What is leptospirosis?

Leptospirosis is an infectious disease caused by a type of bacteria called a spirochete. Leptospirosis can be transmitted by many animals such as rats, skunks, opossums, raccoons, foxes, and other vermin. It is transmitted though contact with infected soil or water. The soil or water is contaminated with the waste products of an infected animal. People contract the disease by either ingesting contaminated food or water or by broken skin and mucous membrane (eyes, nose, sinuses, mouth) contact with the contaminated water or soil. Leptospirosis occurs worldwide, but it is most commonly acquired in the tropics. The U.S. Centers for Disease Control and Prevention states 100-200 cases of leptospirosis are reported each year in the United States, with about 50% of cases occurring in Hawaii. Although the incidence in the United States is relatively low, leptospirosis is considered the most widespread disease that is transmitted by animals in the world. A 2010 outbreak in Michigan caused serious illness in numerous pets, raising concern for the local human population. In 2009, typhoons hit the Philippines, causing a leptospirosis outbreak. The Philippines Department of Health then reported 1,887 cases of leptospirosis, which resulted in 138 deaths.

What are leptospirosis symptoms and signs?

Leptospirosis symptoms begin from two to 25 days after initial direct exposure to the urine or tissue of an infected animal. This can even occur via contaminated soil or water. Veterinarians, pet shop owners, sewage workers, and farm employees are at particularly high risk. People participating in outdoor sporting activities like canoeing, rafting, hiking, and camping can also come into contact with contaminated water or soil. The illness typically progresses through two phases:

The first phase of nonspecific flu-like symptoms includes headaches, muscle aches, eye pain with bright lights, followed by chills and fever. Watering and redness of the eyes occurs and symptoms seem to improve by the fifth to ninth day. The second phase begins after a few days of feeling well. The initial symptoms recur with fever and aching with stiffness of the neck. Some patients develop serious inflammation of the nerves to the eyes, brain, spinal column (meningitis), or other nerves. Right upper area abdominal pain may occur. Less common symptoms relate to disease of the liver, lungs, kidneys, and heart.

Leptospirosis associated with liver and kidney disease is called Weil's syndrome and is characterized by yellowing of the eyes (jaundice). Patients with Weil's syndrome can also develop kidney disease and have more serious involvement of the organs affected.

How is leptospirosis diagnosed?

The diagnosis of leptospirosis is made by culture of the bacterial organism Leptospira from infected blood, spinal fluid, or urine. However, many doctors must rely upon rising Leptospira antibody levels in the blood in order to make the diagnosis, as the technique required to perform the culturing is delicate and difficult.

How is the treatment for leptospirosis? What is the prognosis for leptospirosis?
The treatment of leptospirosis involves high doses of antibiotics. Antibiotic treatment (doxycycline [Vibramycin, Oracea, Adoxa, Atridox], penicillin) is most effective when initiated early in the course of the illness. Severely ill patients may need hospitalization for IV fluid and antibiotic treatment. Severe liver and kidney manifestations of the infection may require intensive medical care and sometimes dialysis treatment. However, even in severe cases, liver and kidney function often does return after recovery from the illness. Mortality rates for severe illness with leptospirosis can range from 5%-40%, depending on the severity of organ dysfunction and the patient's general health prior to infection. Most previously healthy patients have a good prognosis and will make a full recovery.

Can leptospirosis be prevented with a vaccine?

A vaccine for leptospirosis is available and used in some countries in Europe and Asia. It must be given every year like a flu shot. A longer-acting vaccine is being investigated in Cuba. It is not currently available in the United States. Travelers who are going to an area where leptospirosis is common and who will be engaged in activities that increase likelihood of exposure can take 200 mg of doxycycline per week by mouth starting before and during the time period of potential exposure. According to the Leptospirosis Information Center, there are no drug-resistant strains of the bacteria at this time. Leptospirosis was a reportable disease in the United States, but it was removed from the national CDC list of reportable diseases. It is, however, still reportable in some states, most notably Hawaii.

THE number of leptospirosis cases and deaths is increasing, weeks after floods brought by torrential rains hit Metro Manila and nearby provinces, the Department of Health (DOH) said on Friday.

Dr. Eric Tayag, assistant health secretary and spokesman, told reporters that 783 new leptospirosis cases with 38 deaths were recorded in 20 hospitals in Metro Manila. Half were recorded in San Lazaro Hospital in Manila. He also said that the DOH is expecting 50 leptospirosis cases and other flood-related cases to be brought to hospitals each day. The number of Leptospirosis cases in the country have reached 2,374, with 121 deaths recorded from January to August 11. This is 70.18 percent higher compared to the 1,395 cases recorded during the same period last year, according to the National Epidemiology Center. DOH said that most of the cases were from Region X (Northern Mindanao) with 38.8 percent; Region VI (Western Visayas), 18.7 percent; National Capital Region, 7.8 percent. Ages of those afflicted were ranged from less than two months to 93 years old (median=28.25 years). Majority (79 percent) of the cases reported were male, while most (28.2 percent) of the cases belonged to the 21 to 30 years age group. Tayag said that the Health department already conducted an emergency meeting with hospitals in Metro Manila to assess their capability as some hospitals are running out of beds not solely due to leptospirosis cases but also to the upsurge of dengue, pneumonia and other illnesses prevalent during the rainy season. Leptospirosis is an infection commonly transmitted to humans from floodwater and mud contaminated by animal urineusually from ratsand comes in contact with lesions in the skin, eyes, or the mucous membranes. The bacteria usually find their way through abraded skin or even minor cuts. It appears four to 14 days after exposure. DOH warned that although leptospirosis has a low fatality rate, it increases with age and may reach 20 percent or more in patients with jaundice and kidney damage. Symptoms include fever, chills, and intense headache. In extreme cases, complications like meningitis, renal failure, and respiratory distress may arise and lead to death. The Health department advised those who waded in floodwaters to watch out for signs and symptoms and bring themselves for a medical checkup.