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Leptospirosis

Introduction

Leptospirosis is an infectious disease which occurs worldwide. It is more common in tropical and sub tropical areas. It is a zoonotic illness which means that organisms are transmitted directly or indirectly from animals to humans. Leptospirosis characteristically occurs during rainy weather or flooding. Between 1000 to 2000 patients are admitted to hospitals to take medication for rat fever on a yearly basis. Incidence is highest among the [rice] paddy farmers.

According to Dr. Jayantha Rajapakse of faculty of Veterinary Medicine and Animal Science – University of Peradeniya, in Sri Lanka a total of 10,000 cases have been reported and nearly 500 people have died. Most likely the disease is under- diagnosed because of the non specific initial presentation and difficulties in laboratory diagnosis. Most number of patients detected as suffering from leptospirosis are from Matara district. Also Gampaha and Kegalle districts have recorded a higher incidence.

Causative agents

Pathogenic bacteria called leptospires. They are found in the kidneys of certain animals such as rodents like rats and bandicoots, canines, livestock, and wild mammals.

Pathogenesis/Actions in the body

It is transmitted to humans by exposure of abraded skin or mucous membranes (nasal, oral or eye) to water or wet soil or food and water that has been contaminated by urine from asymptomatic chronically infected animals, especially rodents. After infection the organisms enter the blood and invade all tissues and organs. Patient can develop symptoms about 1 – 2 weeks following exposure.

Symptoms and signs

Initial symptoms are abrupt onset of fever, chills, muscle pain especially in calf muscles and back, headache, cough, nausea, vomiting and diarrhea. Characteristically conjunctival suffusion i.e. red eyes and tenderness of muscles occur.

The 2nd phase of disease occurs after a short period of relative wellbeing which is due to immunological response to the infection. They can present with aseptic meningitis (Inflammation of brain coverings), myocarditis (Inflammation of heart muscles), pneumonia (Inflammation of lungs), nephritis (Inflammation of kidneys) and hepatitis (Inflammation of liver) with jaundice (yellow eyes). More than 90% of patients have a self limited illness but some develop severe disease with kidney and liver failure.

Complications

Kidney failure, heart failure and wide spread haemorrhage (bleeding) are the main causes of death. Rarely liver failure contributes. Case fatality rate is reported to range from 5 – 30% according to data from Epidemiology unit.

Management

High index of suspicion is essential to diagnose especially if there is a occupational and recreational exposure. Confirmation is mainly by detecting anti bodies.
Leptospirosis is a potentially serious but treatable disease. Treatment with effective antibiotics should be initiated as soon as the disease is suspected without waiting for laboratory results. Supportive care with strict attention to fluid and electrolyte balance is essential. Dialysis is indicated in renal failure.

Prevention and promotion

If you are involved in occupations such as farming, mining, cleaning drains and canals etc. please inform your area MOH or PHI. They will explain how to prevent you getting the disease. The following specific measures can help to prevent leptospirosis.

  • Keeping areas around human habitation clean to control rodents
  • Keep animals away from gardens, playgrounds and other places where children play
  • Where there can be recreational and occupational exposure, protective clothing, knee-high boots, gloves etc should be worn and wounds covered with waterproof dressing
  • Use boiled and cooled water to drink. Never drink stagnant water directly from rivers and lakes
  • Avoid walking in flood water
  • Doxycycline has been reported to give some protection against infection and disease

 

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