Introduction
Leptospirosis is a zoonosis with global distribution. Acute kidney injury and hepatic impairment are the main clinical signs in severe cases. Such cases often require prolonged hospitalization and nursing, whilst undergoing renal replacement therapy (RRT). Strict vigilance by nursing staff is essential to minimize zoonotic risk to staff, and risk of nosocomial infections associated with patient instrumentation.
Synopsis
A 1.7 kg 6-month-old intact male spitz was presented with a 2-day history of lethargy, anorexia and vomiting. Blood tests revealed severe azotemia, moderate hyperphosphatemia and mild hypoglycemia. Electrolytes and a complete blood count were within reference range. Witness Lepto® test was positive.
Peripheral venous catheter, indwelling closed-collection urinary catheter and nasogastric tube were placed, and urine output-matched fluid therapy, antimicrobials, enteral feeding, and antiemetics were commenced. Worsening azotemia and oligoanuria prompted central venous catheter (CVC) placement for RRT. Improvement in clinical and laboratory parameters followed 3 RRT sessions, and following return of voluntary appetite the dog was discharged on day 10.
The multi-instrumented patient presented here required high-level nursing care to minimize complications. Consequently, strict protocols were vital to protect staff from zoonotic risk.
Particular care was performed to limit direct contact between staff members and other ICU patients and bodily fluids of the leptospirosis dog. Upon admission, this dog was handled with gloves as he had clinical signs consistent with leptospirosis, with special care when dealing with urine and blood. Confirmation of the zoonotic disease required a specific nursing care plan to prevent bodily fluid contact when managing the closed urinary collection system, discarding urine from the collection bag, performing daily care of peripheral and central catheters, and handling all blood samples.
Conclusion
The nursing requirements of dogs with leptospirosis undergoing RRT increases risk for zoonotic transmission and instrument-related patient infections. Special caution with protocolized nursing care is vital to minimize such risks. I will present our approach to these patients in this presentation.
E-mail: claire.ravachol@vetagro-sup.fr