{cite journal| author=SPINU I, TOPCIU V et al.| title=[MAN AS A VIRAL RESERVOIR IN AN EPIDEMIC OF LEPTOSPIROSIS OCCURRING IN THE JUNGLE]. | journal=Arch Roum Pathol Exp Microbiol | year= 1963 | volume= 22 | issue= | pages= 1081-100 | pmid=14166972 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14166972 }} </ref><ref name="pmid987112">{{cite journal| author=Kiktenko VS, Balashov NG, Rodina VN| title=Leptospirosis infection through insemination of animals. | journal=J Hyg Epidemiol Microbiol Immunol | year= 1976 | volume= 21 | issue= 2 | pages= 207-13 | pmid=987112 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=987112 }} </ref>

== Historical Perspective ==
Adof Weil is the first physician described about the severe form of leptospirosis and the name [[Weil's disease]] is named after him in the year 1886. He also described the [[jaundice]] with [[splenomegaly]], [[renal failure]], [[skin rash]] and conjunctival suffusion.<ref name="pmid25388129">{{cite journal| author=Adler B| title=History of leptospirosis and leptospira. | journal=Curr Top Microbiol Immunol | year= 2015 | volume= 387 | issue= | pages= 1-9 | pmid=25388129 | doi=10.1007/978-3-662-45059-8_1 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25388129 }} </ref> Japanees scientists Kitamura and Hara named this disease as autumn fever and seven day disease in 1918.<ref name="Kobayashi2001">{{cite journal|last1=Kobayashi|first1=Yuzuru|title=Discovery of the causative organism of Weil's disease: historical view|journal=Journal of Infection and Chemotherapy|volume=7|issue=1|year=2001|pages=10–15|issn=1341321X|doi=10.1007/s101560170028}}</ref>

== Classification ==
Leptospirosis is classified into anicteric and icteric form of leptospirosis based on the clinical presentation.

== Pathophysiology ==

== Causes ==
Leptospirosis is caused by an infection with ''[[Leptospira]]''. Several species of Leptospira have identified and have been classified, genotypically, which include both pathogenic and saprophytic species. Among the pathogenic species, over 300 serovars have been identified by serotyping methods.<ref name="pmid22843698">{{cite journal| author=Forbes AE, Zochowski WJ, Dubrey SW, Sivaprakasam V| title=Leptospirosis and Weil's disease in the UK. | journal=QJM | year= 2012 | volume= 105 | issue= 12 | pages= 1151-62 | pmid=22843698 | doi=10.1093/qjmed/hcs145 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22843698 }} </ref>

== Differential Diagnosis ==
Leptospirosis must be differentiated from other diseases that cause fever, diarrhea, nausea and vomiting, such as ebola, typhoid fever, malaria, yellow fever, and other enteric bacterial infections. Moderate to severe leptospirosis must be differentiated from dengue fever.

== Epidemiology and Demographics==
Leptospirosis occurs worldwide but is most common in temperate or tropical climates. It is an occupational hazard for many people who work outdoors or with animals, for example, farmers, sewer workers, veterinarians, fish workers, dairy farmers, or military personnel. It is a recreational hazard for campers or those who participate in outdoor sports in contaminated areas and has been associated with swimming, wading, and whitewater rafting in contaminated lakes and rivers. The incidence is also increasing among urban children. Epidemiology of human leptospirosis is complex and dynamic, due to the interaction of pathogen, host, animal reservoir, and environment. With the increase in urban population, occupational and recreational exposure to surface water and climatic changes results in increase in prevalence of leptospirosis recently.

== Risk Factors ==
The risk of acquiring leptospirosis is associated with contact with animals, which made leptospirosis as an important occupational disease, especially affecting farmers, slaughterhouse workers, pet traders, veterinarians, rodent catchers and sewer workers who are in contact with mammalian species which acts as a natural carriers of leptospires.<ref name="pmid11292640">{{cite journal| author=Levett PN| title=Leptospirosis. | journal=Clin Microbiol Rev | year= 2001 | volume= 14 | issue= 2 | pages= 296-326 | pmid=11292640 | doi=10.1128/CMR.14.2.296-326.2001 | pmc=88975 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11292640 }} </ref> According to World health organization survey highest risk groups are subsistence farmers and people living in urban slums.<ref name="pmid16148523">{{cite journal| author=McBride AJ, Athanazio DA, Reis MG, Ko AI| title=Leptospirosis. | journal=Curr Opin Infect Dis | year= 2005 | volume= 18 | issue= 5 | pages= 376-86 | pmid=16148523 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16148523 }} </ref> Common risk factors in the development of leptospirosis include occupational exposure to animals, tropical or temperate climates, and water sports in contaminated lakes and rivers.

== Natural History, Complications & Prognosis ==
Leptospirosis is transported by the natural carriers such as feral, semi-domestic and farm and pet animals.<ref name="pmid11292640">{{cite journal| author=Levett PN| title=Leptospirosis. | journal=Clin Microbiol Rev | year= 2001 | volume= 14 | issue= 2 | pages= 296-326 | pmid=11292640 | doi=10.1128/CMR.14.2.296-326.2001 | pmc=88975 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11292640 }} </ref> Incubation period for leptospirosis varies between 3-20 days. The disease can cause wide range of symptoms from mild [[flu]]-like symptoms to severe disease with multi [[organ failure]] causing death. The first phase resolves and the patient is asymptomatic briefly before the second phase begins that is characterized by [[meningitis]], [[liver]] damage (causing [[jaundice]]), and [[renal failure]].<ref name="VCNA">{{cite journal|author=Heuter, Kerry J.,Langston, Cathy E.|title=Leptospirosis: A re-emerging zoonotic disease|journal=The Veterinary Clinics of North America|year=2003|volume=33|pages=791-807}}</ref> The disease leptospirosis is poorly known and unaware of its natural history is mainly due to the wide range of non specific symptoms, subclinical nature of the disease in animals, and non specific laboratory tests making the disease difficult to diagnose.<ref name="pmid16600656">{{cite journal| author=Vieira ML, Gama-Simões MJ, Collares-Pereira M| title=Human leptospirosis in Portugal: A retrospective study of eighteen years. | journal=Int J Infect Dis | year= 2006 | volume= 10 | issue= 5 | pages= 378-86 | pmid=16600656 | doi=10.1016/j.ijid.2005.07.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16600656 }} </ref> Outcome of the patient depends upon the pathogenic [[serovar]] and [[immunological]] status.

== Diagnosis ==
Clinical symptoms of leptospirosis are very wide, with mild anicteric presentation at one end to severe leptospirosis with severe [[jaundice]] and multiple organ involvement. Classic presentation of leptospirosis is a biphasic illness, and the onset of Symptoms within 2–30 days (incubation period) of exposure to the bacteria. Serious symptoms may manifest earlier on Days 4–6 of the illness depending on the type of pathogen and host immunological status.<ref>{{cite book | last = Faine | first = S | title = Guidelines for the control of leptospirosis | publisher = World Health Organization Obtainable from WHO Publication Centre USA | location = Geneva Albany, N.Y | year = 1982 | isbn = 924170067X }}</ref> As the clinical manifestations of the disease are non specific, the clinical diagnosis is difficult. The laboratory investigations for leptospirosis should be considered in patient with an abrupt onset of [[fever]], [[chills]], conjunctival suffusion, [[headache]], [[myalgia]] and [[jaundice]] with history of occupational exposure to infected animals or contaminated with animal urine.<ref>{{cite book | last = LastName | first = FirstName | title = Human leptospirosis : guidance for diagnosis, surveillance and control | publisher = World Health Organization | location = Geneva | year = 2003 | isbn = 9241545895 }}</ref> The diagnosis of leptospirosis is based upon clinical suspicion and lab findings, so lab tests should be considered in a patient with a history of contact with potentially infected animals, soil or surface waters contaminated by animal urine.<ref name="pmid22843698">{{cite journal| author=Forbes AE, Zochowski WJ, Dubrey SW, Sivaprakasam V| title=Leptospirosis and Weil's disease in the UK. | journal=QJM | year= 2012 | volume= 105 | issue= 12 | pages= 1151-62 | pmid=22843698 | doi=10.1093/qjmed/hcs145 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22843698 }} </ref> Leptospires can be found in [[blood]] and [[CSF]] for the first 7 to 10 days and then in the [[urine]]. Hence, in the early diagnosis, specimen of choice should be, [[blood]] or [[CSF]] for [[culture]]. From the second week onwards serological tests are useful in the diagnosis.

== Treatment ==
All patients with suspected leptospirosis require [[antimicrobial]] therapy. [[Antimicrobial drug|Antimicrobial]] therapy is the mainstay of therapy for Leptospirosis. Antimicrobial therapies include either [[penicillin]], [[ampicillin]], [[doxycycline]], or [[ceftriaxone]]. Patients with [[meningitis]] often require high-dose [[penicillin]], whereas patients with [[Weil's disease]] often require either [[azithromycin]] or [[doxycycline]]. Supportive measures include [[detoxification]] and normalization of electrolyte imbalances. [[Dialysis]] is reserved for patients with severe disease who fail antimicrobial therapy.

== Prevention ==

==References==
{{Reflist|2}}

[[Category:Disease]]
[[Category:Infectious disease]]

Leptospirosis physical examination

2017-03-09T21:19:05Z

Venkata Sivakrishna Kumar Pulivarthi: /* Physical Examination Findings */

__NOTOC__
{{Leptospirosis}}
{{CMG}};{{AE}}{{VSKP}}
==Overview==
Physical examination findings of leptospirosis depends upon the severity of the disease. In the early days of the disease, patient may show signs of upper respiratory tract infections, later findings varies with the severity of the disease, immune status of the host and the organ system involved.

==Physical Examination Findings==
=== Appearance of the Patient ===
* Patient present with [[irritability]] and [[restlessness]].

=== Vital Signs ===
* [[Hypotension]] and circulatory collapse.
* [[Tachypnea]]
* [[Tachycardia]]

=== Skin ===
* [[Macular]], [[maculopapular]] [[erythematous]] skin eruptions are seen in the [[face]] and [[trunk]].<ref name="pmid14902167">{{cite journal| author=BEESON PB, HANKEY DD| title=Leptospiral meningitis. | journal=AMA Arch Intern Med | year= 1952 | volume= 89 | issue= 4 | pages= 575-83 | pmid=14902167 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14902167 }} </ref>
* [[Purpura]] due to [[thrombocytopenia]].
<gallery>File:Leptospirosis rash.jpg</gallery>

=== HEENT ===
* Icteric [[sclera]] is seen in patients with icteric leptospirosis
* Conjunctival suffusion: a charecterestic finding seen in patients with anicteric leptosirosis. Usually bilaeral and involving palpebral [[conjunctiva]].<ref name="Budihal2014">{{cite journal|last1=Budihal|first1=Suman Veerappa|title=Leptospirosis Diagnosis: Competancy of Various Laboratory Tests|journal=JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH|year=2014|issn=2249782X|doi=10.7860/JCDR/2014/6593.3950}}</ref>
* Conjunctival hemorrhages: may be unilateral or bilateral.<ref name="pmid1224630">{{cite journal| author=King SD, Urquhart AE| title=Laboratory investigations on four cases of leptospiral meningitis in Jamaica. | journal=West Indian Med J | year= 1975 | volume= 24 | issue= 4 | pages= 196-201 | pmid=1224630 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1224630 }} </ref>
<gallery>File:Leptospirosis eye.jpg</gallery>

=== Neck ===

=== Lungs ===
* [[Crepitations]] common in basal regions

=== Heart ===

=== Abdomen ===
* [[Right upper quadrant]] [[Tenderness (medicine)|tenderness]]<ref name="pmid9071036">{{cite journal| author=Silva MV, Camargo ED, Batista L, Vaz AJ, Ferreira AW, Barbosa PR| title=Application of anti-leptospira ELISA-IgM for the etiologic elucidation of meningitis. | journal=Rev Inst Med Trop Sao Paulo | year= 1996 | volume= 38 | issue= 2 | pages= 153-6 | pmid=9071036 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9071036 }} </ref>

* [[Hepatomegaly]]

=== Genitourinary ===

=== Extremities ===
* [[Edema]] of the [[extremities]]
* [[Cool extremities|cold clammy extremities]]

=== Neuromuscular ===
Signs of [[meningitis]] such as [[neck stiffness]], [[nuchal rigidity]] are present.

Other signs include:
* [[Nystagmus]]
* [[Spasticity]]

==References==
{{reflist|2}}

[[Category:Infectious disease]]
[[Category:Diseases]]

Leptospirosis physical examination

2017-03-09T21:17:38Z

Venkata Sivakrishna Kumar Pulivarthi: /* Overview */

__NOTOC__
{{Leptospirosis}}
{{CMG}};{{AE}}{{VSKP}}
==Overview==
Physical examination findings of leptospirosis depends upon the severity of the disease. In the early days of the disease, patient may show signs of upper respiratory tract infections, later findings varies with the severity of the disease, immune status of the host and the organ system involved.

==Physical Examination Findings==
<ref name="Budihal2014">{{cite journal|last1=Budihal|first1=Suman Veerappa|title=Leptospirosis Diagnosis: Competancy of Various Laboratory Tests|journal=JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH|year=2014|issn=2249782X|doi=10.7860/JCDR/2014/6593.3950}}</ref><ref name="pmid14902167">{{cite journal| author=BEESON PB, HANKEY DD| title=Leptospiral meningitis. | journal=AMA Arch Intern Med | year= 1952 | volume= 89 | issue= 4 | pages= 575-83 | pmid=14902167 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14902167 }} </ref><ref name="pmid1224630">{{cite journal| author=King SD, Urquhart AE| title=Laboratory investigations on four cases of leptospiral meningitis in Jamaica. | journal=West Indian Med J | year= 1975 | volume= 24 | issue= 4 | pages= 196-201 | pmid=1224630 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1224630 }} </ref><ref name="pmid9071036">{{cite journal| author=Silva MV, Camargo ED, Batista L, Vaz AJ, Ferreira AW, Barbosa PR| title=Application of anti-leptospira ELISA-IgM for the etiologic elucidation of meningitis. | journal=Rev Inst Med Trop Sao Paulo | year= 1996 | volume= 38 | issue= 2 | pages= 153-6 | pmid=9071036 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9071036 }} </ref>
=== Appearance of the Patient ===
* Patient present with [[irritability]] and [[restlessness]].

=== Vital Signs ===
* [[Hypotension]] and circulatory collapse.
* [[Tachypnea]]
* [[Tachycardia]]

=== Skin ===
* [[Macular]], [[maculopapular]] [[erythematous]] skin eruptions are seen in the [[face]] and [[trunk]].
* [[Purpura]] due to [[thrombocytopenia]].
<gallery>File:Leptospirosis rash.jpg</gallery>

=== HEENT ===
* Icteric [[sclera]] is seen in patients with icteric leptospirosis
* Conjunctival suffusion: a charecterestic finding seen in patients with anicteric leptosirosis. Usually bilaeral and involving palpebral [[conjunctiva]].
* Conjunctival hemorrhages: may be unilateral or bilateral.
<gallery>File:Leptospirosis eye.jpg</gallery>

=== Neck ===

=== Lungs ===
* [[Crepitations]] common in basal regions

=== Heart ===

=== Abdomen ===
* [[Right upper quadrant]] [[Tenderness (medicine)|tenderness]]

* [[Hepatomegaly]]

=== Genitourinary ===

=== Extremities ===
* [[Edema]] of the [[extremities]]
* [[Cool extremities|cold clammy extremities]]

=== Neuromuscular ===
Signs of [[meningitis]] such as [[neck stiffness]], [[nuchal rigidity]] are present.

Other signs include:
* [[Nystagmus]]
* [[Spasticity]]

==References==
{{reflist|2}}

[[Category:Infectious disease]]
[[Category:Diseases]]

Leptospirosis overview

2017-03-09T20:59:37Z

Venkata Sivakrishna Kumar Pulivarthi:

__NOTOC__
[[File:Leptospira.png|right|200px]]
{{Leptospirosis}}

{{CMG}};{{AE}}{{VSKP}}

==Overview==

'''Leptospirosis''' (also known as '''Weil's disease''', '''canicola fever''', '''canefield fever''', '''nanukayami fever''', '''7-day fever''' and many more<ref name=NORD> Leptospirosis. National Organization for Rare Diseases (2015). http://rarediseases.org/rare-diseases/leptospirosis/ Accessed on July 28, 2016 </ref>) is a [[infectious disease|bacterial]] [[zoonotic]] disease caused by [[spirochaete]]s of the [[genus]] ''[[Leptospira]]'' that affects [[human]]s and a wide range of animals, including mammals, birds, amphibians, and reptiles.<ref name=Leptospirosis> Leptospirosis. Centers for Disease Control and Prevention (2015). https://www.cdc.gov/leptospirosis/ Accessed on July 28, 2016 </ref> It was first described by [[Adolf Weil (physician)|Adolf Weil]] in 1886 when he reported an "acute infectious disease with [[splenomegaly|enlargement of spleen]], [[jaundice]] and [[nephritis]]". ''Leptospira'' was first observed in 1907 from a [[post mortem]] [[kidney|renal tissue]] slice.<ref>Stimson AM (1907). "Note on an organism found in yellow-fever tissue." ''Public Health Reports'' '''22''':541.</ref>

Though being recognised among the world's most common [[zoonosis|zoonoses]], leptospirosis is a relatively rare bacterial [[infection]] in humans. The infection is commonly transmitted to humans by allowing [[fresh water]] that has been contaminated by animal [[urine]] to come in contact with unhealed breaks in the [[skin]], [[eye]]s or with the [[mucous membrane]]s. Outside of [[Tropics|tropical]] areas, leptospirosis cases have a relatively distinct seasonality with most of them occurring August-September/February-March.

Recently, with the improved health and safety methods in the work place, more infections are occurring due to recreational activities rather than occupational exposure.<ref name="pmid2786228">{{cite journal| author=Philipp R, Waitkins S, Caul O, Roome A, McMahon S, Enticott R| title=Leptospiral and hepatitis A antibodies amongst windsurfers and waterskiers in Bristol City Docks. | journal=Public Health | year= 1989 | volume= 103 | issue= 2 | pages= 123-9 | pmid=2786228 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2786228 }} </ref><ref name="pmid1490212">{{cite journal| author=Philipp R, King C, Hughes A| title=Understanding of Weil's disease among canoeists. | journal=Br J Sports Med | year= 1992 | volume= 26 | issue= 4 | pages= 223-7 | pmid=1490212 | doi= | pmc=1479000 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1490212 }} </ref>

Leptospires can survive for a prolonged period outside the animal host, especially in the environment favored by warm moist conditions with a neutral pH. Animal body fluids such as urine, semen and products of conception with pathogenic leptospires, pose a potential risk to humans through prolonged excretion of bacteria.Other less common mechanisms of transmission include direct infection from animal urine, human to human spread, sexual transmission and via breast milk.<ref name="pmid20186328">{{cite journal| author=Ganoza CA, Matthias MA, Saito M, Cespedes M, Gotuzzo E, Vinetz JM| title=Asymptomatic renal colonization of humans in the peruvian Amazon by Leptospira. | journal=PLoS Negl Trop Dis | year= 2010 | volume= 4 | issue= 2 | pages= e612 | pmid=20186328 | doi=10.1371/journal.pntd.0000612 | pmc=2826405 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20186328 }} </ref><ref name="pmid14166972">{{cite journal| author=SPINU I, TOPCIU V et al.| title=[MAN AS A VIRAL RESERVOIR IN AN EPIDEMIC OF LEPTOSPIROSIS OCCURRING IN THE JUNGLE]. | journal=Arch Roum Pathol Exp Microbiol | year= 1963 | volume= 22 | issue= | pages= 1081-100 | pmid=14166972 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14166972 }} </ref><ref name="pmid987112">{{cite journal| author=Kiktenko VS, Balashov NG, Rodina VN| title=Leptospirosis infection through insemination of animals. | journal=J Hyg Epidemiol Microbiol Immunol | year= 1976 | volume= 21 | issue= 2 | pages= 207-13 | pmid=987112 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=987112 }} </ref>

== Historical Perspective ==
Adof Weil is the first physician described about the severe form of leptospirosis and the name [[Weil's disease]] is named after him in the year 1886. He also described the [[jaundice]] with [[splenomegaly]], [[renal failure]], [[skin rash]] and conjunctival suffusion.<ref name="pmid25388129">{{cite journal| author=Adler B| title=History of leptospirosis and leptospira. | journal=Curr Top Microbiol Immunol | year= 2015 | volume= 387 | issue= | pages= 1-9 | pmid=25388129 | doi=10.1007/978-3-662-45059-8_1 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25388129 }} </ref> Japanees scientists Kitamura and Hara named this disease as autumn fever and seven day disease in 1918.<ref name="Kobayashi2001">{{cite journal|last1=Kobayashi|first1=Yuzuru|title=Discovery of the causative organism of Weil's disease: historical view|journal=Journal of Infection and Chemotherapy|volume=7|issue=1|year=2001|pages=10–15|issn=1341321X|doi=10.1007/s101560170028}}</ref>

== Classification ==
Leptospirosis is classified into anicteric and icteric form of leptospirosis based on the clinical presentation.

