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Situations that interfere with the normal flow of urine predispose to urinary system infections. Bladder infections are common, especially in women, caused by bowel bacteria ascending from the urethra. Pyelonephritis is a feared complication. Leptospirosis is a widespread zoonosis spread by urine, in which the kidneys are infected from the bloodstream. Usually

Table 25.2 Leptospirosis

© Wafer or animal urine contaminated with Leptospira sp. splashes onto mucous membrane or abraded skin

(2) The bacteria infect the bloodstream and are carried throughout all the body tissue causing fever, intense pain

(3) Symptoms subside and bacteria disappear from blood and tissues, except kidneys

(?) Symptoms recur associated with severe damage to liver and kidneys

(§) Complete recovery occurs if kidney failure can be effectively treated

(6) Excretion of Leptospira continues in urine i © ' ©

Symptoms Many mild and asymptomatic cases.

Others have a biphasic illness: spiking fever, headache, muscle pain, bloodshot eyes in the first (septicemic) phase, then

1 to 3 days of improvement; second (immune) phase has recurrence of severe symptoms with heart, brain, liver, and kidney damage

Incubation period Usually about 10 days (range,

Causative agent Leptospira interrogans, a cultivable spirochete with many serotypes

Pathogenesis The bacteria penetrate mucous membranes or breaks in the skin, multiply in the bloodstream, and are carried to all parts of the body. Severe pain with penetration of body tissues, but little or no tissue damage. Immune phase: damage to cells that line small blood vessels and clotting of blood. Causes severe damage to the liver, kidneys, heart, brain, and other organs

Epidemiology Worldwide distribution. Wide range of animal hosts chronically excrete the bacteria in their urine, causing contamination of natural waters and soils. Organisms remain infectious for long periods of time under warm, moist, neutral or alkaline conditions.

Prevention and Avoid contact with animal urine.Vaccines treatment prevent disease in domestic animals, may not prevent urinary carriage. Tetracycline antibiotics preventive in epidemics.Various antibacterial medications useful in treatment of leptospirosis, but only if given early in the disease. Symptoms often worsen transiently with effective treatment due to the massive release of leptospiral antigens

25.4 Non-Venereal Genital System Diseases 639

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