Hypoprothrombinemia

During the month of June and August 2000, two children were admitted in the paediatric ward of Holy Family Hospital These children were in the age group of 7-- 8 years with the following complaints:

For twenty days previous to their admission to the hospital, they were having fever, loss of appetite, pain in abdomen, vomiting and loose motions, deep yellow coloured urine, yellowish discolouration of skin and eyes and also had breathing difficulty. Both children were treated for 15-17 days and finally diagnosed as Leptospirosis.

LEPTOSPIROSIS: Leptospirosis is a generalized infection of man and animals caused by spirochetes of the genus leptospira. Two types of leptospirosis present, Anicteric leptospirosis and Icteric leptospirosis.

EPIDEMIOLOGY: Leptospirosis is a zoonosis of worldwide distribution. Leptospirosis infects many species of wild and domestic animals that have been isolated from birds, fish and reptiles. The infected animals excrete spirochetes in urine for an extended period of time. The majority ofhuman cases world wide result from occupational exposure to rat contaminated water or soil. Occupational groups with a high incidence of leptospirosis include agricultural workers, persons who live or work in rat infected environment, individuals involved in animal husbandry and laboratory workers.

PATHOPHYSIOLOGY-Leptospires enter human body through moist and preferably abraded skin or through,mucous membrane. Followingthe penetration of skin or mucous membrane leptospirosis circulate in the blood stream and spread to all organs of the body. The primary lesion causes damage to the endothelial lining of small blood vessels which results in ischemic damage to the liver, kidney, meninges and muscles.

After an incubation period of 7-12 days,, an initial septicemic phase, leptospires can be isolated from the blood; cerebrospinal fluid and other tissues. Initial symptoms: last for 2-7 days and a second symptomatic or immune phase begins. The immune phase is associated with the appearance of circulating antibodies, despite the presence of these antibodies still leptospires can be found in kidney and urine.

PROGNOSIS

Leptospirosis anicteric is generally a self limiting disease lasting up to 1 to 3 weeks and even a,relapse may occur. Mortality role may reach upto 20% or more in elderly patients who lave severe kidney and hepatic involvement.

COMPLICATIONS

Azotemia, Oliguria, Jugular venous distention. Orthostatic changes in blood pressure, Haemorrhage, Purpura, Hemolysis, Gastrointestinal bleeding, Hypoprothrombinemia and Thrombocytopenia

MEDICALMANAGEMENT

Leptospira are sensitive to Penicillin, Tetra, cyclin and Erythromycin.

1. Treatment within first few days of illness may reduce the severity of disease but has little effect if started later on.

2. These antibiotics are usually given for 10 days.

3. Symptomatic and supportive care is initiated particularly for renal and hepatic failure.

These two children were treated with following medicines:

Inj. Gentamycin 50 mg BD

Inj. Ceftriaxone 1.5 gm BD

Inj. Crystalline Penicillin 6.5 lac BDx 10 days

Inj. Metrogyl 150 mg TDS

Inj. Rantac 20mg BD

Cap. Amplicillin 250mg BD

Tab. Udlin 150mg

Tab. Aldactone 25mg

NURSING MANAGEMENT

1. Monitoring of strict fluid intake and output.

2. Promptly report the occurence of dyspnea oliguria or haemorrhage.

3. Severely ill patients should be nursed in propped-up position to lessen the risk of secondary pulmonary complications.

4. Patients with vomiting should be managed by I/V fluids and electrolyte replacement.

5. Daily weight and abdominal girth should be taken for the patients with ascitis.

PREVENTION

* Avoid the use of contaminated water and soil,

* Use rodent control measures.

* Immunization of dogs and other domestic animals and birds.

* Good environmental sanitation

* Immunization/antimicrobial prophylaxis with doxycycline.may be,of value to certain high risk occupational groups

REFERENCES

- Behrman Richard E. and Kliegman Robert M. "Nelson Text Book of Paediatrics." 14th Edition. Philadelphia, W.B. Saunders Co. 1992. Pp 781 - 783.

- Ameil's and Forfar. "Text Book of Paediatric. %th Edition, Great Britain. Wiliam Cloves Ltd. 1992. Pp 1367-1368

- William Hathaway E. and Groothvis Jessie R. "Current Paediatric Diagnosis and Treatment "lth Edition. Singapore, Divsion of Prentice Hall. 1987. Pp 895.896

Authors: 2nd Year GNM Students, Holy Family Hospital, Okhla, New Delhi. [at the time of writing this article]

Copyright Trained Nurses' Association of India Jul 2002
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