== Pathophysiology ==

== Causes ==
Leptospirosis is caused by an infection with ''[[Leptospira]]''. Several species of Leptospira have identified and have been classified, genotypically, which include both pathogenic and saprophytic species. Among the pathogenic species, over 300 serovars have been identified by serotyping methods.<ref name="pmid22843698">{{cite journal| author=Forbes AE, Zochowski WJ, Dubrey SW, Sivaprakasam V| title=Leptospirosis and Weil's disease in the UK. | journal=QJM | year= 2012 | volume= 105 | issue= 12 | pages= 1151-62 | pmid=22843698 | doi=10.1093/qjmed/hcs145 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22843698 }} </ref>

== Differential Diagnosis ==
Leptospirosis must be differentiated from other diseases that cause fever, diarrhea, nausea and vomiting, such as ebola, typhoid fever, malaria, yellow fever, and other enteric bacterial infections. Moderate to severe leptospirosis must be differentiated from dengue fever.

== Epidemiology and Demographics==
Leptospirosis occurs worldwide but is most common in temperate or tropical climates. It is an occupational hazard for many people who work outdoors or with animals, for example, farmers, sewer workers, veterinarians, fish workers, dairy farmers, or military personnel. It is a recreational hazard for campers or those who participate in outdoor sports in contaminated areas and has been associated with swimming, wading, and whitewater rafting in contaminated lakes and rivers. The incidence is also increasing among urban children. Epidemiology of human leptospirosis is complex and dynamic, due to the interaction of pathogen, host, animal reservoir, and environment. With the increase in urban population, occupational and recreational exposure to surface water and climatic changes results in increase in prevalence of leptospirosis recently.

== Risk Factors ==
The risk of acquiring leptospirosis is associated with contact with animals, which made leptospirosis as an important occupational disease, especially affecting farmers, slaughterhouse workers, pet traders, veterinarians, rodent catchers and sewer workers who are in contact with mammalian species which acts as a natural carriers of leptospires.<ref name="pmid11292640">{{cite journal| author=Levett PN| title=Leptospirosis. | journal=Clin Microbiol Rev | year= 2001 | volume= 14 | issue= 2 | pages= 296-326 | pmid=11292640 | doi=10.1128/CMR.14.2.296-326.2001 | pmc=88975 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11292640 }} </ref> According to World health organization survey highest risk groups are subsistence farmers and people living in urban slums.<ref name="pmid16148523">{{cite journal| author=McBride AJ, Athanazio DA, Reis MG, Ko AI| title=Leptospirosis. | journal=Curr Opin Infect Dis | year= 2005 | volume= 18 | issue= 5 | pages= 376-86 | pmid=16148523 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16148523 }} </ref> Common risk factors in the development of leptospirosis include occupational exposure to animals, tropical or temperate climates, and water sports in contaminated lakes and rivers.

== Natural History, Complications & Prognosis ==
Leptospirosis is transported by the natural carriers such as feral, semi-domestic and farm and pet animals.<ref name="pmid11292640">{{cite journal| author=Levett PN| title=Leptospirosis. | journal=Clin Microbiol Rev | year= 2001 | volume= 14 | issue= 2 | pages= 296-326 | pmid=11292640 | doi=10.1128/CMR.14.2.296-326.2001 | pmc=88975 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11292640 }} </ref> Incubation period for leptospirosis varies between 3-20 days. The disease can cause wide range of symptoms from mild [[flu]]-like symptoms to severe disease with multi [[organ failure]] causing death. The first phase resolves and the patient is asymptomatic briefly before the second phase begins that is characterized by [[meningitis]], [[liver]] damage (causing [[jaundice]]), and [[renal failure]].<ref name="VCNA">{{cite journal|author=Heuter, Kerry J.,Langston, Cathy E.|title=Leptospirosis: A re-emerging zoonotic disease|journal=The Veterinary Clinics of North America|year=2003|volume=33|pages=791-807}}</ref> The disease leptospirosis is poorly known and unaware of its natural history is mainly due to the wide range of non specific symptoms, subclinical nature of the disease in animals, and non specific laboratory tests making the disease difficult to diagnose.<ref name="pmid16600656">{{cite journal| author=Vieira ML, Gama-Simões MJ, Collares-Pereira M| title=Human leptospirosis in Portugal: A retrospective study of eighteen years. | journal=Int J Infect Dis | year= 2006 | volume= 10 | issue= 5 | pages= 378-86 | pmid=16600656 | doi=10.1016/j.ijid.2005.07.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16600656 }} </ref> Outcome of the patient depends upon the pathogenic [[serovar]] and [[immunological]] status.

== Diagnosis ==
Clinical symptoms of leptospirosis are very wide, with mild anicteric presentation at one end to severe leptospirosis with severe [[jaundice]] and multiple organ involvement. Classic presentation of leptospirosis is a biphasic illness, and the onset of Symptoms within 2–30 days (incubation period) of exposure to the bacteria. Serious symptoms may manifest earlier on Days 4–6 of the illness depending on the type of pathogen and host immunological status.<ref>{{cite book | last = Faine | first = S | title = Guidelines for the control of leptospirosis | publisher = World Health Organization Obtainable from WHO Publication Centre USA | location = Geneva Albany, N.Y | year = 1982 | isbn = 924170067X }}</ref> As the clinical manifestations of the disease are non specific, the clinical diagnosis is difficult. The laboratory investigations for leptospirosis should be considered in patient with an abrupt onset of [[fever]], [[chills]], conjunctival suffusion, [[headache]], [[myalgia]] and [[jaundice]] with history of occupational exposure to infected animals or contaminated with animal urine.<ref>{{cite book | last = LastName | first = FirstName | title = Human leptospirosis : guidance for diagnosis, surveillance and control | publisher = World Health Organization | location = Geneva | year = 2003 | isbn = 9241545895 }}</ref> The diagnosis of leptospirosis is based upon clinical suspicion and lab findings, so lab tests should be considered in a patient with a history of contact with potentially infected animals, soil or surface waters contaminated by animal urine.<ref name="pmid22843698">{{cite journal| author=Forbes AE, Zochowski WJ, Dubrey SW, Sivaprakasam V| title=Leptospirosis and Weil's disease in the UK. | journal=QJM | year= 2012 | volume= 105 | issue= 12 | pages= 1151-62 | pmid=22843698 | doi=10.1093/qjmed/hcs145 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22843698 }} </ref> Leptospires can be found in [[blood]] and [[CSF]] for the first 7 to 10 days and then in the [[urine]]. Hence, in the early diagnosis, specimen of choice should be, [[blood]] or [[CSF]] for [[culture]]. From the second week onwards serological tests are useful in the diagnosis.

== Treatment ==
All patients with suspected leptospirosis require [[antimicrobial]] therapy. [[Antimicrobial drug|Antimicrobial]] therapy is the mainstay of therapy for Leptospirosis. Antimicrobial therapies include either [[penicillin]], [[ampicillin]], [[doxycycline]], or [[ceftriaxone]]. Patients with [[meningitis]] often require high-dose [[penicillin]], whereas patients with [[Weil's disease]] often require either [[azithromycin]] or [[doxycycline]]. Supportive measures include [[detoxification]] and normalization of electrolyte imbalances. [[Dialysis]] is reserved for patients with severe disease who fail antimicrobial therapy.

== Prevention ==

==References==
{{Reflist|2}}

[[Category:Disease]]
[[Category:Infectious disease]]

Leptospirosis overview

2017-03-09T20:58:25Z

Venkata Sivakrishna Kumar Pulivarthi: /* Treatment */

__NOTOC__
[[File:Leptospira.png|right|200px]]
{{Leptospirosis}}

{{CMG}}

==Overview==

'''Leptospirosis''' (also known as '''Weil's disease''', '''canicola fever''', '''canefield fever''', '''nanukayami fever''', '''7-day fever''' and many more<ref name=NORD> Leptospirosis. National Organization for Rare Diseases (2015). http://rarediseases.org/rare-diseases/leptospirosis/ Accessed on July 28, 2016 </ref>) is a [[infectious disease|bacterial]] [[zoonotic]] disease caused by [[spirochaete]]s of the [[genus]] ''[[Leptospira]]'' that affects [[human]]s and a wide range of animals, including mammals, birds, amphibians, and reptiles.<ref name=Leptospirosis> Leptospirosis. Centers for Disease Control and Prevention (2015). https://www.cdc.gov/leptospirosis/ Accessed on July 28, 2016 </ref> It was first described by [[Adolf Weil (physician)|Adolf Weil]] in 1886 when he reported an "acute infectious disease with [[splenomegaly|enlargement of spleen]], [[jaundice]] and [[nephritis]]". ''Leptospira'' was first observed in 1907 from a [[post mortem]] [[kidney|renal tissue]] slice.<ref>Stimson AM (1907). "Note on an organism found in yellow-fever tissue." ''Public Health Reports'' '''22''':541.</ref>

Though being recognised among the world's most common [[zoonosis|zoonoses]], leptospirosis is a relatively rare bacterial [[infection]] in humans. The infection is commonly transmitted to humans by allowing [[fresh water]] that has been contaminated by animal [[urine]] to come in contact with unhealed breaks in the [[skin]], [[eye]]s or with the [[mucous membrane]]s. Outside of [[Tropics|tropical]] areas, leptospirosis cases have a relatively distinct seasonality with most of them occurring August-September/February-March.

Recently, with the improved health and safety methods in the work place, more infections are occurring due to recreational activities rather than occupational exposure.<ref name="pmid2786228">{{cite journal| author=Philipp R, Waitkins S, Caul O, Roome A, McMahon S, Enticott R| title=Leptospiral and hepatitis A antibodies amongst windsurfers and waterskiers in Bristol City Docks. | journal=Public Health | year= 1989 | volume= 103 | issue= 2 | pages= 123-9 | pmid=2786228 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2786228 }} </ref><ref name="pmid1490212">{{cite journal| author=Philipp R, King C, Hughes A| title=Understanding of Weil's disease among canoeists. | journal=Br J Sports Med | year= 1992 | volume= 26 | issue= 4 | pages= 223-7 | pmid=1490212 | doi= | pmc=1479000 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1490212 }} </ref>

Leptospires can survive for a prolonged period outside the animal host, especially in the environment favored by warm moist conditions with a neutral pH. Animal body fluids such as urine, semen and products of conception with pathogenic leptospires, pose a potential risk to humans through prolonged excretion of bacteria.Other less common mechanisms of transmission include direct infection from animal urine, human to human spread, sexual transmission and via breast milk.<ref name="pmid20186328">{{cite journal| author=Ganoza CA, Matthias MA, Saito M, Cespedes M, Gotuzzo E, Vinetz JM| title=Asymptomatic renal colonization of humans in the peruvian Amazon by Leptospira. | journal=PLoS Negl Trop Dis | year= 2010 | volume= 4 | issue= 2 | pages= e612 | pmid=20186328 | doi=10.1371/journal.pntd.0000612 | pmc=2826405 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20186328 }} </ref><ref name="pmid14166972">{{cite journal| author=SPINU I, TOPCIU V et al.| title=[MAN AS A VIRAL RESERVOIR IN AN EPIDEMIC OF LEPTOSPIROSIS OCCURRING IN THE JUNGLE]. | journal=Arch Roum Pathol Exp Microbiol | year= 1963 | volume= 22 | issue= | pages= 1081-100 | pmid=14166972 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14166972 }} </ref><ref name="pmid987112">{{cite journal| author=Kiktenko VS, Balashov NG, Rodina VN| title=Leptospirosis infection through insemination of animals. | journal=J Hyg Epidemiol Microbiol Immunol | year= 1976 | volume= 21 | issue= 2 | pages= 207-13 | pmid=987112 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=987112 }} </ref>

== Historical Perspective ==
Adof Weil is the first physician described about the severe form of leptospirosis and the name [[Weil's disease]] is named after him in the year 1886. He also described the [[jaundice]] with [[splenomegaly]], [[renal failure]], [[skin rash]] and conjunctival suffusion.<ref name="pmid25388129">{{cite journal| author=Adler B| title=History of leptospirosis and leptospira. | journal=Curr Top Microbiol Immunol | year= 2015 | volume= 387 | issue= | pages= 1-9 | pmid=25388129 | doi=10.1007/978-3-662-45059-8_1 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25388129 }} </ref> Japanees scientists Kitamura and Hara named this disease as autumn fever and seven day disease in 1918.<ref name="Kobayashi2001">{{cite journal|last1=Kobayashi|first1=Yuzuru|title=Discovery of the causative organism of Weil's disease: historical view|journal=Journal of Infection and Chemotherapy|volume=7|issue=1|year=2001|pages=10–15|issn=1341321X|doi=10.1007/s101560170028}}</ref>

== Classification ==
Leptospirosis is classified into anicteric and icteric form of leptospirosis based on the clinical presentation.

== Pathophysiology ==

== Causes ==
Leptospirosis is caused by an infection with ''[[Leptospira]]''. Several species of Leptospira have identified and have been classified, genotypically, which include both pathogenic and saprophytic species. Among the pathogenic species, over 300 serovars have been identified by serotyping methods.<ref name="pmid22843698">{{cite journal| author=Forbes AE, Zochowski WJ, Dubrey SW, Sivaprakasam V| title=Leptospirosis and Weil's disease in the UK. | journal=QJM | year= 2012 | volume= 105 | issue= 12 | pages= 1151-62 | pmid=22843698 | doi=10.1093/qjmed/hcs145 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22843698 }} </ref>

== Differential Diagnosis ==
Leptospirosis must be differentiated from other diseases that cause fever, diarrhea, nausea and vomiting, such as ebola, typhoid fever, malaria, yellow fever, and other enteric bacterial infections. Moderate to severe leptospirosis must be differentiated from dengue fever.

== Epidemiology and Demographics==
Leptospirosis occurs worldwide but is most common in temperate or tropical climates. It is an occupational hazard for many people who work outdoors or with animals, for example, farmers, sewer workers, veterinarians, fish workers, dairy farmers, or military personnel. It is a recreational hazard for campers or those who participate in outdoor sports in contaminated areas and has been associated with swimming, wading, and whitewater rafting in contaminated lakes and rivers. The incidence is also increasing among urban children. Epidemiology of human leptospirosis is complex and dynamic, due to the interaction of pathogen, host, animal reservoir, and environment. With the increase in urban population, occupational and recreational exposure to surface water and climatic changes results in increase in prevalence of leptospirosis recently.

== Risk Factors ==
The risk of acquiring leptospirosis is associated with contact with animals, which made leptospirosis as an important occupational disease, especially affecting farmers, slaughterhouse workers, pet traders, veterinarians, rodent catchers and sewer workers who are in contact with mammalian species which acts as a natural carriers of leptospires.<ref name="pmid11292640">{{cite journal| author=Levett PN| title=Leptospirosis. | journal=Clin Microbiol Rev | year= 2001 | volume= 14 | issue= 2 | pages= 296-326 | pmid=11292640 | doi=10.1128/CMR.14.2.296-326.2001 | pmc=88975 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11292640 }} </ref> According to World health organization survey highest risk groups are subsistence farmers and people living in urban slums.<ref name="pmid16148523">{{cite journal| author=McBride AJ, Athanazio DA, Reis MG, Ko AI| title=Leptospirosis. | journal=Curr Opin Infect Dis | year= 2005 | volume= 18 | issue= 5 | pages= 376-86 | pmid=16148523 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16148523 }} </ref> Common risk factors in the development of leptospirosis include occupational exposure to animals, tropical or temperate climates, and water sports in contaminated lakes and rivers.

== Natural History, Complications & Prognosis ==
Leptospirosis is transported by the natural carriers such as feral, semi-domestic and farm and pet animals.<ref name="pmid11292640">{{cite journal| author=Levett PN| title=Leptospirosis. | journal=Clin Microbiol Rev | year= 2001 | volume= 14 | issue= 2 | pages= 296-326 | pmid=11292640 | doi=10.1128/CMR.14.2.296-326.2001 | pmc=88975 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11292640 }} </ref> Incubation period for leptospirosis varies between 3-20 days. The disease can cause wide range of symptoms from mild [[flu]]-like symptoms to severe disease with multi [[organ failure]] causing death. The first phase resolves and the patient is asymptomatic briefly before the second phase begins that is characterized by [[meningitis]], [[liver]] damage (causing [[jaundice]]), and [[renal failure]].<ref name="VCNA">{{cite journal|author=Heuter, Kerry J.,Langston, Cathy E.|title=Leptospirosis: A re-emerging zoonotic disease|journal=The Veterinary Clinics of North America|year=2003|volume=33|pages=791-807}}</ref> The disease leptospirosis is poorly known and unaware of its natural history is mainly due to the wide range of non specific symptoms, subclinical nature of the disease in animals, and non specific laboratory tests making the disease difficult to diagnose.<ref name="pmid16600656">{{cite journal| author=Vieira ML, Gama-Simões MJ, Collares-Pereira M| title=Human leptospirosis in Portugal: A retrospective study of eighteen years. | journal=Int J Infect Dis | year= 2006 | volume= 10 | issue= 5 | pages= 378-86 | pmid=16600656 | doi=10.1016/j.ijid.2005.07.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16600656 }} </ref> Outcome of the patient depends upon the pathogenic [[serovar]] and [[immunological]] status.

== Diagnosis ==
Clinical symptoms of leptospirosis are very wide, with mild anicteric presentation at one end to severe leptospirosis with severe [[jaundice]] and multiple organ involvement. Classic presentation of leptospirosis is a biphasic illness, and the onset of Symptoms within 2–30 days (incubation period) of exposure to the bacteria. Serious symptoms may manifest earlier on Days 4–6 of the illness depending on the type of pathogen and host immunological status.<ref>{{cite book | last = Faine | first = S | title = Guidelines for the control of leptospirosis | publisher = World Health Organization Obtainable from WHO Publication Centre USA | location = Geneva Albany, N.Y | year = 1982 | isbn = 924170067X }}</ref> As the clinical manifestations of the disease are non specific, the clinical diagnosis is difficult. The laboratory investigations for leptospirosis should be considered in patient with an abrupt onset of [[fever]], [[chills]], conjunctival suffusion, [[headache]], [[myalgia]] and [[jaundice]] with history of occupational exposure to infected animals or contaminated with animal urine.<ref>{{cite book | last = LastName | first = FirstName | title = Human leptospirosis : guidance for diagnosis, surveillance and control | publisher = World Health Organization | location = Geneva | year = 2003 | isbn = 9241545895 }}</ref> The diagnosis of leptospirosis is based upon clinical suspicion and lab findings, so lab tests should be considered in a patient with a history of contact with potentially infected animals, soil or surface waters contaminated by animal urine.<ref name="pmid22843698">{{cite journal| author=Forbes AE, Zochowski WJ, Dubrey SW, Sivaprakasam V| title=Leptospirosis and Weil's disease in the UK. | journal=QJM | year= 2012 | volume= 105 | issue= 12 | pages= 1151-62 | pmid=22843698 | doi=10.1093/qjmed/hcs145 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22843698 }} </ref> Leptospires can be found in [[blood]] and [[CSF]] for the first 7 to 10 days and then in the [[urine]]. Hence, in the early diagnosis, specimen of choice should be, [[blood]] or [[CSF]] for [[culture]]. From the second week onwards serological tests are useful in the diagnosis.

== Treatment ==
All patients with suspected leptospirosis require [[antimicrobial]] therapy. [[Antimicrobial drug|Antimicrobial]] therapy is the mainstay of therapy for Leptospirosis. Antimicrobial therapies include either [[penicillin]], [[ampicillin]], [[doxycycline]], or [[ceftriaxone]]. Patients with [[meningitis]] often require high-dose [[penicillin]], whereas patients with [[Weil's disease]] often require either [[azithromycin]] or [[doxycycline]]. Supportive measures include [[detoxification]] and normalization of electrolyte imbalances. [[Dialysis]] is reserved for patients with severe disease who fail antimicrobial therapy.

== Prevention ==

==References==
{{Reflist|2}}

[[Category:Disease]]
[[Category:Infectious disease]]

Leptospirosis overview

2017-03-09T20:57:41Z

Venkata Sivakrishna Kumar Pulivarthi: /* Diagnosis */

__NOTOC__
[[File:Leptospira.png|right|200px]]
{{Leptospirosis}}

{{CMG}}

==Overview==

'''Leptospirosis''' (also known as '''Weil's disease''', '''canicola fever''', '''canefield fever''', '''nanukayami fever''', '''7-day fever''' and many more<ref name=NORD> Leptospirosis. National Organization for Rare Diseases (2015). http://rarediseases.org/rare-diseases/leptospirosis/ Accessed on July 28, 2016 </ref>) is a [[infectious disease|bacterial]] [[zoonotic]] disease caused by [[spirochaete]]s of the [[genus]] ''[[Leptospira]]'' that affects [[human]]s and a wide range of animals, including mammals, birds, amphibians, and reptiles.<ref name=Leptospirosis> Leptospirosis. Centers for Disease Control and Prevention (2015). https://www.cdc.gov/leptospirosis/ Accessed on July 28, 2016 </ref> It was first described by [[Adolf Weil (physician)|Adolf Weil]] in 1886 when he reported an "acute infectious disease with [[splenomegaly|enlargement of spleen]], [[jaundice]] and [[nephritis]]". ''Leptospira'' was first observed in 1907 from a [[post mortem]] [[kidney|renal tissue]] slice.<ref>Stimson AM (1907). "Note on an organism found in yellow-fever tissue." ''Public Health Reports'' '''22''':541.</ref>

Though being recognised among the world's most common [[zoonosis|zoonoses]], leptospirosis is a relatively rare bacterial [[infection]] in humans. The infection is commonly transmitted to humans by allowing [[fresh water]] that has been contaminated by animal [[urine]] to come in contact with unhealed breaks in the [[skin]], [[eye]]s or with the [[mucous membrane]]s. Outside of [[Tropics|tropical]] areas, leptospirosis cases have a relatively distinct seasonality with most of them occurring August-September/February-March.

Recently, with the improved health and safety methods in the work place, more infections are occurring due to recreational activities rather than occupational exposure.<ref name="pmid2786228">{{cite journal| author=Philipp R, Waitkins S, Caul O, Roome A, McMahon S, Enticott R| title=Leptospiral and hepatitis A antibodies amongst windsurfers and waterskiers in Bristol City Docks. | journal=Public Health | year= 1989 | volume= 103 | issue= 2 | pages= 123-9 | pmid=2786228 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2786228 }} </ref><ref name="pmid1490212">{{cite journal| author=Philipp R, King C, Hughes A| title=Understanding of Weil's disease among canoeists. | journal=Br J Sports Med | year= 1992 | volume= 26 | issue= 4 | pages= 223-7 | pmid=1490212 | doi= | pmc=1479000 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1490212 }} </ref>

Leptospires can survive for a prolonged period outside the animal host, especially in the environment favored by warm moist conditions with a neutral pH. Animal body fluids such as urine, semen and products of conception with pathogenic leptospires, pose a potential risk to humans through prolonged excretion of bacteria.Other less common mechanisms of transmission include direct infection from animal urine, human to human spread, sexual transmission and via breast milk.<ref name="pmid20186328">{{cite journal| author=Ganoza CA, Matthias MA, Saito M, Cespedes M, Gotuzzo E, Vinetz JM| title=Asymptomatic renal colonization of humans in the peruvian Amazon by Leptospira. | journal=PLoS Negl Trop Dis | year= 2010 | volume= 4 | issue= 2 | pages= e612 | pmid=20186328 | doi=10.1371/journal.pntd.0000612 | pmc=2826405 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20186328 }} </ref><ref name="pmid14166972">{{cite journal| author=SPINU I, TOPCIU V et al.| title=[MAN AS A VIRAL RESERVOIR IN AN EPIDEMIC OF LEPTOSPIROSIS OCCURRING IN THE JUNGLE]. | journal=Arch Roum Pathol Exp Microbiol | year= 1963 | volume= 22 | issue= | pages= 1081-100 | pmid=14166972 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14166972 }} </ref><ref name="pmid987112">{{cite journal| author=Kiktenko VS, Balashov NG, Rodina VN| title=Leptospirosis infection through insemination of animals. | journal=J Hyg Epidemiol Microbiol Immunol | year= 1976 | volume= 21 | issue= 2 | pages= 207-13 | pmid=987112 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=987112 }} </ref>

== Historical Perspective ==
Adof Weil is the first physician described about the severe form of leptospirosis and the name [[Weil's disease]] is named after him in the year 1886. He also described the [[jaundice]] with [[splenomegaly]], [[renal failure]], [[skin rash]] and conjunctival suffusion.<ref name="pmid25388129">{{cite journal| author=Adler B| title=History of leptospirosis and leptospira. | journal=Curr Top Microbiol Immunol | year= 2015 | volume= 387 | issue= | pages= 1-9 | pmid=25388129 | doi=10.1007/978-3-662-45059-8_1 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25388129 }} </ref> Japanees scientists Kitamura and Hara named this disease as autumn fever and seven day disease in 1918.<ref name="Kobayashi2001">{{cite journal|last1=Kobayashi|first1=Yuzuru|title=Discovery of the causative organism of Weil's disease: historical view|journal=Journal of Infection and Chemotherapy|volume=7|issue=1|year=2001|pages=10–15|issn=1341321X|doi=10.1007/s101560170028}}</ref>

== Classification ==
Leptospirosis is classified into anicteric and icteric form of leptospirosis based on the clinical presentation.

== Pathophysiology ==

== Causes ==
Leptospirosis is caused by an infection with ''[[Leptospira]]''. Several species of Leptospira have identified and have been classified, genotypically, which include both pathogenic and saprophytic species. Among the pathogenic species, over 300 serovars have been identified by serotyping methods.<ref name="pmid22843698">{{cite journal| author=Forbes AE, Zochowski WJ, Dubrey SW, Sivaprakasam V| title=Leptospirosis and Weil's disease in the UK. | journal=QJM | year= 2012 | volume= 105 | issue= 12 | pages= 1151-62 | pmid=22843698 | doi=10.1093/qjmed/hcs145 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22843698 }} </ref>

== Differential Diagnosis ==
Leptospirosis must be differentiated from other diseases that cause fever, diarrhea, nausea and vomiting, such as ebola, typhoid fever, malaria, yellow fever, and other enteric bacterial infections. Moderate to severe leptospirosis must be differentiated from dengue fever.

== Epidemiology and Demographics==
Leptospirosis occurs worldwide but is most common in temperate or tropical climates. It is an occupational hazard for many people who work outdoors or with animals, for example, farmers, sewer workers, veterinarians, fish workers, dairy farmers, or military personnel. It is a recreational hazard for campers or those who participate in outdoor sports in contaminated areas and has been associated with swimming, wading, and whitewater rafting in contaminated lakes and rivers. The incidence is also increasing among urban children. Epidemiology of human leptospirosis is complex and dynamic, due to the interaction of pathogen, host, animal reservoir, and environment. With the increase in urban population, occupational and recreational exposure to surface water and climatic changes results in increase in prevalence of leptospirosis recently.

== Risk Factors ==
The risk of acquiring leptospirosis is associated with contact with animals, which made leptospirosis as an important occupational disease, especially affecting farmers, slaughterhouse workers, pet traders, veterinarians, rodent catchers and sewer workers who are in contact with mammalian species which acts as a natural carriers of leptospires.<ref name="pmid11292640">{{cite journal| author=Levett PN| title=Leptospirosis. | journal=Clin Microbiol Rev | year= 2001 | volume= 14 | issue= 2 | pages= 296-326 | pmid=11292640 | doi=10.1128/CMR.14.2.296-326.2001 | pmc=88975 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11292640 }} </ref> According to World health organization survey highest risk groups are subsistence farmers and people living in urban slums.<ref name="pmid16148523">{{cite journal| author=McBride AJ, Athanazio DA, Reis MG, Ko AI| title=Leptospirosis. | journal=Curr Opin Infect Dis | year= 2005 | volume= 18 | issue= 5 | pages= 376-86 | pmid=16148523 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16148523 }} </ref> Common risk factors in the development of leptospirosis include occupational exposure to animals, tropical or temperate climates, and water sports in contaminated lakes and rivers.

== Natural History, Complications & Prognosis ==
Leptospirosis is transported by the natural carriers such as feral, semi-domestic and farm and pet animals.<ref name="pmid11292640">{{cite journal| author=Levett PN| title=Leptospirosis. | journal=Clin Microbiol Rev | year= 2001 | volume= 14 | issue= 2 | pages= 296-326 | pmid=11292640 | doi=10.1128/CMR.14.2.296-326.2001 | pmc=88975 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11292640 }} </ref> Incubation period for leptospirosis varies between 3-20 days. The disease can cause wide range of symptoms from mild [[flu]]-like symptoms to severe disease with multi [[organ failure]] causing death. The first phase resolves and the patient is asymptomatic briefly before the second phase begins that is characterized by [[meningitis]], [[liver]] damage (causing [[jaundice]]), and [[renal failure]].<ref name="VCNA">{{cite journal|author=Heuter, Kerry J.,Langston, Cathy E.|title=Leptospirosis: A re-emerging zoonotic disease|journal=The Veterinary Clinics of North America|year=2003|volume=33|pages=791-807}}</ref> The disease leptospirosis is poorly known and unaware of its natural history is mainly due to the wide range of non specific symptoms, subclinical nature of the disease in animals, and non specific laboratory tests making the disease difficult to diagnose.<ref name="pmid16600656">{{cite journal| author=Vieira ML, Gama-Simões MJ, Collares-Pereira M| title=Human leptospirosis in Portugal: A retrospective study of eighteen years. | journal=Int J Infect Dis | year= 2006 | volume= 10 | issue= 5 | pages= 378-86 | pmid=16600656 | doi=10.1016/j.ijid.2005.07.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16600656 }} </ref> Outcome of the patient depends upon the pathogenic [[serovar]] and [[immunological]] status.

== Diagnosis ==
Clinical symptoms of leptospirosis are very wide, with mild anicteric presentation at one end to severe leptospirosis with severe [[jaundice]] and multiple organ involvement. Classic presentation of leptospirosis is a biphasic illness, and the onset of Symptoms within 2–30 days (incubation period) of exposure to the bacteria. Serious symptoms may manifest earlier on Days 4–6 of the illness depending on the type of pathogen and host immunological status.<ref>{{cite book | last = Faine | first = S | title = Guidelines for the control of leptospirosis | publisher = World Health Organization Obtainable from WHO Publication Centre USA | location = Geneva Albany, N.Y | year = 1982 | isbn = 924170067X }}</ref> As the clinical manifestations of the disease are non specific, the clinical diagnosis is difficult. The laboratory investigations for leptospirosis should be considered in patient with an abrupt onset of [[fever]], [[chills]], conjunctival suffusion, [[headache]], [[myalgia]] and [[jaundice]] with history of occupational exposure to infected animals or contaminated with animal urine.<ref>{{cite book | last = LastName | first = FirstName | title = Human leptospirosis : guidance for diagnosis, surveillance and control | publisher = World Health Organization | location = Geneva | year = 2003 | isbn = 9241545895 }}</ref> The diagnosis of leptospirosis is based upon clinical suspicion and lab findings, so lab tests should be considered in a patient with a history of contact with potentially infected animals, soil or surface waters contaminated by animal urine.<ref name="pmid22843698">{{cite journal| author=Forbes AE, Zochowski WJ, Dubrey SW, Sivaprakasam V| title=Leptospirosis and Weil's disease in the UK. | journal=QJM | year= 2012 | volume= 105 | issue= 12 | pages= 1151-62 | pmid=22843698 | doi=10.1093/qjmed/hcs145 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22843698 }} </ref> Leptospires can be found in [[blood]] and [[CSF]] for the first 7 to 10 days and then in the [[urine]]. Hence, in the early diagnosis, specimen of choice should be, [[blood]] or [[CSF]] for [[culture]]. From the second week onwards serological tests are useful in the diagnosis.

== Treatment ==

== Prevention ==

==References==
{{Reflist|2}}

[[Category:Disease]]
[[Category:Infectious disease]]

Leptospirosis overview

2017-03-09T20:55:52Z

Venkata Sivakrishna Kumar Pulivarthi: /* Diagnosis */

__NOTOC__
[[File:Leptospira.png|right|200px]]
{{Leptospirosis}}

{{CMG}}

==Overview==

'''Leptospirosis''' (also known as '''Weil's disease''', '''canicola fever''', '''canefield fever''', '''nanukayami fever''', '''7-day fever''' and many more<ref name=NORD> Leptospirosis. National Organization for Rare Diseases (2015). http://rarediseases.org/rare-diseases/leptospirosis/ Accessed on July 28, 2016 </ref>) is a [[infectious disease|bacterial]] [[zoonotic]] disease caused by [[spirochaete]]s of the [[genus]] ''[[Leptospira]]'' that affects [[human]]s and a wide range of animals, including mammals, birds, amphibians, and reptiles.<ref name=Leptospirosis> Leptospirosis. Centers for Disease Control and Prevention (2015). https://www.cdc.gov/leptospirosis/ Accessed on July 28, 2016 </ref> It was first described by [[Adolf Weil (physician)|Adolf Weil]] in 1886 when he reported an "acute infectious disease with [[splenomegaly|enlargement of spleen]], [[jaundice]] and [[nephritis]]". ''Leptospira'' was first observed in 1907 from a [[post mortem]] [[kidney|renal tissue]] slice.<ref>Stimson AM (1907). "Note on an organism found in yellow-fever tissue." ''Public Health Reports'' '''22''':541.</ref>

Though being recognised among the world's most common [[zoonosis|zoonoses]], leptospirosis is a relatively rare bacterial [[infection]] in humans. The infection is commonly transmitted to humans by allowing [[fresh water]] that has been contaminated by animal [[urine]] to come in contact with unhealed breaks in the [[skin]], [[eye]]s or with the [[mucous membrane]]s. Outside of [[Tropics|tropical]] areas, leptospirosis cases have a relatively distinct seasonality with most of them occurring August-September/February-March.

Recently, with the improved health and safety methods in the work place, more infections are occurring due to recreational activities rather than occupational exposure.<ref name="pmid2786228">{{cite journal| author=Philipp R, Waitkins S, Caul O, Roome A, McMahon S, Enticott R| title=Leptospiral and hepatitis A antibodies amongst windsurfers and waterskiers in Bristol City Docks. | journal=Public Health | year= 1989 | volume= 103 | issue= 2 | pages= 123-9 | pmid=2786228 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2786228 }} </ref><ref name="pmid1490212">{{cite journal| author=Philipp R, King C, Hughes A| title=Understanding of Weil's disease among canoeists. | journal=Br J Sports Med | year= 1992 | volume= 26 | issue= 4 | pages= 223-7 | pmid=1490212 | doi= | pmc=1479000 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1490212 }} </ref>

Leptospires can survive for a prolonged period outside the animal host, especially in the environment favored by warm moist conditions with a neutral pH. Animal body fluids such as urine, semen and products of conception with pathogenic leptospires, pose a potential risk to humans through prolonged excretion of bacteria.Other less common mechanisms of transmission include direct infection from animal urine, human to human spread, sexual transmission and via breast milk.<ref name="pmid20186328">{{cite journal| author=Ganoza CA, Matthias MA, Saito M, Cespedes M, Gotuzzo E, Vinetz JM| title=Asymptomatic renal colonization of humans in the peruvian Amazon by Leptospira. | journal=PLoS Negl Trop Dis | year= 2010 | volume= 4 | issue= 2 | pages= e612 | pmid=20186328 | doi=10.1371/journal.pntd.0000612 | pmc=2826405 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20186328 }} </ref><ref name="pmid14166972">{{cite journal| author=SPINU I, TOPCIU V et al.| title=[MAN AS A VIRAL RESERVOIR IN AN EPIDEMIC OF LEPTOSPIROSIS OCCURRING IN THE JUNGLE]. | journal=Arch Roum Pathol Exp Microbiol | year= 1963 | volume= 22 | issue= | pages= 1081-100 | pmid=14166972 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14166972 }} </ref><ref name="pmid987112">{{cite journal| author=Kiktenko VS, Balashov NG, Rodina VN| title=Leptospirosis infection through insemination of animals. | journal=J Hyg Epidemiol Microbiol Immunol | year= 1976 | volume= 21 | issue= 2 | pages= 207-13 | pmid=987112 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=987112 }} </ref>

== Historical Perspective ==
Adof Weil is the first physician described about the severe form of leptospirosis and the name [[Weil's disease]] is named after him in the year 1886. He also described the [[jaundice]] with [[splenomegaly]], [[renal failure]], [[skin rash]] and conjunctival suffusion.<ref name="pmid25388129">{{cite journal| author=Adler B| title=History of leptospirosis and leptospira. | journal=Curr Top Microbiol Immunol | year= 2015 | volume= 387 | issue= | pages= 1-9 | pmid=25388129 | doi=10.1007/978-3-662-45059-8_1 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25388129 }} </ref> Japanees scientists Kitamura and Hara named this disease as autumn fever and seven day disease in 1918.<ref name="Kobayashi2001">{{cite journal|last1=Kobayashi|first1=Yuzuru|title=Discovery of the causative organism of Weil's disease: historical view|journal=Journal of Infection and Chemotherapy|volume=7|issue=1|year=2001|pages=10–15|issn=1341321X|doi=10.1007/s101560170028}}</ref>

== Classification ==
Leptospirosis is classified into anicteric and icteric form of leptospirosis based on the clinical presentation.

== Pathophysiology ==

== Causes ==
Leptospirosis is caused by an infection with ''[[Leptospira]]''. Several species of Leptospira have identified and have been classified, genotypically, which include both pathogenic and saprophytic species. Among the pathogenic species, over 300 serovars have been identified by serotyping methods.<ref name="pmid22843698">{{cite journal| author=Forbes AE, Zochowski WJ, Dubrey SW, Sivaprakasam V| title=Leptospirosis and Weil's disease in the UK. | journal=QJM | year= 2012 | volume= 105 | issue= 12 | pages= 1151-62 | pmid=22843698 | doi=10.1093/qjmed/hcs145 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22843698 }} </ref>

== Differential Diagnosis ==
Leptospirosis must be differentiated from other diseases that cause fever, diarrhea, nausea and vomiting, such as ebola, typhoid fever, malaria, yellow fever, and other enteric bacterial infections. Moderate to severe leptospirosis must be differentiated from dengue fever.

== Epidemiology and Demographics==
Leptospirosis occurs worldwide but is most common in temperate or tropical climates. It is an occupational hazard for many people who work outdoors or with animals, for example, farmers, sewer workers, veterinarians, fish workers, dairy farmers, or military personnel. It is a recreational hazard for campers or those who participate in outdoor sports in contaminated areas and has been associated with swimming, wading, and whitewater rafting in contaminated lakes and rivers. The incidence is also increasing among urban children. Epidemiology of human leptospirosis is complex and dynamic, due to the interaction of pathogen, host, animal reservoir, and environment. With the increase in urban population, occupational and recreational exposure to surface water and climatic changes results in increase in prevalence of leptospirosis recently.

== Risk Factors ==
The risk of acquiring leptospirosis is associated with contact with animals, which made leptospirosis as an important occupational disease, especially affecting farmers, slaughterhouse workers, pet traders, veterinarians, rodent catchers and sewer workers who are in contact with mammalian species which acts as a natural carriers of leptospires.<ref name="pmid11292640">{{cite journal| author=Levett PN| title=Leptospirosis. | journal=Clin Microbiol Rev | year= 2001 | volume= 14 | issue= 2 | pages= 296-326 | pmid=11292640 | doi=10.1128/CMR.14.2.296-326.2001 | pmc=88975 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11292640 }} </ref> According to World health organization survey highest risk groups are subsistence farmers and people living in urban slums.<ref name="pmid16148523">{{cite journal| author=McBride AJ, Athanazio DA, Reis MG, Ko AI| title=Leptospirosis. | journal=Curr Opin Infect Dis | year= 2005 | volume= 18 | issue= 5 | pages= 376-86 | pmid=16148523 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16148523 }} </ref> Common risk factors in the development of leptospirosis include occupational exposure to animals, tropical or temperate climates, and water sports in contaminated lakes and rivers.

== Natural History, Complications & Prognosis ==
Leptospirosis is transported by the natural carriers such as feral, semi-domestic and farm and pet animals.<ref name="pmid11292640">{{cite journal| author=Levett PN| title=Leptospirosis. | journal=Clin Microbiol Rev | year= 2001 | volume= 14 | issue= 2 | pages= 296-326 | pmid=11292640 | doi=10.1128/CMR.14.2.296-326.2001 | pmc=88975 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11292640 }} </ref> Incubation period for leptospirosis varies between 3-20 days. The disease can cause wide range of symptoms from mild [[flu]]-like symptoms to severe disease with multi [[organ failure]] causing death. The first phase resolves and the patient is asymptomatic briefly before the second phase begins that is characterized by [[meningitis]], [[liver]] damage (causing [[jaundice]]), and [[renal failure]].<ref name="VCNA">{{cite journal|author=Heuter, Kerry J.,Langston, Cathy E.|title=Leptospirosis: A re-emerging zoonotic disease|journal=The Veterinary Clinics of North America|year=2003|volume=33|pages=791-807}}</ref> The disease leptospirosis is poorly known and unaware of its natural history is mainly due to the wide range of non specific symptoms, subclinical nature of the disease in animals, and non specific laboratory tests making the disease difficult to diagnose.<ref name="pmid16600656">{{cite journal| author=Vieira ML, Gama-Simões MJ, Collares-Pereira M| title=Human leptospirosis in Portugal: A retrospective study of eighteen years. | journal=Int J Infect Dis | year= 2006 | volume= 10 | issue= 5 | pages= 378-86 | pmid=16600656 | doi=10.1016/j.ijid.2005.07.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16600656 }} </ref> Outcome of the patient depends upon the pathogenic [[serovar]] and [[immunological]] status.

== Diagnosis ==
Clinical symptoms of leptospirosis are very wide, with mild anicteric presentation at one end to severe leptospirosis with severe [[jaundice]] and multiple organ involvement. Classic presentation of leptospirosis is a biphasic illness, and the onset of Symptoms within 2–30 days (incubation period) of exposure to the bacteria. Serious symptoms may manifest earlier on Days 4–6 of the illness depending on the type of pathogen and host immunological status.<ref>{{cite book | last = Faine | first = S | title = Guidelines for the control of leptospirosis | publisher = World Health Organization Obtainable from WHO Publication Centre USA | location = Geneva Albany, N.Y | year = 1982 | isbn = 924170067X }}</ref> As the clinical manifestations of the disease are non specific, the clinical diagnosis is difficult. The laboratory investigations for leptospirosis should be considered in patient with an abrupt onset of [[fever]], [[chills]], conjunctival suffusion, [[headache]], [[myalgia]] and [[jaundice]] with history of occupational exposure to infected animals or contaminated with animal urine.<ref>{{cite book | last = LastName | first = FirstName | title = Human leptospirosis : guidance for diagnosis, surveillance and control | publisher = World Health Organization | location = Geneva | year = 2003 | isbn = 9241545895 }}</ref>

== Treatment ==

== Prevention ==

==References==
{{Reflist|2}}

[[Category:Disease]]
[[Category:Infectious disease]]

Leptospirosis overview

2017-03-09T20:53:17Z

Venkata Sivakrishna Kumar Pulivarthi: /* Natural History, Complications & Prognosis */

__NOTOC__
[[File:Leptospira.png|right|200px]]
{{Leptospirosis}}

{{CMG}}

==Overview==

'''Leptospirosis''' (also known as '''Weil's disease''', '''canicola fever''', '''canefield fever''', '''nanukayami fever''', '''7-day fever''' and many more<ref name=NORD> Leptospirosis. National Organization for Rare Diseases (2015). http://rarediseases.org/rare-diseases/leptospirosis/ Accessed on July 28, 2016 </ref>) is a [[infectious disease|bacterial]] [[zoonotic]] disease caused by [[spirochaete]]s of the [[genus]] ''[[Leptospira]]'' that affects [[human]]s and a wide range of animals, including mammals, birds, amphibians, and reptiles.<ref name=Leptospirosis> Leptospirosis. Centers for Disease Control and Prevention (2015). https://www.cdc.gov/leptospirosis/ Accessed on July 28, 2016 </ref> It was first described by [[Adolf Weil (physician)|Adolf Weil]] in 1886 when he reported an "acute infectious disease with [[splenomegaly|enlargement of spleen]], [[jaundice]] and [[nephritis]]". ''Leptospira'' was first observed in 1907 from a [[post mortem]] [[kidney|renal tissue]] slice.<ref>Stimson AM (1907). "Note on an organism found in yellow-fever tissue." ''Public Health Reports'' '''22''':541.</ref>

Though being recognised among the world's most common [[zoonosis|zoonoses]], leptospirosis is a relatively rare bacterial [[infection]] in humans. The infection is commonly transmitted to humans by allowing [[fresh water]] that has been contaminated by animal [[urine]] to come in contact with unhealed breaks in the [[skin]], [[eye]]s or with the [[mucous membrane]]s. Outside of [[Tropics|tropical]] areas, leptospirosis cases have a relatively distinct seasonality with most of them occurring August-September/February-March.

Recently, with the improved health and safety methods in the work place, more infections are occurring due to recreational activities rather than occupational exposure.<ref name="pmid2786228">{{cite journal| author=Philipp R, Waitkins S, Caul O, Roome A, McMahon S, Enticott R| title=Leptospiral and hepatitis A antibodies amongst windsurfers and waterskiers in Bristol City Docks. | journal=Public Health | year= 1989 | volume= 103 | issue= 2 | pages= 123-9 | pmid=2786228 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2786228 }} </ref><ref name="pmid1490212">{{cite journal| author=Philipp R, King C, Hughes A| title=Understanding of Weil's disease among canoeists. | journal=Br J Sports Med | year= 1992 | volume= 26 | issue= 4 | pages= 223-7 | pmid=1490212 | doi= | pmc=1479000 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1490212 }} </ref>

Leptospires can survive for a prolonged period outside the animal host, especially in the environment favored by warm moist conditions with a neutral pH. Animal body fluids such as urine, semen and products of conception with pathogenic leptospires, pose a potential risk to humans through prolonged excretion of bacteria.Other less common mechanisms of transmission include direct infection from animal urine, human to human spread, sexual transmission and via breast milk.<ref name="pmid20186328">{{cite journal| author=Ganoza CA, Matthias MA, Saito M, Cespedes M, Gotuzzo E, Vinetz JM| title=Asymptomatic renal colonization of humans in the peruvian Amazon by Leptospira. | journal=PLoS Negl Trop Dis | year= 2010 | volume= 4 | issue= 2 | pages= e612 | pmid=20186328 | doi=10.1371/journal.pntd.0000612 | pmc=2826405 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20186328 }} </ref><ref name="pmid14166972">{{cite journal| author=SPINU I, TOPCIU V et al.| title=[MAN AS A VIRAL RESERVOIR IN AN EPIDEMIC OF LEPTOSPIROSIS OCCURRING IN THE JUNGLE]. | journal=Arch Roum Pathol Exp Microbiol | year= 1963 | volume= 22 | issue= | pages= 1081-100 | pmid=14166972 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14166972 }} </ref><ref name="pmid987112">{{cite journal| author=Kiktenko VS, Balashov NG, Rodina VN| title=Leptospirosis infection through insemination of animals. | journal=J Hyg Epidemiol Microbiol Immunol | year= 1976 | volume= 21 | issue= 2 | pages= 207-13 | pmid=987112 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=987112 }} </ref>

== Historical Perspective ==
Adof Weil is the first physician described about the severe form of leptospirosis and the name [[Weil's disease]] is named after him in the year 1886. He also described the [[jaundice]] with [[splenomegaly]], [[renal failure]], [[skin rash]] and conjunctival suffusion.<ref name="pmid25388129">{{cite journal| author=Adler B| title=History of leptospirosis and leptospira. | journal=Curr Top Microbiol Immunol | year= 2015 | volume= 387 | issue= | pages= 1-9 | pmid=25388129 | doi=10.1007/978-3-662-45059-8_1 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25388129 }} </ref> Japanees scientists Kitamura and Hara named this disease as autumn fever and seven day disease in 1918.<ref name="Kobayashi2001">{{cite journal|last1=Kobayashi|first1=Yuzuru|title=Discovery of the causative organism of Weil's disease: historical view|journal=Journal of Infection and Chemotherapy|volume=7|issue=1|year=2001|pages=10–15|issn=1341321X|doi=10.1007/s101560170028}}</ref>

== Classification ==
Leptospirosis is classified into anicteric and icteric form of leptospirosis based on the clinical presentation.

== Pathophysiology ==

== Causes ==
Leptospirosis is caused by an infection with ''[[Leptospira]]''. Several species of Leptospira have identified and have been classified, genotypically, which include both pathogenic and saprophytic species. Among the pathogenic species, over 300 serovars have been identified by serotyping methods.<ref name="pmid22843698">{{cite journal| author=Forbes AE, Zochowski WJ, Dubrey SW, Sivaprakasam V| title=Leptospirosis and Weil's disease in the UK. | journal=QJM | year= 2012 | volume= 105 | issue= 12 | pages= 1151-62 | pmid=22843698 | doi=10.1093/qjmed/hcs145 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22843698 }} </ref>

== Differential Diagnosis ==
Leptospirosis must be differentiated from other diseases that cause fever, diarrhea, nausea and vomiting, such as ebola, typhoid fever, malaria, yellow fever, and other enteric bacterial infections. Moderate to severe leptospirosis must be differentiated from dengue fever.

== Epidemiology and Demographics==
Leptospirosis occurs worldwide but is most common in temperate or tropical climates. It is an occupational hazard for many people who work outdoors or with animals, for example, farmers, sewer workers, veterinarians, fish workers, dairy farmers, or military personnel. It is a recreational hazard for campers or those who participate in outdoor sports in contaminated areas and has been associated with swimming, wading, and whitewater rafting in contaminated lakes and rivers. The incidence is also increasing among urban children. Epidemiology of human leptospirosis is complex and dynamic, due to the interaction of pathogen, host, animal reservoir, and environment. With the increase in urban population, occupational and recreational exposure to surface water and climatic changes results in increase in prevalence of leptospirosis recently.

== Risk Factors ==
The risk of acquiring leptospirosis is associated with contact with animals, which made leptospirosis as an important occupational disease, especially affecting farmers, slaughterhouse workers, pet traders, veterinarians, rodent catchers and sewer workers who are in contact with mammalian species which acts as a natural carriers of leptospires.<ref name="pmid11292640">{{cite journal| author=Levett PN| title=Leptospirosis. | journal=Clin Microbiol Rev | year= 2001 | volume= 14 | issue= 2 | pages= 296-326 | pmid=11292640 | doi=10.1128/CMR.14.2.296-326.2001 | pmc=88975 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11292640 }} </ref> According to World health organization survey highest risk groups are subsistence farmers and people living in urban slums.<ref name="pmid16148523">{{cite journal| author=McBride AJ, Athanazio DA, Reis MG, Ko AI| title=Leptospirosis. | journal=Curr Opin Infect Dis | year= 2005 | volume= 18 | issue= 5 | pages= 376-86 | pmid=16148523 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16148523 }} </ref> Common risk factors in the development of leptospirosis include occupational exposure to animals, tropical or temperate climates, and water sports in contaminated lakes and rivers.

== Natural History, Complications & Prognosis ==
Leptospirosis is transported by the natural carriers such as feral, semi-domestic and farm and pet animals.<ref name="pmid11292640">{{cite journal| author=Levett PN| title=Leptospirosis. | journal=Clin Microbiol Rev | year= 2001 | volume= 14 | issue= 2 | pages= 296-326 | pmid=11292640 | doi=10.1128/CMR.14.2.296-326.2001 | pmc=88975 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11292640 }} </ref> Incubation period for leptospirosis varies between 3-20 days. The disease can cause wide range of symptoms from mild [[flu]]-like symptoms to severe disease with multi [[organ failure]] causing death. The first phase resolves and the patient is asymptomatic briefly before the second phase begins that is characterized by [[meningitis]], [[liver]] damage (causing [[jaundice]]), and [[renal failure]].<ref name="VCNA">{{cite journal|author=Heuter, Kerry J.,Langston, Cathy E.|title=Leptospirosis: A re-emerging zoonotic disease|journal=The Veterinary Clinics of North America|year=2003|volume=33|pages=791-807}}</ref> The disease leptospirosis is poorly known and unaware of its natural history is mainly due to the wide range of non specific symptoms, subclinical nature of the disease in animals, and non specific laboratory tests making the disease difficult to diagnose.<ref name="pmid16600656">{{cite journal| author=Vieira ML, Gama-Simões MJ, Collares-Pereira M| title=Human leptospirosis in Portugal: A retrospective study of eighteen years. | journal=Int J Infect Dis | year= 2006 | volume= 10 | issue= 5 | pages= 378-86 | pmid=16600656 | doi=10.1016/j.ijid.2005.07.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16600656 }} </ref> Outcome of the patient depends upon the pathogenic [[serovar]] and [[immunological]] status.

== Diagnosis ==

== Treatment ==

== Prevention ==

==References==
{{Reflist|2}}

[[Category:Disease]]
[[Category:Infectious disease]]

Leptospirosis overview

2017-03-09T20:52:43Z

Venkata Sivakrishna Kumar Pulivarthi: /* Risk Factors */

Leptospirosis overview

2017-03-09T20:51:44Z

Venkata Sivakrishna Kumar Pulivarthi: /* Epidemiology and Demographics[edit | edit source] */

Leptospirosis differential diagnosis

2017-03-09T20:50:57Z

Venkata Sivakrishna Kumar Pulivarthi: /* Overview */

__NOTOC__
{{Leptospirosis}}

{{CMG}};{{AE}}{{VSKP}}
==Overview==
Leptospirosis must be differentiated from other diseases that cause [[fever]], [[diarrhea]], [[nausea]] and [[vomiting]], such as [[ebola]], [[typhoid fever]], [[malaria]], [[yellow fever]], and other enteric bacterial infections. Moderate to severe leptospirosis must be differentiated from [[dengue fever]].

==Differential diagnosis==

[[Differential diagnosis]] list for leptospirosis is very large due to diverse symptomatics. For forms with middle to high severity, the list includes [[dengue fever]] and other hemorrhagic [[fever]]s, [[hepatitis]] of various [[etiology|etiologies]], viral [[meningitis]], [[malaria]] and [[typhoid fever]]. Light forms should be distinguished from [[influenza]] and other related viral diseases. Specific tests are a must for proper diagnosis of leptospirosis. Under circumstances of limited access (e.g., developing countries) to specific diagnostic means, close attention must be paid to [[Anamnesis (medicine)|anamnesis]] of the patient. Factors like certain dwelling areas, seasonality, contact with [[stagnant water]] (swimming, working on flooded meadows, etc) and/or rodents in the medical history support the leptospirosis hypothesis and serve as indications for specific tests (if available).
=== Differential Diagnosis for Hemorrhagic fever ===
{| class="wikitable"
! rowspan="2" |Disease
! rowspan="2" |Incubation period
! rowspan="2" |Vector
! colspan="7" |Symptoms
! colspan="2" |Physical signs
! colspan="2" |Lab findings
! rowspan="2" |Other findings
! rowspan="2" |Treatment
|-
!Fever
!Cough
!Rash
!Joint pain
!Myalgia
!Diarrhea
!Common hemorrhagic symptoms
!Characterestic physical finding
!Icterus
!Plasma Creatine kinase
!Confirmatory test
|-
![[Leptospirosis]]
|align=center|2 to 30 days
|align=center|Rodents

Domestic animals
|align=center|[[Fever]] last for 4-7 days, remission for 1-2 days and then relapse
|align=center|✔
|align=center|Present over legs, Hemorrhagic rash
|align=center|✔
|align=center|✔
(Severe [[myalgia]] is characteristic of leptospirosis typically localized to the [[Calf muscle|calf]] and [[lumbar]] areas)
|align=center|✔
|align=center|[[conjunctival hemorrhage]],
[[Hemoptysis]]
|align=center|[[Conjunctival hemorrhage|Conjunctival suffusion]]
|align=center|✔
|align=center|Elevated
|align=center|[[Agglutination|Microscopic agglutination test]] of urine
|align=center|History of exposure to soil or water
contaminated by infected rodents

Recent history travel to tropical,
sub tropical areas or humid areas
|align=center|[[NSAIDs]]
|-
!'''[[Dengue fever|Dengue]]'''
|align=center|4 to 10 days
|align=center|''[[Aedes]]'' [[Aedes|mosquito]]
|align=center|[[Fever]] last for 1-2 days,
remission for 1-2 days and then relapse for 1-2 days
(Biphasic fever pattern)
|align=center|X
|align=center|Over legs and trunk

pruritic rash May be hemorrhagic
|align=center|✔
|align=center|✔
|align=center|X
|align=center|[[Upper gastrointestinal bleeding]]
|align=center|[[Lymphadenopathy|Painful lymphadenopathy]]
|align=center|X
| align="center" |Normal
|align=center|Serology showing positive [[IgM]] or [[IgG]]
|align=center|Recent travel to South America, Africa, Southeast Asia
|align=center|Supportive care
Avoid aspirin and other [[NSAIDs]]
|-
!'''[[Malaria]]'''
|align=center|
* ''[[Plasmodium falciparum]]: 9-14 days''
* ''[[Plasmodium vivax]]: 12-18 days''
* ''[[Plasmodium ovale]]: 18-40 days''
|align=center|[[Anopheles|Female Anopheles]]
|align=center|Fever present daily or on alternate day or every 3 days depending on [[Plasmodium|Plasmodium sps]].
|align=center|X
|align=center|No rash
|align=center|X
|align=center|✔
|align=center|X
|align=center|[[Hematuria|Bloody urine]]
|align=center|[[Hepatosplenomegaly]]
|align=center|✔
|align=center|Normal
|align=center|[[Giemsa stain|Giemsa]] stained thick and thin blood smears
|align=center|Recent travel to South America, Africa, Southeast Asia
|align=center|[[Antimalarial medication|Anti malarial regimen]]
|-
!'''[[Ebola]]'''
|align=center|2 to 21 days.
|align=center|No vector

Human to human transmission

[[Airborne transmission|Air born disease]]
|align=center|✔
|align=center|✔
|align=center|[[Maculopapular]],
non-pruritic [[rash]] with [[erythema]]

Centripetal distribution
|align=center|✔
|align=center|✔
|align=center|✔

May be bloody in the early phase
|align=center|[[Epistaxis]]

[[Mucosal bleeding]]
|align=center|Sudden onset of high [[fever]] with [[conjunctival injection]] and early [[gastrointestinal]] symptoms
|align=center|X
| align="center" |Normal
| align="center" |[[RT-PCR]]
| align="center" |Recent visit to endemic area especially African countries
| align="center" |Isolation of the patient,

Supportive therapy
|-
!'''[[Influenza]]'''
|align=center|1-4 days
|align=center|No vector

[[Airborne transmission|Air born disease]]
|align=center|✔
|align=center|✔
|align=center|✔/X
|align=center|✔
|align=center|✔
|align=center|✔
|align=center|X
|align=center|[[Fever]] and upper respiratory symptoms
|align=center|X
|align=center|Normal
|align=center|[[Viral culture]] or [[PCR]]
|align=center|Health care workers
Patients with co-morbid conditions
|align=center|Symptomatic treatment

[[Oseltamivir]] or [[zanamivir]]
|-
!'''[[Yellow fever]]'''
|align=center|3 to 6 days
|align=center|[[Aedes]] or [[Aedes|Haemagogus]] species mosquitoes
|align=center|✔
|align=center|✔
|align=center|X
|align=center|X
|align=center|✔
|align=center|X
|align=center|[[Conjunctival hemorrhage]],

[[Hemoptysis]]
|align=center|Relative [[bradycardia]]([[Faget's sign]])
|align=center|✔
| align="center" |Normal
| align="center" |[[RT-PCR]],

[[Nucleic acid amplification technique|Nucleic acid amplification test]],

[[Immunohistochemical staining|Immuno-histochemical staining]]
| align="center" |Recent travel to Africa, South and Central America, and the Caribbean.

Tropical rain forests of south America
| align="center" |Symptomatic treatment,

[[Anti inflammatory medications|Anti-inflammatory drugs]]
|-
!'''[[Typhoid fever]]'''
|align=center|6 to 30 days
|align=center|No vector

[[Airborne transmission|Air born disease]]
|align=center|✔
|align=center|X
|align=center|Blanching [[erythematous]]
[[maculopapular]][[lesions]] on the
lower chest and abdomen
|align=center|✔
|align=center|✔
|align=center|✔
|align=center|[[Intestinal bleeding]]
|align=center|[[Rose spots]]
|align=center|X
| align="center" |Normal
|align=center|Blood or stool culture showing ''[[Salmonella typhi|salmonella typhi sps]].''
|align=center|Residence in [[endemic]] area

Recent travel to [[endemic]] area
|align=center|[[Fluoroquinolones]],

[[Cephalosporin|Third generation cephalosporins]],

[[Azithromycin]]
|}

==References==
{{Reflist|2}}

[[Category:Disease]]
[[Category:Infectious disease]]

Leptospirosis overview

2017-03-09T20:50:22Z

Venkata Sivakrishna Kumar Pulivarthi: /* Differential Diagnosis */

Leptospirosis overview

2017-03-09T20:48:44Z

Venkata Sivakrishna Kumar Pulivarthi: /* Causes */

Leptospirosis overview

2017-03-09T20:47:10Z

Venkata Sivakrishna Kumar Pulivarthi: /* Classification */

Leptospirosis overview

2017-03-09T20:46:04Z

Venkata Sivakrishna Kumar Pulivarthi: /* Historical Perspective */

Leptospirosis overview

2017-03-09T20:45:31Z

Venkata Sivakrishna Kumar Pulivarthi: /* Overview */

Leptospirosis pathophysiology

2017-03-09T20:34:24Z

Venkata Sivakrishna Kumar Pulivarthi: /* Transmission */

__NOTOC__
[[File:Rat.jpg|right|200px]]
{{Leptospirosis}}
{{CMG}}; {{AE}}{{VSKP}}
==Overview==
Leptospires shed in the urine of animals to the environment from where humans are infected by incidental hosts. In Carriers these bacteria harbour in the [[renal tubules]] and can persist in soil or surface water and then transmits to human hosts via mucous membranes or abraded skin.<ref name="pmid13559904">{{cite journal| author=BABUDIERI B| title=Animal reservoirs of leptospires. | journal=Ann N Y Acad Sci | year= 1958 | volume= 70 | issue= 3 | pages= 393-413 | pmid=13559904 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=13559904 }} </ref><ref name="ForbesZochowski2012">{{cite journal|last1=Forbes|first1=A. E.|last2=Zochowski|first2=W. J.|last3=Dubrey|first3=S. W.|last4=Sivaprakasam|first4=V.|title=Leptospirosis and Weil's disease in the UK|journal=QJM|volume=105|issue=12|year=2012|pages=1151–1162|issn=1460-2725|doi=10.1093/qjmed/hcs145}}</ref> Pathogen transmit through various mechanisms such as broken skin, mucus membranes and the conjunctivae, exposure to contaminated water are at risk of contracting leptospirosis.<ref name="pmid22843698">{{cite journal| author=Forbes AE, Zochowski WJ, Dubrey SW, Sivaprakasam V| title=Leptospirosis and Weil's disease in the UK. | journal=QJM | year= 2012 | volume= 105 | issue= 12 | pages= 1151-62 | pmid=22843698 | doi=10.1093/qjmed/hcs145 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22843698 }} </ref>

==Pathogenesis==
The disease leptospirosis involves a spectrum of symptoms ranging from subclinical infection to a severe syndrome of multiorgan infection with high mortality and Weil’s disease represents only the most severe presentation. Severe leptospirosis is frequently caused by serovars of the icterohaemorrhagiae serogroup. The presentation of leptospirosis is biphasic, with the acute or septicemic phase lasting about a week, followed by the immune phase, characterized by antibody production and excretion of leptospires in the urine.<ref name="Levett2001">{{cite journal|last1=Levett|first1=P. N.|title=Leptospirosis|journal=Clinical Microbiology Reviews|volume=14|issue=2|year=2001|pages=296–326|issn=0893-8512|doi=10.1128/CMR.14.2.296-326.2001}}</ref>
[[File:Leptospirosis pathogenesis.jpg|center]]
=== Reservoirs ===
The major reservoir for leptospirosis is rat and small rodents that appear to harbour more virulent strains of the disease.<ref name="Picardeau2013">{{cite journal|last1=Picardeau|first1=M.|title=Diagnosis and epidemiology of leptospirosis|journal=Médecine et Maladies Infectieuses|volume=43|issue=1|year=2013|pages=1–9|issn=0399077X|doi=10.1016/j.medmal.2012.11.005}}</ref>
===Carriers===
Domestic animals such as dogs,cattle and pigs acts as potential carriers that increases the risk of leptospirosis in humans. These carriers are generally asymptomatic.<ref name="pmid19011247">{{cite journal| author=Gaudie CM, Featherstone CA, Phillips WS, McNaught R, Rhodes PM, Errington J et al.| title=Human Leptospira interrogans serogroup icterohaemorrhagiae infection (Weil's disease) acquired from pet rats. | journal=Vet Rec | year= 2008 | volume= 163 | issue= 20 | pages= 599-601 | pmid=19011247 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19011247 }} </ref><ref name="pmid19202179">{{cite journal| author=Strugnell BW, Featherstone C, Gent M, Lister P, Evans G, Okereke E et al.| title=Weil's disease associated with the adoption of a feral rat. | journal=Vet Rec | year= 2009 | volume= 164 | issue= 6 | pages= 186 | pmid=19202179 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19202179 }} </ref>

=== Modes of transmission ===
# Direct contact with urine or tissue of infected animal: Through skin abrasions, intact mucus membrane
# Indirect contact: Broken skin with infected soil, water or vegetation, Through ingestion of contaminated food and water
# Droplet infection: Inhalation of droplets of infected urine
Infection can occurs either by direct contact with the carrier’s urine or through indirect transmission via urine-contaminated environment. Infection due to direct transmission through direct oral intake of contaminated drinking water or food is very rare.<ref name="pmid3618584">{{cite journal| author=Cacciapuoti B, Ciceroni L, Maffei C, Di Stanislao F, Strusi P, Calegari L et al.| title=A waterborne outbreak of leptospirosis. | journal=Am J Epidemiol | year= 1987 | volume= 126 | issue= 3 | pages= 535-45 | pmid=3618584 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3618584 }} </ref> Pathogenic leptospires live in the renal system and the genital tracts of domestic animals which act as sites of persistence.<ref name="pmid4081333">{{cite journal| author=Ellis WA, O'Brien JJ, Cassells JA, Neill SD, Hanna J| title=Excretion of Leptospira interrogans serovar hardjo following calving or abortion. | journal=Res Vet Sci | year= 1985 | volume= 39 | issue= 3 | pages= 296-8 | pmid=4081333 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4081333 }} </ref><ref name="pmid3705357">{{cite journal| author=Ellis WA, McParland PJ, Bryson DG, Thiermann AB, Montgomery J| title=Isolation of leptospires from the genital tract and kidneys of aborted sows. | journal=Vet Rec | year= 1986 | volume= 118 | issue= 11 | pages= 294-5 | pmid=3705357 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3705357 }} </ref> Bacteria shed from the infected animals such as rodents and domesticat animals through urine. These animals may not show signs of disease, but humans shows signs of illness after contact with infected urine, or through contact with water, soil or food that has been contaminated and the outbreaks are associates with floodwaters. The major route of infection by leptospires is probably by transmission through indirect contact with leptospires secreted into the environment. Humans are considered dead end hosts, but sometimes they also act as carriers. Mammalian species (e.g. rodents, insectivores, dogs, pigs and cattle) act as the main carriers of the disease.<ref name="pmid20186328">{{cite journal| author=Ganoza CA, Matthias MA, Saito M, Cespedes M, Gotuzzo E, Vinetz JM| title=Asymptomatic renal colonization of humans in the peruvian Amazon by Leptospira. | journal=PLoS Negl Trop Dis | year= 2010 | volume= 4 | issue= 2 | pages= e612 | pmid=20186328 | doi=10.1371/journal.pntd.0000612 | pmc=2826405 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20186328 }} </ref>
Leptospires are excreted in urine into the environment, where they can survive for several months, depending on favourable environmental conditions such as humid and temperate areas. The pathogen may also be excreted in the products of abortion in mammalian animal species.<ref name="pmid4081333">{{cite journal| author=Ellis WA, O'Brien JJ, Cassells JA, Neill SD, Hanna J| title=Excretion of Leptospira interrogans serovar hardjo following calving or abortion. | journal=Res Vet Sci | year= 1985 | volume= 39 | issue= 3 | pages= 296-8 | pmid=4081333 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4081333 }} </ref>

Pathological findings of leptospirosis are due to the development of the following:<ref name="Budihal2014">{{cite journal|last1=Budihal|first1=Suman Veerappa|title=Leptospirosis Diagnosis: Competancy of Various Laboratory Tests|journal=JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH|year=2014|issn=2249782X|doi=10.7860/JCDR/2014/6593.3950}}</ref><ref name="pmid14902167">{{cite journal| author=BEESON PB, HANKEY DD| title=Leptospiral meningitis. | journal=AMA Arch Intern Med | year= 1952 | volume= 89 | issue= 4 | pages= 575-83 | pmid=14902167 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14902167 }} </ref><ref name="pmid1224630">{{cite journal| author=King SD, Urquhart AE| title=Laboratory investigations on four cases of leptospiral meningitis in Jamaica. | journal=West Indian Med J | year= 1975 | volume= 24 | issue= 4 | pages= 196-201 | pmid=1224630 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1224630 }} </ref><ref name="pmid9071036">{{cite journal| author=Silva MV, Camargo ED, Batista L, Vaz AJ, Ferreira AW, Barbosa PR| title=Application of anti-leptospira ELISA-IgM for the etiologic elucidation of meningitis. | journal=Rev Inst Med Trop Sao Paulo | year= 1996 | volume= 38 | issue= 2 | pages= 153-6 | pmid=9071036 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9071036 }} </ref>
* [[Vasculitis]]
* [[Endothelial]] damage
* [[Inflammatory]] infiltrates composed of moncytic cells, [[plasma cells]], [[histiocytes]], and [[neutrophils]].

{| border="0"
|-
|align=center| '''Type of toxin production depends on the serovar'''
'''Hemolytic toxins:'''

Hemolysins are produced from several serovars such as serovars ballum, hardjo, pomona, and tarassovi which are sphingomyelinases

'''Leptospira'''

'''⬇'''

'''[[Toxin]] production'''

'''⬇'''

'''Damage to small [[blood vessels]]'''

'''⬇'''

'''[[Vasculitis]]'''

'''⬇'''

'''• Direct cytotoxic injury or Immunological injury 
• Fluid extavasation into the interstitial compartment due to [[vasculitis]]
'''

'''⬇'''

'''Acute renal injury and [[vascular]] injury to internal organs'''
|}

==Gross Pathology==
Gross findings of various organ systems are present as:<ref name="pmid13862141">{{cite journal| author=AREAN VM| title=The pathologic anatomy and pathogenesis of fatal human leptospirosis (Weil's disease). | journal=Am J Pathol | year= 1962 | volume= 40 | issue= | pages= 393-423 | pmid=13862141 | doi= | pmc=1949541 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=13862141 }} </ref>
* Extensive [[petechial hemorrhages]] are common.
* Discoloration of organs is seen in severe cases of icteric leptospirosis.

== Microscopic Pathology ==
===Liver===
* No significant structural destruction is seen<ref name="pmid13862141">{{cite journal| author=AREAN VM| title=The pathologic anatomy and pathogenesis of fatal human leptospirosis (Weil's disease). | journal=Am J Pathol | year= 1962 | volume= 40 | issue= | pages= 393-423 | pmid=13862141 | doi= | pmc=1949541 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=13862141 }} </ref><ref name="pmid4298629">{{cite journal| author=De Brito T, Machado MM, Montans SD, Hoshino S, Freymüller E| title=Liver biopsy in human leptospirosis: a light and electron microscopy study. | journal=Virchows Arch Pathol Anat Physiol Klin Med | year= 1967 | volume= 342 | issue= 1 | pages= 61-9 | pmid=4298629 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4298629 }} </ref>
* [[Intrahepatic cholestasis]] is seen in few cases
* [[Hypertrophy (medical)|Hypertrophy]] and [[hyperplasia]] of [[Kupffer cells]]
* Erythrophagocytosis
===Kidney===
* Common histopathological presentation in kidney includes [[interstitial nephritis]] with infiltration of [[neutrophils]] and [[Monocytes|monocytes.]]<ref name="pmid13862141">{{cite journal| author=AREAN VM| title=The pathologic anatomy and pathogenesis of fatal human leptospirosis (Weil's disease). | journal=Am J Pathol | year= 1962 | volume= 40 | issue= | pages= 393-423 | pmid=13862141 | doi= | pmc=1949541 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=13862141 }} </ref>
* Leptospires are seen in [[renal tubules]].
* Electron microscopy findings include:<ref name="pmid14072448">{{cite journal| author=PENNA D, DE BRITO T, PUPO AA, MACHADO MM, AYROZA PA, DE ALMEIDA SS| title=KIDNEY BIOPSY IN HUMAN LEPTOSPIROSIS. | journal=Am J Trop Med Hyg | year= 1963 | volume= 12 | issue= | pages= 896-901 | pmid=14072448 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14072448 }} </ref><ref name="SitprijaEvans1970">{{cite journal|last1=Sitprija|first1=Visith|last2=Evans|first2=Hilary|title=The kidney in human leptospirosis|journal=The American Journal of Medicine|volume=49|issue=6|year=1970|pages=780–788|issn=00029343|doi=10.1016/S0002-9343(70)80059-6}}</ref>

** Thickened tubular [[basement membrane]]
** Denuded tubular brush borders
** Mitochondrial depletion in tubular cells
* Glomerular destruction associated with [[proteinuria]] is seen in few cases.
===Heart===
Leptospirosis is associate with interstitial [[myocarditis]].<ref name="pmid3446572">{{cite journal| author=De Biase L, De Curtis G, Paparoni S, Sciarra D, Campa PP| title=Fatal leptospiral myocarditis. | journal=G Ital Cardiol | year= 1987 | volume= 17 | issue= 11 | pages= 992-4 | pmid=3446572 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3446572 }} </ref><ref name="BritoMorais2016">{{cite journal|last1=Brito|first1=T. De|last2=Morais|first2=C. F.|last3=Yasuda|first3=P. H.|last4=Lancellotti|first4=Carmen P.|last5=Hoshino-Shimizu|first5=Sumie|last6=Yamashiro|first6=E.|last7=Alves|first7=V. A. Ferreira|title=Cardiovascular involvement in human and experimental leptospirosis: Pathologic findings and immunohistochemical detection of leptospiral antigen|journal=Annals of Tropical Medicine & Parasitology|volume=81|issue=3|year=2016|pages=207–214|issn=0003-4983|doi=10.1080/00034983.1987.11812114}}</ref><ref name="pmid13464040">{{cite journal| author=AREAN VM| title=Leptospiral myocarditis. | journal=Lab Invest | year= 1957 | volume= 6 | issue= 5 | pages= 462-71 | pmid=13464040 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=13464040 }} </ref><ref name="pmid871034">{{cite journal| author=Ramachandran S, Perera MV| title=Cardiac and pulmonary involvement in leptospirosis. | journal=Trans R Soc Trop Med Hyg | year= 1977 | volume= 71 | issue= 1 | pages= 56-9 | pmid=871034 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=871034 }} </ref>
* Cellular infiltration predominantly with [[lymphocytes]] and [[plasma cells]].
* [[Petechial hemorrhages]] (epicardial hemorrhages are common)
* Epicardial infilteration of [[mononuclear cells]].
* [[Pericardial effusion]]
* coronary arteritis
===Lungs===
Common pulmonary presentation in leptospirosis are [[pulmonary congestion]] and [[hemorrhage]].<ref name="pmid13862141">{{cite journal| author=AREAN VM| title=The pathologic anatomy and pathogenesis of fatal human leptospirosis (Weil's disease). | journal=Am J Pathol | year= 1962 | volume= 40 | issue= | pages= 393-423 | pmid=13862141 | doi= | pmc=1949541 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=13862141 }} </ref><ref name="pmid871034">{{cite journal| author=Ramachandran S, Perera MV| title=Cardiac and pulmonary involvement in leptospirosis. | journal=Trans R Soc Trop Med Hyg | year= 1977 | volume= 71 | issue= 1 | pages= 56-9 | pmid=871034 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=871034 }} </ref><ref name="pmid9080878">{{cite journal| author=Nicodemo AC, Duarte MI, Alves VA, Takakura CF, Santos RT, Nicodemo EL| title=Lung lesions in human leptospirosis: microscopic, immunohistochemical, and ultrastructural features related to thrombocytopenia. | journal=Am J Trop Med Hyg | year= 1997 | volume= 56 | issue= 2 | pages= 181-7 | pmid=9080878 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9080878 }} </ref><ref name="pmid6790049">{{cite journal| author=Zaltzman M, Kallenbach JM, Goss GD, Lewis M, Zwi S, Gear JH| title=Adult respiratory distress syndrome in Leptospira canicola infection. | journal=Br Med J (Clin Res Ed) | year= 1981 | volume= 283 | issue= 6290 | pages= 519-20 | pmid=6790049 | doi= | pmc=1507945 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6790049 }} </ref>
* Alveolar infiltration by [[monocytes]] and [[neutrophils]].
* Hyaline membrane formation.
* Leptospires are seen within the [[endothelial cells]] in interalveolar septa, and also attached to capillary endothelial cells.
===Skeletal muscle===
* Focal [[necrosis]] of muscle fibers with infiltration of [[histiocytes]], [[neutrophils]], and [[plasma cells]].
===Brain===
* Perivascular cuffing is seen.

==References==
{{Reflist|2}}

Leptospirosis causes

2017-03-09T20:27:13Z

Venkata Sivakrishna Kumar Pulivarthi: /* Causes */

__NOTOC__
{{Leptospirosis}}

{{CMG}};{{AE}}{{VSKP}}

'''For more information about ''Leptospira''''' '''[[Leptospira|click here]]'''
==Overview==
Leptospirosis is caused by an infection with ''[[Leptospira]]''. Several species of Leptospira have identified and have been classified, genotypically, which include both pathogenic and saprophytic species. Among the pathogenic species, over 300 serovars have been identified by serotyping methods.<ref name="pmid22843698">{{cite journal| author=Forbes AE, Zochowski WJ, Dubrey SW, Sivaprakasam V| title=Leptospirosis and Weil's disease in the UK. | journal=QJM | year= 2012 | volume= 105 | issue= 12 | pages= 1151-62 | pmid=22843698 | doi=10.1093/qjmed/hcs145 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22843698 }} </ref>

==Causes==
* Phylum: Spirochaetes
* Class: Spirochaetes
* Order: Spirochaetales
* Species: Leptospira
* Family: Leptospiraceae
Leptospirosis is caused by a spirochaete bacterium called ''[[Leptospira]]'' spp. that has at 5 different [[serovar]]s of importance in the United States causing disease (icterohaemorrhagiae, canicola, pomona, grippotyphosa, and bratislava).<ref name=VCNA>{{cite journal|author=Heuter, Kerry J.,Langston, Cathy E.|title=Leptospirosis: A re-emerging zoonotic disease|journal=The Veterinary Clinics of North America|year=2003|volume=33|pages=791-807}}</ref> There are other (less common) infectious strains. It should however be noted that genetically different leptospira organisms may be identical serologically and vice versa. Hence, an argument exists on the basis of strain identification. The traditional serologic system is seemingly more useful from diagnostic and epidemiologic standpoint at the moment (which may change with further development and spread of technologies like [[PCR]]).

Leptospirosis is transmitted by the urine of an infected animal, and is contagious as long as it is still moist. Although rats, mice and voles are important primary hosts, a wide range of other mammals including dogs, deer, rabbits, hedgehogs, cows, sheep, raccoons, possums, skunks, and even certain marine mammals are also able to carry and transmit the disease as secondary hosts. Dogs may lick the urine of an infected animal off the grass or soil, or drink from an infected puddle. There have been reports of "house dogs" contracting leptospirosis apparently from licking the urine of infected mice that entered the house. The type of habitats most likely to carry infective bacteria are muddy riverbanks, ditches, gulleys and muddy livestock rearing areas where there is regular passage of either wild or farm mammals. There is a direct correlation between the amount of rainfall and the incidence of leptospirosis, making it seasonal in temperate climates and year-round in tropical climates.

Leptospirosis is also transmitted by the semen of infected animals<ref name="lept">{{cite journal | author=Kiktenko VS| title=Leptospirosis infection through insemination of animals.| journal=J Hyg Epidemiol Microbiol Immunol.| year=1976| volume=21| issue=2| page=207-213| url=http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=987112&dopt=Abstract}}</ref>. Abattoir workers can contract the disease through contact with infected blood or body fluids.

Humans become infected through contact with water, food, or soil containing urine from these infected animals. This may happen by swallowing contaminated food or water or through skin contact. The disease is not known to be spread from person to person and cases of bacterial dissemination in convalescence are extremely rare in humans. Leptospirosis is common among watersport enthusiasts in specific areas as prolonged immersion in water is known to promote the entry of the bacteria. Occupational risk factors include [[veterinarian]]s, slaughter house workers, farmers, and sewer workers. An outbreak in an inner city environment has been linked to contact with rat urine.<ref name=VCNA>{{cite journal|author=Heuter, Kerry J.,Langston, Cathy E.|title=Leptospirosis: A re-emerging zoonotic disease|journal=The Veterinary Clinics of North America|year=2003|volume=33|pages=791-807}}</ref>

{| border="2" cellpadding="4" cellspacing="0" style="margin: 1em 1em 1em 0; background: #f9f9f9; border: 1px #aaa solid; border-collapse: collapse;" width="75%"
!colspan="1" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF| '''Species'''}}
!colspan="1" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF| '''Serovar'''}}
!colspan="1" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF|Serogroup}}
|-
! colspan="3" |Pathogenic serovars
|-
|L interrogans
|australis
|Australis
|-
|
|bradtislava
|Australis
|-
|
|bataviae
|Bataviae
|-
|
|Canicola
|Canicola
|-
|
|hebdomadis
|Hebdomadis
|-
|
|icterohaemorrhagiae
|Icterohaemorrhagiae
|-
|
|lai
|Icterohaemorrhagiae
|-
|
|pomon
|Pomona
|-
|
|pyrogenes
|Pyrogenes
|-
|
|hardjo
|Sejroe
|-
|L alexanderi
|manhao3
|Manhao
|-
|L fainei
|hurstbridge
|Hurstbridge
|-
|L inadai
|lyme
|Lyme
|-
|L kirschneri
|bim
|Autumnalis
|-
|
|cynopteri
|Cynopteri
|-
|
|grippotyphosa
|Grippotyphosa
|-
|
|mozdok
|Pomona
|-
|
|panama
|Panama
|-
|L meyeri
|semranga
|Semaranga
|-
|L borgpetersenii
|ballum
|Ballum
|-
|
|castellonis
|Ballum
|-
|
|javanica
|Javanica
|-
|
|sejore
|Sejroe
|-
|
|tarassovi
|Tarassovi
|-
|L weillii
|celledoni
|Celledoni
|-
|L noguchii
|fortbragg
|Autumnaslis
|-
|L santarosai
|brasiliensis
georgia
|Bataviae
Mini
|-
|Genomospecies 1
|pingchang
|Ranarum
|-
|Genomospecies 4
|hualin
|Icterohaemorrhagiae
|-
|Genomospecies 5
|saopaulo
|Semaranga
|-
! colspan="3" |Saprophytic serovars
|-
|Genomospecies 3
|holland
|Holland
|-
|L biflexa
|patoc
|Semaranga
|-
|L wolbachii
|codice
|
|}

==References==
{{Reflist|2}}

[[Category:Disease]]
[[Category:Infectious disease]]

File:Work-boots.jpg

2017-03-09T20:22:28Z

Venkata Sivakrishna Kumar Pulivarthi:

File:Adventure racing.jpg

2017-03-09T20:19:38Z

Venkata Sivakrishna Kumar Pulivarthi:

Leptospirosis primary prevention

2017-03-09T20:17:36Z

Venkata Sivakrishna Kumar Pulivarthi:

__NOTOC__
[[File:Work-boots.jpg|200px|right]]
{{Leptospirosis}}
{{CMG}};{{AE}}{{VSKP}}
==Overview==
==Primary Prevention==
===General measures===
General protective measures to be taken by risk groups as follows.
* Recreational activities :
** Protective clothing and appropriate shoes to protect from infection from contaminated sources such as animal urine.<ref name="pmid22843698">{{cite journal| author=Forbes AE, Zochowski WJ, Dubrey SW, Sivaprakasam V| title=Leptospirosis and Weil's disease in the UK. | journal=QJM | year= 2012 | volume= 105 | issue= 12 | pages= 1151-62 | pmid=22843698 | doi=10.1093/qjmed/hcs145 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22843698 }} </ref>
** Immediate washing or bathing after recreational activities if exposed to stagnant water or soil
* workers and farmers:<ref>{{cite web |url=http://www.hse.gov.uk/pubns/aise2.pdf |title=prevention of leptospirosis |author= |date= |website= |publisher= |access-date= |quote=}}</ref>
** Learning good animal husbandry techniques and using of personal protective equipment that minimize the risk of transmission
** Eradication or control of rodent population in the fields or working place

===Prophylaxis===
Prophylactic antibiotic for leptospirosis is needed for risk group who are unavoidably in contact with rodents or working in stagnant water and far from medical help such as disaster-zone aid workers, military personnel. Recommended drug of choice is [[doxycycline]] with a dose of 200mg weekly, starting 1 or 2 days before exposure and continuing until the high-risk situation resolve(maximum of not more than 8weeks).<ref name="pmid6363930">{{cite journal| author=Takafuji ET, Kirkpatrick JW, Miller RN, Karwacki JJ, Kelley PW, Gray MR et al.| title=An efficacy trial of doxycycline chemoprophylaxis against leptospirosis. | journal=N Engl J Med | year= 1984 | volume= 310 | issue= 8 | pages= 497-500 | pmid=6363930 | doi=10.1056/NEJM198402233100805 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6363930 }} </ref>

===Vaccines===
As the pathogenic serovars include wide variety of group, [[vaccine]] against leptospirosis is short lived and unprotective.<ref name="pmid16333195">{{cite journal| author=Koizumi N, Watanabe H| title=Leptospirosis vaccines: past, present, and future. | journal=J Postgrad Med | year= 2005 | volume= 51 | issue= 3 | pages= 210-4 | pmid=16333195 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16333195 }} </ref>

==References==
{{reflist|2}}

[[Category:Infectious disease]]
[[Category:Diseases]]

Leptospirosis risk factors

2017-03-09T20:14:40Z

Venkata Sivakrishna Kumar Pulivarthi:

__NOTOC__
[[File:Adventure racing.jpg|right]]
{{Leptospirosis}}

{{CMG}};{{AE}}{{VSKP}}
==Overview==
The risk of acquiring leptospirosis is associated with contact with animals, which made leptospirosis as an important occupational disease, especially affecting farmers, slaughterhouse workers, pet traders, veterinarians, rodent catchers and sewer workers who are in contact with mammalian species which acts as a natural carriers of leptospires.<ref name="pmid11292640">{{cite journal| author=Levett PN| title=Leptospirosis. | journal=Clin Microbiol Rev | year= 2001 | volume= 14 | issue= 2 | pages= 296-326 | pmid=11292640 | doi=10.1128/CMR.14.2.296-326.2001 | pmc=88975 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11292640 }} </ref> According to World health organization survey highest risk groups are subsistence farmers and people living in urban slums.<ref name="pmid16148523">{{cite journal| author=McBride AJ, Athanazio DA, Reis MG, Ko AI| title=Leptospirosis. | journal=Curr Opin Infect Dis | year= 2005 | volume= 18 | issue= 5 | pages= 376-86 | pmid=16148523 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16148523 }} </ref> Common risk factors in the development of leptospirosis include occupational exposure to animals, tropical or temperate climates, and water sports in contaminated lakes and rivers.

==Risk factors==
Leptospirosis occurs worldwide, but is most common in temperate or tropical climates. Severe form of leptospirosis is more common in the risk group of age < 5 or > 65 years with comorbid conditions, such as [[pneumonia]], [[immunocompromised]] status, history of [[liver]] diseases such as [[alcoholic liver disease]].<ref name="pmid22843698">{{cite journal| author=Forbes AE, Zochowski WJ, Dubrey SW, Sivaprakasam V| title=Leptospirosis and Weil's disease in the UK. | journal=QJM | year= 2012 | volume= 105 | issue= 12 | pages= 1151-62 | pmid=22843698 | doi=10.1093/qjmed/hcs145 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22843698 }} </ref> It is an occupational hazard for many people who work outdoors or with animals, such as:<ref>{{cite web |url=https://www.cdc.gov/leptospirosis/exposure/index.html |title= risk factors |author= |date=June 9, 2015 |website= center for disease control and prevention |publisher= |access-date= |quote=}}</ref>

=== Common Risk Factors ===
* Farmers
* Mine workers
* Sewer workers
* Slaughterhouse workers
* Veterinarians and animal caretakers
* Fish workers
* Dairy farmers
* Military personnel

The disease has also been associated with swimming, wading, kayaking, and rafting in contaminated lakes and rivers. As such, it is a recreational hazard for campers or those who participate in outdoor sports. The risk is likely greater for those who participate in these activities in tropical or temperate climates.

In addition, incidence of Leptospirosis infection among urban children appears to be increasing.
{| border="1"
|+
! colspan="1" rowspan="2" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF|Activities involving direct animal contact}}
! colspan="2" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF|Indirect animal contact}}
|-
! colspan="1" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF| Occupational activities}}
! colspan="1" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF| Recreational activities}}
|-
|
* Abattoir worker
* Farmer/dairy farmer
* Veterinary surgeon
* Meat inspector
* Rodent control worker
* Pet shop owner
* Butcher
* Animal shelter worker
* Pet owner
* Gamekeeper
|
* Sewer worker
* Miner
* Military personnel
* Septic tank cleaner
* Fish farm worker
* Canal and river worker
* Watercress farmer
* Flood relief worker
* Gravel pit worker
* Street dweller/urban slums
* Construction and demolition site worker Plumber
|
* Open water swimming
* Canoeing/Kayaking
* Sailing/wind surfing
* Potholing/caving
* Adventure traveller
* Fresh water fishing
* White water rafting
* Rowing
* Orienteering/triathlon
* Golf (stagnant pool traps)
|-
|}

==References==
{{reflist|2}}

[[Category:Infectious disease]]
[[Category:Diseases]]

File:Rat.jpg

2017-03-09T20:09:15Z

Venkata Sivakrishna Kumar Pulivarthi:

File:Leptospirosis eye.jpg

2017-03-09T20:06:40Z

Venkata Sivakrishna Kumar Pulivarthi:

Leptospirosis pathophysiology

2017-03-09T20:04:59Z

Venkata Sivakrishna Kumar Pulivarthi:

__NOTOC__
[[File:Rat.jpg|right|200px]]
{{Leptospirosis}}
{{CMG}}; {{AE}}{{VSKP}}
==Overview==
Leptospires shed in the urine of animals to the environment from where humans are infected by incidental hosts. In Carriers these bacteria harbour in the [[renal tubules]] and can persist in soil or surface water and then transmits to human hosts via mucous membranes or abraded skin.<ref name="pmid13559904">{{cite journal| author=BABUDIERI B| title=Animal reservoirs of leptospires. | journal=Ann N Y Acad Sci | year= 1958 | volume= 70 | issue= 3 | pages= 393-413 | pmid=13559904 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=13559904 }} </ref><ref name="ForbesZochowski2012">{{cite journal|last1=Forbes|first1=A. E.|last2=Zochowski|first2=W. J.|last3=Dubrey|first3=S. W.|last4=Sivaprakasam|first4=V.|title=Leptospirosis and Weil's disease in the UK|journal=QJM|volume=105|issue=12|year=2012|pages=1151–1162|issn=1460-2725|doi=10.1093/qjmed/hcs145}}</ref> Pathogen transmit through various mechanisms such as broken skin, mucus membranes and the conjunctivae, exposure to contaminated water are at risk of contracting leptospirosis.<ref name="pmid22843698">{{cite journal| author=Forbes AE, Zochowski WJ, Dubrey SW, Sivaprakasam V| title=Leptospirosis and Weil's disease in the UK. | journal=QJM | year= 2012 | volume= 105 | issue= 12 | pages= 1151-62 | pmid=22843698 | doi=10.1093/qjmed/hcs145 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22843698 }} </ref>

==Pathogenesis==
The disease leptospirosis involves a spectrum of symptoms ranging from subclinical infection to a severe syndrome of multiorgan infection with high mortality and Weil’s disease represents only the most severe presentation. Severe leptospirosis is frequently caused by serovars of the icterohaemorrhagiae serogroup. The presentation of leptospirosis is biphasic, with the acute or septicemic phase lasting about a week, followed by the immune phase, characterized by antibody production and excretion of leptospires in the urine.<ref name="Levett2001">{{cite journal|last1=Levett|first1=P. N.|title=Leptospirosis|journal=Clinical Microbiology Reviews|volume=14|issue=2|year=2001|pages=296–326|issn=0893-8512|doi=10.1128/CMR.14.2.296-326.2001}}</ref>
[[File:Leptospirosis pathogenesis.jpg|center]]
=== Reservoirs ===
The major reservoir for leptospirosis is rat and small rodents that appear to harbour more virulent strains of the disease.<ref name="Picardeau2013">{{cite journal|last1=Picardeau|first1=M.|title=Diagnosis and epidemiology of leptospirosis|journal=Médecine et Maladies Infectieuses|volume=43|issue=1|year=2013|pages=1–9|issn=0399077X|doi=10.1016/j.medmal.2012.11.005}}</ref>
===Carriers===
Domestic animals such as dogs,cattle and pigs acts as potential carriers that increases the risk of leptospirosis in humans. These carriers are generally asymptomatic.<ref name="pmid19011247">{{cite journal| author=Gaudie CM, Featherstone CA, Phillips WS, McNaught R, Rhodes PM, Errington J et al.| title=Human Leptospira interrogans serogroup icterohaemorrhagiae infection (Weil's disease) acquired from pet rats. | journal=Vet Rec | year= 2008 | volume= 163 | issue= 20 | pages= 599-601 | pmid=19011247 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19011247 }} </ref><ref name="pmid19202179">{{cite journal| author=Strugnell BW, Featherstone C, Gent M, Lister P, Evans G, Okereke E et al.| title=Weil's disease associated with the adoption of a feral rat. | journal=Vet Rec | year= 2009 | volume= 164 | issue= 6 | pages= 186 | pmid=19202179 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19202179 }} </ref>

===Transmission===
Infection can occurs either by direct contact with the carrier’s urine or through indirect transmission via urine-contaminated environment. Infection due to direct transmission through direct oral intake of contaminated drinking water or food is very rare.<ref name="pmid3618584">{{cite journal| author=Cacciapuoti B, Ciceroni L, Maffei C, Di Stanislao F, Strusi P, Calegari L et al.| title=A waterborne outbreak of leptospirosis. | journal=Am J Epidemiol | year= 1987 | volume= 126 | issue= 3 | pages= 535-45 | pmid=3618584 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3618584 }} </ref> Pathogenic leptospires live in the renal system and the genital tracts of domestic animals which act as sites of persistence.<ref name="pmid4081333">{{cite journal| author=Ellis WA, O'Brien JJ, Cassells JA, Neill SD, Hanna J| title=Excretion of Leptospira interrogans serovar hardjo following calving or abortion. | journal=Res Vet Sci | year= 1985 | volume= 39 | issue= 3 | pages= 296-8 | pmid=4081333 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4081333 }} </ref><ref name="pmid3705357">{{cite journal| author=Ellis WA, McParland PJ, Bryson DG, Thiermann AB, Montgomery J| title=Isolation of leptospires from the genital tract and kidneys of aborted sows. | journal=Vet Rec | year= 1986 | volume= 118 | issue= 11 | pages= 294-5 | pmid=3705357 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3705357 }} </ref> Bacteria shed from the infected animals such as rodents and domesticat animals through urine. These animals may not show signs of disease, but humans shows signs of illness after contact with infected urine, or through contact with water, soil or food that has been contaminated and the outbreaks are associates with floodwaters. The major route of infection by leptospires is probably by transmission through indirect contact with leptospires secreted into the environment. Humans are considered dead end hosts, but sometimes they also act as carriers. Mammalian species (e.g. rodents, insectivores, dogs, pigs and cattle) act as the main carriers of the disease.<ref name="pmid20186328">{{cite journal| author=Ganoza CA, Matthias MA, Saito M, Cespedes M, Gotuzzo E, Vinetz JM| title=Asymptomatic renal colonization of humans in the peruvian Amazon by Leptospira. | journal=PLoS Negl Trop Dis | year= 2010 | volume= 4 | issue= 2 | pages= e612 | pmid=20186328 | doi=10.1371/journal.pntd.0000612 | pmc=2826405 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20186328 }} </ref>
Leptospires are excreted in urine into the environment, where they can survive for several months, depending on favourable environmental conditions such as humid and temperate areas. The pathogen may also be excreted in the products of abortion in mammalian animal species.<ref name="pmid4081333">{{cite journal| author=Ellis WA, O'Brien JJ, Cassells JA, Neill SD, Hanna J| title=Excretion of Leptospira interrogans serovar hardjo following calving or abortion. | journal=Res Vet Sci | year= 1985 | volume= 39 | issue= 3 | pages= 296-8 | pmid=4081333 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4081333 }} </ref>

Pathological findings of leptospirosis are due to the development of the following:<ref name="Budihal2014">{{cite journal|last1=Budihal|first1=Suman Veerappa|title=Leptospirosis Diagnosis: Competancy of Various Laboratory Tests|journal=JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH|year=2014|issn=2249782X|doi=10.7860/JCDR/2014/6593.3950}}</ref><ref name="pmid14902167">{{cite journal| author=BEESON PB, HANKEY DD| title=Leptospiral meningitis. | journal=AMA Arch Intern Med | year= 1952 | volume= 89 | issue= 4 | pages= 575-83 | pmid=14902167 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14902167 }} </ref><ref name="pmid1224630">{{cite journal| author=King SD, Urquhart AE| title=Laboratory investigations on four cases of leptospiral meningitis in Jamaica. | journal=West Indian Med J | year= 1975 | volume= 24 | issue= 4 | pages= 196-201 | pmid=1224630 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1224630 }} </ref><ref name="pmid9071036">{{cite journal| author=Silva MV, Camargo ED, Batista L, Vaz AJ, Ferreira AW, Barbosa PR| title=Application of anti-leptospira ELISA-IgM for the etiologic elucidation of meningitis. | journal=Rev Inst Med Trop Sao Paulo | year= 1996 | volume= 38 | issue= 2 | pages= 153-6 | pmid=9071036 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9071036 }} </ref>
* [[Vasculitis]]
* [[Endothelial]] damage
* [[Inflammatory]] infiltrates composed of moncytic cells, [[plasma cells]], [[histiocytes]], and [[neutrophils]].

{| border="0"
|-
|align=center| '''Type of toxin production depends on the serovar'''
'''Hemolytic toxins:'''

Hemolysins are produced from several serovars such as serovars ballum, hardjo, pomona, and tarassovi which are sphingomyelinases

'''Leptospira'''

'''⬇'''

'''[[Toxin]] production'''

'''⬇'''

'''Damage to small [[blood vessels]]'''

'''⬇'''

'''[[Vasculitis]]'''

'''⬇'''

'''• Direct cytotoxic injury or Immunological injury 
• Fluid extavasation into the interstitial compartment due to [[vasculitis]]
'''

'''⬇'''

'''Acute renal injury and [[vascular]] injury to internal organs'''
|}

==Gross Pathology==
Gross findings of various organ systems are present as:<ref name="pmid13862141">{{cite journal| author=AREAN VM| title=The pathologic anatomy and pathogenesis of fatal human leptospirosis (Weil's disease). | journal=Am J Pathol | year= 1962 | volume= 40 | issue= | pages= 393-423 | pmid=13862141 | doi= | pmc=1949541 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=13862141 }} </ref>
* Extensive [[petechial hemorrhages]] are common.
* Discoloration of organs is seen in severe cases of icteric leptospirosis.

== Microscopic Pathology ==
===Liver===
* No significant structural destruction is seen<ref name="pmid13862141">{{cite journal| author=AREAN VM| title=The pathologic anatomy and pathogenesis of fatal human leptospirosis (Weil's disease). | journal=Am J Pathol | year= 1962 | volume= 40 | issue= | pages= 393-423 | pmid=13862141 | doi= | pmc=1949541 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=13862141 }} </ref><ref name="pmid4298629">{{cite journal| author=De Brito T, Machado MM, Montans SD, Hoshino S, Freymüller E| title=Liver biopsy in human leptospirosis: a light and electron microscopy study. | journal=Virchows Arch Pathol Anat Physiol Klin Med | year= 1967 | volume= 342 | issue= 1 | pages= 61-9 | pmid=4298629 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4298629 }} </ref>
* [[Intrahepatic cholestasis]] is seen in few cases
* [[Hypertrophy (medical)|Hypertrophy]] and [[hyperplasia]] of [[Kupffer cells]]
* Erythrophagocytosis
===Kidney===
* Common histopathological presentation in kidney includes [[interstitial nephritis]] with infiltration of [[neutrophils]] and [[Monocytes|monocytes.]]<ref name="pmid13862141">{{cite journal| author=AREAN VM| title=The pathologic anatomy and pathogenesis of fatal human leptospirosis (Weil's disease). | journal=Am J Pathol | year= 1962 | volume= 40 | issue= | pages= 393-423 | pmid=13862141 | doi= | pmc=1949541 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=13862141 }} </ref>
* Leptospires are seen in [[renal tubules]].
* Electron microscopy findings include:<ref name="pmid14072448">{{cite journal| author=PENNA D, DE BRITO T, PUPO AA, MACHADO MM, AYROZA PA, DE ALMEIDA SS| title=KIDNEY BIOPSY IN HUMAN LEPTOSPIROSIS. | journal=Am J Trop Med Hyg | year= 1963 | volume= 12 | issue= | pages= 896-901 | pmid=14072448 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14072448 }} </ref><ref name="SitprijaEvans1970">{{cite journal|last1=Sitprija|first1=Visith|last2=Evans|first2=Hilary|title=The kidney in human leptospirosis|journal=The American Journal of Medicine|volume=49|issue=6|year=1970|pages=780–788|issn=00029343|doi=10.1016/S0002-9343(70)80059-6}}</ref>

** Thickened tubular [[basement membrane]]
** Denuded tubular brush borders
** Mitochondrial depletion in tubular cells
* Glomerular destruction associated with [[proteinuria]] is seen in few cases.
===Heart===
Leptospirosis is associate with interstitial [[myocarditis]].<ref name="pmid3446572">{{cite journal| author=De Biase L, De Curtis G, Paparoni S, Sciarra D, Campa PP| title=Fatal leptospiral myocarditis. | journal=G Ital Cardiol | year= 1987 | volume= 17 | issue= 11 | pages= 992-4 | pmid=3446572 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3446572 }} </ref><ref name="BritoMorais2016">{{cite journal|last1=Brito|first1=T. De|last2=Morais|first2=C. F.|last3=Yasuda|first3=P. H.|last4=Lancellotti|first4=Carmen P.|last5=Hoshino-Shimizu|first5=Sumie|last6=Yamashiro|first6=E.|last7=Alves|first7=V. A. Ferreira|title=Cardiovascular involvement in human and experimental leptospirosis: Pathologic findings and immunohistochemical detection of leptospiral antigen|journal=Annals of Tropical Medicine & Parasitology|volume=81|issue=3|year=2016|pages=207–214|issn=0003-4983|doi=10.1080/00034983.1987.11812114}}</ref><ref name="pmid13464040">{{cite journal| author=AREAN VM| title=Leptospiral myocarditis. | journal=Lab Invest | year= 1957 | volume= 6 | issue= 5 | pages= 462-71 | pmid=13464040 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=13464040 }} </ref><ref name="pmid871034">{{cite journal| author=Ramachandran S, Perera MV| title=Cardiac and pulmonary involvement in leptospirosis. | journal=Trans R Soc Trop Med Hyg | year= 1977 | volume= 71 | issue= 1 | pages= 56-9 | pmid=871034 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=871034 }} </ref>
* Cellular infiltration predominantly with [[lymphocytes]] and [[plasma cells]].
* [[Petechial hemorrhages]] (epicardial hemorrhages are common)
* Epicardial infilteration of [[mononuclear cells]].
* [[Pericardial effusion]]
* coronary arteritis
===Lungs===
Common pulmonary presentation in leptospirosis are [[pulmonary congestion]] and [[hemorrhage]].<ref name="pmid13862141">{{cite journal| author=AREAN VM| title=The pathologic anatomy and pathogenesis of fatal human leptospirosis (Weil's disease). | journal=Am J Pathol | year= 1962 | volume= 40 | issue= | pages= 393-423 | pmid=13862141 | doi= | pmc=1949541 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=13862141 }} </ref><ref name="pmid871034">{{cite journal| author=Ramachandran S, Perera MV| title=Cardiac and pulmonary involvement in leptospirosis. | journal=Trans R Soc Trop Med Hyg | year= 1977 | volume= 71 | issue= 1 | pages= 56-9 | pmid=871034 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=871034 }} </ref><ref name="pmid9080878">{{cite journal| author=Nicodemo AC, Duarte MI, Alves VA, Takakura CF, Santos RT, Nicodemo EL| title=Lung lesions in human leptospirosis: microscopic, immunohistochemical, and ultrastructural features related to thrombocytopenia. | journal=Am J Trop Med Hyg | year= 1997 | volume= 56 | issue= 2 | pages= 181-7 | pmid=9080878 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9080878 }} </ref><ref name="pmid6790049">{{cite journal| author=Zaltzman M, Kallenbach JM, Goss GD, Lewis M, Zwi S, Gear JH| title=Adult respiratory distress syndrome in Leptospira canicola infection. | journal=Br Med J (Clin Res Ed) | year= 1981 | volume= 283 | issue= 6290 | pages= 519-20 | pmid=6790049 | doi= | pmc=1507945 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6790049 }} </ref>
* Alveolar infiltration by [[monocytes]] and [[neutrophils]].
* Hyaline membrane formation.
* Leptospires are seen within the [[endothelial cells]] in interalveolar septa, and also attached to capillary endothelial cells.
===Skeletal muscle===
* Focal [[necrosis]] of muscle fibers with infiltration of [[histiocytes]], [[neutrophils]], and [[plasma cells]].
===Brain===
* Perivascular cuffing is seen.

==References==
{{Reflist|2}}

Leptospirosis physical examination

2017-03-09T20:01:34Z

Venkata Sivakrishna Kumar Pulivarthi: /* Physical Examination Findings */

__NOTOC__
{{Leptospirosis}}
{{CMG}};{{AE}}{{VSKP}}
==Overview==
==Physical Examination Findings==
<ref name="Budihal2014">{{cite journal|last1=Budihal|first1=Suman Veerappa|title=Leptospirosis Diagnosis: Competancy of Various Laboratory Tests|journal=JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH|year=2014|issn=2249782X|doi=10.7860/JCDR/2014/6593.3950}}</ref><ref name="pmid14902167">{{cite journal| author=BEESON PB, HANKEY DD| title=Leptospiral meningitis. | journal=AMA Arch Intern Med | year= 1952 | volume= 89 | issue= 4 | pages= 575-83 | pmid=14902167 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14902167 }} </ref><ref name="pmid1224630">{{cite journal| author=King SD, Urquhart AE| title=Laboratory investigations on four cases of leptospiral meningitis in Jamaica. | journal=West Indian Med J | year= 1975 | volume= 24 | issue= 4 | pages= 196-201 | pmid=1224630 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1224630 }} </ref><ref name="pmid9071036">{{cite journal| author=Silva MV, Camargo ED, Batista L, Vaz AJ, Ferreira AW, Barbosa PR| title=Application of anti-leptospira ELISA-IgM for the etiologic elucidation of meningitis. | journal=Rev Inst Med Trop Sao Paulo | year= 1996 | volume= 38 | issue= 2 | pages= 153-6 | pmid=9071036 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9071036 }} </ref>
=== Appearance of the Patient ===
* Patient present with [[irritability]] and [[restlessness]].

=== Vital Signs ===
* [[Hypotension]] and circulatory collapse.
* [[Tachypnea]]
* [[Tachycardia]]

=== Skin ===
* [[Macular]], [[maculopapular]] [[erythematous]] skin eruptions are seen in the [[face]] and [[trunk]].
* [[Purpura]] due to [[thrombocytopenia]].
<gallery>File:Leptospirosis rash.jpg</gallery>

=== HEENT ===
* Icteric [[sclera]] is seen in patients with icteric leptospirosis
* Conjunctival suffusion: a charecterestic finding seen in patients with anicteric leptosirosis. Usually bilaeral and involving palpebral [[conjunctiva]].
* Conjunctival hemorrhages: may be unilateral or bilateral.
<gallery>File:Leptospirosis eye.jpg</gallery>

=== Neck ===

=== Lungs ===
* [[Crepitations]] common in basal regions

=== Heart ===

=== Abdomen ===
* [[Right upper quadrant]] [[Tenderness (medicine)|tenderness]]

* [[Hepatomegaly]]

=== Genitourinary ===

=== Extremities ===
* [[Edema]] of the [[extremities]]
* [[Cool extremities|cold clammy extremities]]

=== Neuromuscular ===
Signs of [[meningitis]] such as [[neck stiffness]], [[nuchal rigidity]] are present.

Other signs include:
* [[Nystagmus]]
* [[Spasticity]]

==References==
{{reflist|2}}

[[Category:Infectious disease]]
[[Category:Diseases]]

Leptospirosis physical examination

2017-03-09T19:59:10Z

Venkata Sivakrishna Kumar Pulivarthi: /* Physical Examination Findings */

__NOTOC__
{{Leptospirosis}}
{{CMG}};{{AE}}{{VSKP}}
==Overview==
==Physical Examination Findings==
<ref name="Budihal2014">{{cite journal|last1=Budihal|first1=Suman Veerappa|title=Leptospirosis Diagnosis: Competancy of Various Laboratory Tests|journal=JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH|year=2014|issn=2249782X|doi=10.7860/JCDR/2014/6593.3950}}</ref><ref name="pmid14902167">{{cite journal| author=BEESON PB, HANKEY DD| title=Leptospiral meningitis. | journal=AMA Arch Intern Med | year= 1952 | volume= 89 | issue= 4 | pages= 575-83 | pmid=14902167 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14902167 }} </ref><ref name="pmid1224630">{{cite journal| author=King SD, Urquhart AE| title=Laboratory investigations on four cases of leptospiral meningitis in Jamaica. | journal=West Indian Med J | year= 1975 | volume= 24 | issue= 4 | pages= 196-201 | pmid=1224630 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1224630 }} </ref><ref name="pmid9071036">{{cite journal| author=Silva MV, Camargo ED, Batista L, Vaz AJ, Ferreira AW, Barbosa PR| title=Application of anti-leptospira ELISA-IgM for the etiologic elucidation of meningitis. | journal=Rev Inst Med Trop Sao Paulo | year= 1996 | volume= 38 | issue= 2 | pages= 153-6 | pmid=9071036 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9071036 }} </ref>
=== Appearance of the Patient ===
* Patient present with [[irritability]] and [[restlessness]].

=== Vital Signs ===
* [[Hypotension]] and circulatory collapse.
* [[Tachypnea]]
* [[Tachycardia]]

=== Skin ===
* [[Macular]], [[maculopapular]] [[erythematous]] skin eruptions are seen in the [[face]] and [[trunk]].
* [[Purpura]] due to [[thrombocytopenia]].
<gallery>File:Leptospirosis rash.jpg</gallery>

=== HEENT ===
* Icteric [[sclera]] is seen in patients with icteric leptospirosis
* Conjunctival suffusion: a charecterestic finding seen in patients with anicteric leptosirosis. Usually bilaeral and involving palpebral [[conjunctiva]].
* Conjunctival hemorrhages: may be unilateral or bilateral.

=== Neck ===

=== Lungs ===
* [[Crepitations]] common in basal regions

=== Heart ===

=== Abdomen ===
* [[Right upper quadrant]] [[Tenderness (medicine)|tenderness]]

* [[Hepatomegaly]]

=== Genitourinary ===

=== Extremities ===
* [[Edema]] of the [[extremities]]
* [[Cool extremities|cold clammy extremities]]

=== Neuromuscular ===
Signs of [[meningitis]] such as [[neck stiffness]], [[nuchal rigidity]] are present.

Other signs include:
* [[Nystagmus]]
* [[Spasticity]]

==References==
{{reflist|2}}

[[Category:Infectious disease]]
[[Category:Diseases]]

Leptospirosis physical examination

2017-03-09T19:58:11Z

Venkata Sivakrishna Kumar Pulivarthi: /* Skin */

__NOTOC__
{{Leptospirosis}}
{{CMG}};{{AE}}{{VSKP}}
==Overview==
==Physical Examination Findings==
<ref name="Budihal2014">{{cite journal|last1=Budihal|first1=Suman Veerappa|title=Leptospirosis Diagnosis: Competancy of Various Laboratory Tests|journal=JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH|year=2014|issn=2249782X|doi=10.7860/JCDR/2014/6593.3950}}</ref><ref name="pmid14902167">{{cite journal| author=BEESON PB, HANKEY DD| title=Leptospiral meningitis. | journal=AMA Arch Intern Med | year= 1952 | volume= 89 | issue= 4 | pages= 575-83 | pmid=14902167 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14902167 }} </ref><ref name="pmid1224630">{{cite journal| author=King SD, Urquhart AE| title=Laboratory investigations on four cases of leptospiral meningitis in Jamaica. | journal=West Indian Med J | year= 1975 | volume= 24 | issue= 4 | pages= 196-201 | pmid=1224630 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1224630 }} </ref><ref name="pmid9071036">{{cite journal| author=Silva MV, Camargo ED, Batista L, Vaz AJ, Ferreira AW, Barbosa PR| title=Application of anti-leptospira ELISA-IgM for the etiologic elucidation of meningitis. | journal=Rev Inst Med Trop Sao Paulo | year= 1996 | volume= 38 | issue= 2 | pages= 153-6 | pmid=9071036 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9071036 }} </ref>
=== Appearance of the Patient ===
* Patient present with [[irritability]] and [[restlessness]].

=== Vital Signs ===
* [[Hypotension]] and circulatory collapse.
* [[Tachypnea]]
* [[Tachycardia]]

=== Skin ===
* [[Macular]], [[maculopapular]] [[erythematous]] skin eruptions are seen in the [[face]] and [[trunk]].
* [[Purpura]] due to [[thrombocytopenia]].
[[File:Leptospirosis rash.jpg|left|200px]]

=== HEENT ===
* Icteric [[sclera]] is seen in patients with icteric leptospirosis
* Conjunctival suffusion: a charecterestic finding seen in patients with anicteric leptosirosis. Usually bilaeral and involving palpebral [[conjunctiva]].
* Conjunctival hemorrhages: may be unilateral or bilateral.

=== Neck ===

=== Lungs ===
* [[Crepitations]] common in basal regions

=== Heart ===

=== Abdomen ===
* [[Right upper quadrant]] [[Tenderness (medicine)|tenderness]]

* [[Hepatomegaly]]

=== Genitourinary ===

=== Extremities ===
* [[Edema]] of the [[extremities]]
* [[Cool extremities|cold clammy extremities]]

=== Neuromuscular ===
Signs of [[meningitis]] such as [[neck stiffness]], [[nuchal rigidity]] are present.

Other signs include:
* [[Nystagmus]]
* [[Spasticity]]

==References==
{{reflist|2}}

[[Category:Infectious disease]]
[[Category:Diseases]]

File:Leptospirosis rash.jpg

2017-03-09T19:57:24Z

Venkata Sivakrishna Kumar Pulivarthi:

Leptospirosis pathophysiology

2017-03-09T19:56:10Z

Venkata Sivakrishna Kumar Pulivarthi: /* Pathogenesis */

__NOTOC__
{{Leptospirosis}}
{{CMG}}; {{AE}}{{VSKP}}
==Overview==
Leptospires shed in the urine of animals to the environment from where humans are infected by incidental hosts. In Carriers these bacteria harbour in the [[renal tubules]] and can persist in soil or surface water and then transmits to human hosts via mucous membranes or abraded skin.<ref name="pmid13559904">{{cite journal| author=BABUDIERI B| title=Animal reservoirs of leptospires. | journal=Ann N Y Acad Sci | year= 1958 | volume= 70 | issue= 3 | pages= 393-413 | pmid=13559904 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=13559904 }} </ref><ref name="ForbesZochowski2012">{{cite journal|last1=Forbes|first1=A. E.|last2=Zochowski|first2=W. J.|last3=Dubrey|first3=S. W.|last4=Sivaprakasam|first4=V.|title=Leptospirosis and Weil's disease in the UK|journal=QJM|volume=105|issue=12|year=2012|pages=1151–1162|issn=1460-2725|doi=10.1093/qjmed/hcs145}}</ref> Pathogen transmit through various mechanisms such as broken skin, mucus membranes and the conjunctivae, exposure to contaminated water are at risk of contracting leptospirosis.<ref name="pmid22843698">{{cite journal| author=Forbes AE, Zochowski WJ, Dubrey SW, Sivaprakasam V| title=Leptospirosis and Weil's disease in the UK. | journal=QJM | year= 2012 | volume= 105 | issue= 12 | pages= 1151-62 | pmid=22843698 | doi=10.1093/qjmed/hcs145 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22843698 }} </ref>

==Pathogenesis==
The disease leptospirosis involves a spectrum of symptoms ranging from subclinical infection to a severe syndrome of multiorgan infection with high mortality and Weil’s disease represents only the most severe presentation. Severe leptospirosis is frequently caused by serovars of the icterohaemorrhagiae serogroup. The presentation of leptospirosis is biphasic, with the acute or septicemic phase lasting about a week, followed by the immune phase, characterized by antibody production and excretion of leptospires in the urine.<ref name="Levett2001">{{cite journal|last1=Levett|first1=P. N.|title=Leptospirosis|journal=Clinical Microbiology Reviews|volume=14|issue=2|year=2001|pages=296–326|issn=0893-8512|doi=10.1128/CMR.14.2.296-326.2001}}</ref>
[[File:Leptospirosis pathogenesis.jpg|center]]
=== Reservoirs ===
The major reservoir for leptospirosis is rat and small rodents that appear to harbour more virulent strains of the disease.<ref name="Picardeau2013">{{cite journal|last1=Picardeau|first1=M.|title=Diagnosis and epidemiology of leptospirosis|journal=Médecine et Maladies Infectieuses|volume=43|issue=1|year=2013|pages=1–9|issn=0399077X|doi=10.1016/j.medmal.2012.11.005}}</ref>
===Carriers===
Domestic animals such as dogs,cattle and pigs acts as potential carriers that increases the risk of leptospirosis in humans. These carriers are generally asymptomatic.<ref name="pmid19011247">{{cite journal| author=Gaudie CM, Featherstone CA, Phillips WS, McNaught R, Rhodes PM, Errington J et al.| title=Human Leptospira interrogans serogroup icterohaemorrhagiae infection (Weil's disease) acquired from pet rats. | journal=Vet Rec | year= 2008 | volume= 163 | issue= 20 | pages= 599-601 | pmid=19011247 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19011247 }} </ref><ref name="pmid19202179">{{cite journal| author=Strugnell BW, Featherstone C, Gent M, Lister P, Evans G, Okereke E et al.| title=Weil's disease associated with the adoption of a feral rat. | journal=Vet Rec | year= 2009 | volume= 164 | issue= 6 | pages= 186 | pmid=19202179 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19202179 }} </ref>

===Transmission===
Infection can occurs either by direct contact with the carrier’s urine or through indirect transmission via urine-contaminated environment. Infection due to direct transmission through direct oral intake of contaminated drinking water or food is very rare.<ref name="pmid3618584">{{cite journal| author=Cacciapuoti B, Ciceroni L, Maffei C, Di Stanislao F, Strusi P, Calegari L et al.| title=A waterborne outbreak of leptospirosis. | journal=Am J Epidemiol | year= 1987 | volume= 126 | issue= 3 | pages= 535-45 | pmid=3618584 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3618584 }} </ref> Pathogenic leptospires live in the renal system and the genital tracts of domestic animals which act as sites of persistence.<ref name="pmid4081333">{{cite journal| author=Ellis WA, O'Brien JJ, Cassells JA, Neill SD, Hanna J| title=Excretion of Leptospira interrogans serovar hardjo following calving or abortion. | journal=Res Vet Sci | year= 1985 | volume= 39 | issue= 3 | pages= 296-8 | pmid=4081333 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4081333 }} </ref><ref name="pmid3705357">{{cite journal| author=Ellis WA, McParland PJ, Bryson DG, Thiermann AB, Montgomery J| title=Isolation of leptospires from the genital tract and kidneys of aborted sows. | journal=Vet Rec | year= 1986 | volume= 118 | issue= 11 | pages= 294-5 | pmid=3705357 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3705357 }} </ref> Bacteria shed from the infected animals such as rodents and domesticat animals through urine. These animals may not show signs of disease, but humans shows signs of illness after contact with infected urine, or through contact with water, soil or food that has been contaminated and the outbreaks are associates with floodwaters. The major route of infection by leptospires is probably by transmission through indirect contact with leptospires secreted into the environment. Humans are considered dead end hosts, but sometimes they also act as carriers. Mammalian species (e.g. rodents, insectivores, dogs, pigs and cattle) act as the main carriers of the disease.<ref name="pmid20186328">{{cite journal| author=Ganoza CA, Matthias MA, Saito M, Cespedes M, Gotuzzo E, Vinetz JM| title=Asymptomatic renal colonization of humans in the peruvian Amazon by Leptospira. | journal=PLoS Negl Trop Dis | year= 2010 | volume= 4 | issue= 2 | pages= e612 | pmid=20186328 | doi=10.1371/journal.pntd.0000612 | pmc=2826405 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20186328 }} </ref>
Leptospires are excreted in urine into the environment, where they can survive for several months, depending on favourable environmental conditions such as humid and temperate areas. The pathogen may also be excreted in the products of abortion in mammalian animal species.<ref name="pmid4081333">{{cite journal| author=Ellis WA, O'Brien JJ, Cassells JA, Neill SD, Hanna J| title=Excretion of Leptospira interrogans serovar hardjo following calving or abortion. | journal=Res Vet Sci | year= 1985 | volume= 39 | issue= 3 | pages= 296-8 | pmid=4081333 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4081333 }} </ref>

Pathological findings of leptospirosis are due to the development of the following:<ref name="Budihal2014">{{cite journal|last1=Budihal|first1=Suman Veerappa|title=Leptospirosis Diagnosis: Competancy of Various Laboratory Tests|journal=JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH|year=2014|issn=2249782X|doi=10.7860/JCDR/2014/6593.3950}}</ref><ref name="pmid14902167">{{cite journal| author=BEESON PB, HANKEY DD| title=Leptospiral meningitis. | journal=AMA Arch Intern Med | year= 1952 | volume= 89 | issue= 4 | pages= 575-83 | pmid=14902167 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14902167 }} </ref><ref name="pmid1224630">{{cite journal| author=King SD, Urquhart AE| title=Laboratory investigations on four cases of leptospiral meningitis in Jamaica. | journal=West Indian Med J | year= 1975 | volume= 24 | issue= 4 | pages= 196-201 | pmid=1224630 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1224630 }} </ref><ref name="pmid9071036">{{cite journal| author=Silva MV, Camargo ED, Batista L, Vaz AJ, Ferreira AW, Barbosa PR| title=Application of anti-leptospira ELISA-IgM for the etiologic elucidation of meningitis. | journal=Rev Inst Med Trop Sao Paulo | year= 1996 | volume= 38 | issue= 2 | pages= 153-6 | pmid=9071036 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9071036 }} </ref>
* [[Vasculitis]]
* [[Endothelial]] damage
* [[Inflammatory]] infiltrates composed of moncytic cells, [[plasma cells]], [[histiocytes]], and [[neutrophils]].

{| border="0"
|-
|align=center| '''Type of toxin production depends on the serovar'''
'''Hemolytic toxins:'''

Hemolysins are produced from several serovars such as serovars ballum, hardjo, pomona, and tarassovi which are sphingomyelinases

'''Leptospira'''

'''⬇'''

'''[[Toxin]] production'''

'''⬇'''

'''Damage to small [[blood vessels]]'''

'''⬇'''

'''[[Vasculitis]]'''

'''⬇'''

'''• Direct cytotoxic injury or Immunological injury 
• Fluid extavasation into the interstitial compartment due to [[vasculitis]]
'''

'''⬇'''

'''Acute renal injury and [[vascular]] injury to internal organs'''
|}

==Gross Pathology==
Gross findings of various organ systems are present as:<ref name="pmid13862141">{{cite journal| author=AREAN VM| title=The pathologic anatomy and pathogenesis of fatal human leptospirosis (Weil's disease). | journal=Am J Pathol | year= 1962 | volume= 40 | issue= | pages= 393-423 | pmid=13862141 | doi= | pmc=1949541 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=13862141 }} </ref>
* Extensive [[petechial hemorrhages]] are common.
* Discoloration of organs is seen in severe cases of icteric leptospirosis.

== Microscopic Pathology ==
===Liver===
* No significant structural destruction is seen<ref name="pmid13862141">{{cite journal| author=AREAN VM| title=The pathologic anatomy and pathogenesis of fatal human leptospirosis (Weil's disease). | journal=Am J Pathol | year= 1962 | volume= 40 | issue= | pages= 393-423 | pmid=13862141 | doi= | pmc=1949541 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=13862141 }} </ref><ref name="pmid4298629">{{cite journal| author=De Brito T, Machado MM, Montans SD, Hoshino S, Freymüller E| title=Liver biopsy in human leptospirosis: a light and electron microscopy study. | journal=Virchows Arch Pathol Anat Physiol Klin Med | year= 1967 | volume= 342 | issue= 1 | pages= 61-9 | pmid=4298629 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4298629 }} </ref>
* [[Intrahepatic cholestasis]] is seen in few cases
* [[Hypertrophy (medical)|Hypertrophy]] and [[hyperplasia]] of [[Kupffer cells]]
* Erythrophagocytosis
===Kidney===
* Common histopathological presentation in kidney includes [[interstitial nephritis]] with infiltration of [[neutrophils]] and [[Monocytes|monocytes.]]<ref name="pmid13862141">{{cite journal| author=AREAN VM| title=The pathologic anatomy and pathogenesis of fatal human leptospirosis (Weil's disease). | journal=Am J Pathol | year= 1962 | volume= 40 | issue= | pages= 393-423 | pmid=13862141 | doi= | pmc=1949541 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=13862141 }} </ref>
* Leptospires are seen in [[renal tubules]].
* Electron microscopy findings include:<ref name="pmid14072448">{{cite journal| author=PENNA D, DE BRITO T, PUPO AA, MACHADO MM, AYROZA PA, DE ALMEIDA SS| title=KIDNEY BIOPSY IN HUMAN LEPTOSPIROSIS. | journal=Am J Trop Med Hyg | year= 1963 | volume= 12 | issue= | pages= 896-901 | pmid=14072448 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14072448 }} </ref><ref name="SitprijaEvans1970">{{cite journal|last1=Sitprija|first1=Visith|last2=Evans|first2=Hilary|title=The kidney in human leptospirosis|journal=The American Journal of Medicine|volume=49|issue=6|year=1970|pages=780–788|issn=00029343|doi=10.1016/S0002-9343(70)80059-6}}</ref>

** Thickened tubular [[basement membrane]]
** Denuded tubular brush borders
** Mitochondrial depletion in tubular cells
* Glomerular destruction associated with [[proteinuria]] is seen in few cases.
===Heart===
Leptospirosis is associate with interstitial [[myocarditis]].<ref name="pmid3446572">{{cite journal| author=De Biase L, De Curtis G, Paparoni S, Sciarra D, Campa PP| title=Fatal leptospiral myocarditis. | journal=G Ital Cardiol | year= 1987 | volume= 17 | issue= 11 | pages= 992-4 | pmid=3446572 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3446572 }} </ref><ref name="BritoMorais2016">{{cite journal|last1=Brito|first1=T. De|last2=Morais|first2=C. F.|last3=Yasuda|first3=P. H.|last4=Lancellotti|first4=Carmen P.|last5=Hoshino-Shimizu|first5=Sumie|last6=Yamashiro|first6=E.|last7=Alves|first7=V. A. Ferreira|title=Cardiovascular involvement in human and experimental leptospirosis: Pathologic findings and immunohistochemical detection of leptospiral antigen|journal=Annals of Tropical Medicine & Parasitology|volume=81|issue=3|year=2016|pages=207–214|issn=0003-4983|doi=10.1080/00034983.1987.11812114}}</ref><ref name="pmid13464040">{{cite journal| author=AREAN VM| title=Leptospiral myocarditis. | journal=Lab Invest | year= 1957 | volume= 6 | issue= 5 | pages= 462-71 | pmid=13464040 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=13464040 }} </ref><ref name="pmid871034">{{cite journal| author=Ramachandran S, Perera MV| title=Cardiac and pulmonary involvement in leptospirosis. | journal=Trans R Soc Trop Med Hyg | year= 1977 | volume= 71 | issue= 1 | pages= 56-9 | pmid=871034 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=871034 }} </ref>
* Cellular infiltration predominantly with [[lymphocytes]] and [[plasma cells]].
* [[Petechial hemorrhages]] (epicardial hemorrhages are common)
* Epicardial infilteration of [[mononuclear cells]].
* [[Pericardial effusion]]
* coronary arteritis
===Lungs===
Common pulmonary presentation in leptospirosis are [[pulmonary congestion]] and [[hemorrhage]].<ref name="pmid13862141">{{cite journal| author=AREAN VM| title=The pathologic anatomy and pathogenesis of fatal human leptospirosis (Weil's disease). | journal=Am J Pathol | year= 1962 | volume= 40 | issue= | pages= 393-423 | pmid=13862141 | doi= | pmc=1949541 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=13862141 }} </ref><ref name="pmid871034">{{cite journal| author=Ramachandran S, Perera MV| title=Cardiac and pulmonary involvement in leptospirosis. | journal=Trans R Soc Trop Med Hyg | year= 1977 | volume= 71 | issue= 1 | pages= 56-9 | pmid=871034 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=871034 }} </ref><ref name="pmid9080878">{{cite journal| author=Nicodemo AC, Duarte MI, Alves VA, Takakura CF, Santos RT, Nicodemo EL| title=Lung lesions in human leptospirosis: microscopic, immunohistochemical, and ultrastructural features related to thrombocytopenia. | journal=Am J Trop Med Hyg | year= 1997 | volume= 56 | issue= 2 | pages= 181-7 | pmid=9080878 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9080878 }} </ref><ref name="pmid6790049">{{cite journal| author=Zaltzman M, Kallenbach JM, Goss GD, Lewis M, Zwi S, Gear JH| title=Adult respiratory distress syndrome in Leptospira canicola infection. | journal=Br Med J (Clin Res Ed) | year= 1981 | volume= 283 | issue= 6290 | pages= 519-20 | pmid=6790049 | doi= | pmc=1507945 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6790049 }} </ref>
* Alveolar infiltration by [[monocytes]] and [[neutrophils]].
* Hyaline membrane formation.
* Leptospires are seen within the [[endothelial cells]] in interalveolar septa, and also attached to capillary endothelial cells.
===Skeletal muscle===
* Focal [[necrosis]] of muscle fibers with infiltration of [[histiocytes]], [[neutrophils]], and [[plasma cells]].
===Brain===
* Perivascular cuffing is seen.

==References==
{{Reflist|2}}

File:Leptospirosis pathogenesis.jpg

2017-03-09T19:55:12Z

Venkata Sivakrishna Kumar Pulivarthi:

Leptospirosis physical examination

2017-03-09T19:15:32Z

Venkata Sivakrishna Kumar Pulivarthi: /* Physical Examination Findings */

__NOTOC__
{{Leptospirosis}}
{{CMG}};{{AE}}{{VSKP}}
==Overview==
==Physical Examination Findings==
<ref name="Budihal2014">{{cite journal|last1=Budihal|first1=Suman Veerappa|title=Leptospirosis Diagnosis: Competancy of Various Laboratory Tests|journal=JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH|year=2014|issn=2249782X|doi=10.7860/JCDR/2014/6593.3950}}</ref><ref name="pmid14902167">{{cite journal| author=BEESON PB, HANKEY DD| title=Leptospiral meningitis. | journal=AMA Arch Intern Med | year= 1952 | volume= 89 | issue= 4 | pages= 575-83 | pmid=14902167 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14902167 }} </ref><ref name="pmid1224630">{{cite journal| author=King SD, Urquhart AE| title=Laboratory investigations on four cases of leptospiral meningitis in Jamaica. | journal=West Indian Med J | year= 1975 | volume= 24 | issue= 4 | pages= 196-201 | pmid=1224630 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1224630 }} </ref><ref name="pmid9071036">{{cite journal| author=Silva MV, Camargo ED, Batista L, Vaz AJ, Ferreira AW, Barbosa PR| title=Application of anti-leptospira ELISA-IgM for the etiologic elucidation of meningitis. | journal=Rev Inst Med Trop Sao Paulo | year= 1996 | volume= 38 | issue= 2 | pages= 153-6 | pmid=9071036 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9071036 }} </ref>
=== Appearance of the Patient ===
* Patient present with [[irritability]] and [[restlessness]].

=== Vital Signs ===
* [[Hypotension]] and circulatory collapse.
* [[Tachypnea]]
* [[Tachycardia]]

=== Skin ===
* [[Macular]], [[maculopapular]] [[erythematous]] skin eruptions are seen in the [[face]] and [[trunk]].
* [[Purpura]] due to [[thrombocytopenia]].

=== HEENT ===
* Icteric [[sclera]] is seen in patients with icteric leptospirosis
* Conjunctival suffusion: a charecterestic finding seen in patients with anicteric leptosirosis. Usually bilaeral and involving palpebral [[conjunctiva]].
* Conjunctival hemorrhages: may be unilateral or bilateral.

=== Neck ===

=== Lungs ===
* [[Crepitations]] common in basal regions

=== Heart ===

=== Abdomen ===
* [[Right upper quadrant]] [[Tenderness (medicine)|tenderness]]

* [[Hepatomegaly]]

=== Genitourinary ===

=== Extremities ===
* [[Edema]] of the [[extremities]]
* [[Cool extremities|cold clammy extremities]]

=== Neuromuscular ===
Signs of [[meningitis]] such as [[neck stiffness]], [[nuchal rigidity]] are present.

Other signs include:
* [[Nystagmus]]
* [[Spasticity]]

==References==
{{reflist|2}}

[[Category:Infectious disease]]
[[Category:Diseases]]

Leptospirosis history and symptoms

2017-03-09T18:58:44Z

Venkata Sivakrishna Kumar Pulivarthi: /* Other Symptoms */

__NOTOC__
{{Leptospirosis}}

{{CMG}}; {{AE}}{{VSKP}}
==Overview==
Clinical symptoms of leptospirosis are very wide, with mild anicteric presentation at one end to severe leptospirosis with severe [[jaundice]] and multiple organ involvement. Classic presentation of leptospirosis is a biphasic illness, and the onset of Symptoms within 2–30 days (incubation period) of exposure to the bacteria. Serious symptoms may manifest earlier on Days 4–6 of the illness depending on the type of pathogen and host immunological status.<ref>{{cite book | last = Faine | first = S | title = Guidelines for the control of leptospirosis | publisher = World Health Organization Obtainable from WHO Publication Centre USA | location = Geneva Albany, N.Y | year = 1982 | isbn = 924170067X }}</ref>
==Symptoms==
In humans, Leptospirosis can cause a wide range of symptoms, including:<ref name="pmid5319290">{{cite journal| author=Heath CW, Alexander AD, Galton MM| title=Leptospirosis in the United States. Analysis of 483 cases in man, 1949, 1961. | journal=N Engl J Med | year= 1965 | volume= 273 | issue= 17 | pages= 915-22 concl | pmid=5319290 | doi=10.1056/NEJM196510212731706 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=5319290 }} </ref><ref name="pmid9084999">{{cite journal| author=Perrocheau A, Perolat P| title=Epidemiology of leptospirosis in New Caledonia (South Pacific): a one-year survey. | journal=Eur J Epidemiol | year= 1997 | volume= 13 | issue= 2 | pages= 161-7 | pmid=9084999 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9084999 }} </ref>
===Common Symtoms===
* [[Fever]]: Moderate to severe fever with [[chills]].
* [[Myalgia]]: Characterestic of leptospirosis due to involvement of [[Calf (anatomy)|calf]], abdominal & lumbosacral muscles.
* [[Red eyes]]
* [[Headache]]: usually throbbing or retro-orbital headache not relieved by [[analgesics]]
* [[Cough]] & [[chest pain]] seen in patients involving [[lungs]]
* [[Nausea and vomiting]]
* [[Jaundice]]

===Less Common Symptoms===
* [[Abdominal pain]]
* [[Diarrhea]]
* [[Rash]]

== Clinical Presentation ==
{| border="1"
|+
! colspan="1" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF|Acute phase}}
! colspan="3" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF|Immune phase}}
|-
| rowspan="3" |
* Also known as Septicemic phase.
* Begins abruptly.
* Characterized by nonspecific signs such as [[fever]], [[chills]], [[headache]] and conjunctival suffusion.
* Associate with severe [[myalgia]].
* Other less common findings include: [[Photophobia]], [[lymphadenopathy]], [[abdominal pain]], [[nausea]], [[vomiting]], a transient [[rash]], [[sore throat]], [[coughing]] or [[chest pain]].
* Characterestic of this phase also includes: symptoms lasts several days to a week, which is followed by a brief remission, during which the temperature drops and the symptoms disappear.
| colspan="3" |
* It is also known as leptospiruric phase.
* Circulating ([[IgM]]) antibodies are produced and leptospires are present in the [[urine]]
* Characterestic findings that differentiate from other febrile illnesses are [[myalgia]] and conjunctival suffusion.<ref name="pmid22843698">{{cite journal| author=Forbes AE, Zochowski WJ, Dubrey SW, Sivaprakasam V| title=Leptospirosis and Weil's disease in the UK. | journal=QJM | year= 2012 | volume= 105 | issue= 12 | pages= 1151-62 | pmid=22843698 | doi=10.1093/qjmed/hcs145 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22843698 }} </ref>
* Myalgia often involves in [[Calf muscle|calf]] muscles, less commonly involves abdominal and paraspinal muscles.
|-
! colspan="1" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF| Anicteric leptospirosis}}
! colspan="1" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF| Icteric leptospirosis}}
! colspan="1" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF| Severe leptospirosis}}
|-
|
* More common but serious illness is uncommon.
* Most of cases present either subclinical or of very mild severity.
* Few cases present with a febrile illness of sudden onset.
* Other symptoms include [[chills]], [[headache]] (severe with retro-orbital pain and [[photophobia]]), [[myalgia]], [[abdominal pain]], conjunctival suffusion, and skin [[rash]] (transient and last <24 hours).
* May progress to [[aseptic meningitis]] in ≤25% of patients and more common in younger age group than the patients with icteric leptospirosis.
* Mortality is very less when compared to icteric leptospirosis.
|
* Rapidly progressive and severe form of leptospirosis
* Less common form of leptospirosis with incidence of 5%-10%.
* [[Jaundice]] is not associate with hepatocellular injury, eventually [[Liver function tests|LFT]] returns to normal after recovery.
* High mortality rate with a range of 5%-15%.
|Sever form of leptospirosis with organ failure including [[liver]] and [[kidney]]

involvement is known as [[Weil's disease]].
* [[Hepatic]]: Mild to severe form of [[jaundice]] developed within 4-7 days after the initial clinical presentation that can progress to [[hepatic failure]] or [[hepatic encephalopathy]].
* [[Renal]]: Very common presentation involving [[kidneys]] is [[acute interstitial nephritis]], with cola colored urine, [[oliguria]] or [[anuria]].
* [[Pulmonary]]: Milder form of leptospirosis presents with [[cough]], [[chest pain]] and blood tinged sputum, where as in severe form present with [[cough]], [[hemoptysis]], rapidly increasing [[breathlessness]] which may lead to [[respiratory failure]] and death. Hemorrhagic [[pneumonitis]] with [[interstitial]] and intra alveolar [[hemorrhage]] is the commonest cause of death in leptospirosis with case fatality rate of 0%-15%.
* Cardiovascualar: [[Arrhythmias]] present with [[syncope]] and [[palpitations]].
* [[Nervous system]]: [[Meningitis]], [[encephalitis]], focal defecits, spasticity, paralysis, peripheral neuropathies, nerve palsies and radiculopathies.
|}

==References==
{{Reflist|2}}

[[Category:Disease]]
[[Category:Infectious disease]]

Leptospirosis history and symptoms

2017-03-09T18:58:14Z

Venkata Sivakrishna Kumar Pulivarthi: /* Clinical Presentation */

__NOTOC__
{{Leptospirosis}}

{{CMG}}; {{AE}}{{VSKP}}
==Overview==
Clinical symptoms of leptospirosis are very wide, with mild anicteric presentation at one end to severe leptospirosis with severe [[jaundice]] and multiple organ involvement. Classic presentation of leptospirosis is a biphasic illness, and the onset of Symptoms within 2–30 days (incubation period) of exposure to the bacteria. Serious symptoms may manifest earlier on Days 4–6 of the illness depending on the type of pathogen and host immunological status.<ref>{{cite book | last = Faine | first = S | title = Guidelines for the control of leptospirosis | publisher = World Health Organization Obtainable from WHO Publication Centre USA | location = Geneva Albany, N.Y | year = 1982 | isbn = 924170067X }}</ref>
==Symptoms==
In humans, Leptospirosis can cause a wide range of symptoms, including:<ref name="pmid5319290">{{cite journal| author=Heath CW, Alexander AD, Galton MM| title=Leptospirosis in the United States. Analysis of 483 cases in man, 1949, 1961. | journal=N Engl J Med | year= 1965 | volume= 273 | issue= 17 | pages= 915-22 concl | pmid=5319290 | doi=10.1056/NEJM196510212731706 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=5319290 }} </ref><ref name="pmid9084999">{{cite journal| author=Perrocheau A, Perolat P| title=Epidemiology of leptospirosis in New Caledonia (South Pacific): a one-year survey. | journal=Eur J Epidemiol | year= 1997 | volume= 13 | issue= 2 | pages= 161-7 | pmid=9084999 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9084999 }} </ref>
===Common Symtoms===
* [[Fever]]: Moderate to severe fever with [[chills]].
* [[Myalgia]]: Characterestic of leptospirosis due to involvement of [[Calf (anatomy)|calf]], abdominal & lumbosacral muscles.
* [[Red eyes]]
* [[Headache]]: usually throbbing or retro-orbital headache not relieved by [[analgesics]]
* [[Cough]] & [[chest pain]] seen in patients involving [[lungs]]
* [[Nausea and vomiting]]
* [[Jaundice]]

===Other Symptoms===
* [[Abdominal pain]]
* [[Diarrhea]]
* [[Rash]]

== Clinical Presentation ==
{| border="1"
|+
! colspan="1" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF|Acute phase}}
! colspan="3" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF|Immune phase}}
|-
| rowspan="3" |
* Also known as Septicemic phase.
* Begins abruptly.
* Characterized by nonspecific signs such as [[fever]], [[chills]], [[headache]] and conjunctival suffusion.
* Associate with severe [[myalgia]].
* Other less common findings include: [[Photophobia]], [[lymphadenopathy]], [[abdominal pain]], [[nausea]], [[vomiting]], a transient [[rash]], [[sore throat]], [[coughing]] or [[chest pain]].
* Characterestic of this phase also includes: symptoms lasts several days to a week, which is followed by a brief remission, during which the temperature drops and the symptoms disappear.
| colspan="3" |
* It is also known as leptospiruric phase.
* Circulating ([[IgM]]) antibodies are produced and leptospires are present in the [[urine]]
* Characterestic findings that differentiate from other febrile illnesses are [[myalgia]] and conjunctival suffusion.<ref name="pmid22843698">{{cite journal| author=Forbes AE, Zochowski WJ, Dubrey SW, Sivaprakasam V| title=Leptospirosis and Weil's disease in the UK. | journal=QJM | year= 2012 | volume= 105 | issue= 12 | pages= 1151-62 | pmid=22843698 | doi=10.1093/qjmed/hcs145 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22843698 }} </ref>
* Myalgia often involves in [[Calf muscle|calf]] muscles, less commonly involves abdominal and paraspinal muscles.
|-
! colspan="1" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF| Anicteric leptospirosis}}
! colspan="1" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF| Icteric leptospirosis}}
! colspan="1" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF| Severe leptospirosis}}
|-
|
* More common but serious illness is uncommon.
* Most of cases present either subclinical or of very mild severity.
* Few cases present with a febrile illness of sudden onset.
* Other symptoms include [[chills]], [[headache]] (severe with retro-orbital pain and [[photophobia]]), [[myalgia]], [[abdominal pain]], conjunctival suffusion, and skin [[rash]] (transient and last <24 hours).
* May progress to [[aseptic meningitis]] in ≤25% of patients and more common in younger age group than the patients with icteric leptospirosis.
* Mortality is very less when compared to icteric leptospirosis.
|
* Rapidly progressive and severe form of leptospirosis
* Less common form of leptospirosis with incidence of 5%-10%.
* [[Jaundice]] is not associate with hepatocellular injury, eventually [[Liver function tests|LFT]] returns to normal after recovery.
* High mortality rate with a range of 5%-15%.
|Sever form of leptospirosis with organ failure including [[liver]] and [[kidney]]

involvement is known as [[Weil's disease]].
* [[Hepatic]]: Mild to severe form of [[jaundice]] developed within 4-7 days after the initial clinical presentation that can progress to [[hepatic failure]] or [[hepatic encephalopathy]].
* [[Renal]]: Very common presentation involving [[kidneys]] is [[acute interstitial nephritis]], with cola colored urine, [[oliguria]] or [[anuria]].
* [[Pulmonary]]: Milder form of leptospirosis presents with [[cough]], [[chest pain]] and blood tinged sputum, where as in severe form present with [[cough]], [[hemoptysis]], rapidly increasing [[breathlessness]] which may lead to [[respiratory failure]] and death. Hemorrhagic [[pneumonitis]] with [[interstitial]] and intra alveolar [[hemorrhage]] is the commonest cause of death in leptospirosis with case fatality rate of 0%-15%.
* Cardiovascualar: [[Arrhythmias]] present with [[syncope]] and [[palpitations]].
* [[Nervous system]]: [[Meningitis]], [[encephalitis]], focal defecits, spasticity, paralysis, peripheral neuropathies, nerve palsies and radiculopathies.
|}

==References==
{{Reflist|2}}

[[Category:Disease]]
[[Category:Infectious disease]]