What you should know about leptospirosis

LEPTOSPIROSIS is probably the most common infection humans can get from animals and is endemic in many tropical countries, including the Philippines. Illness follows exposure to wet environments contaminated with urine from infected animals, mostly rodents, livestock, or even pets.

“The bacteria can affect us even during summer,” medical doctor Irineo Bernardo, former president of the Philippine Medical Association (PMA), said.

“Dried urine of an infected rodent can affect us especially if the contaminated food is not exposed to direct sunlight. It is important therefore that preventive measures are in place especially when there is the exposure of food or drinking water to infected animals like rodents and other carrier animals,” he said.

Sewer workers, miners, veterinarians, farmers, and people wading through flood waters near creeks and urban waste, and people whose occupation exposes them to animals like rodents, are the usual victims.

Stories on numbers

As of June this year, Department of Health (DOH) records show the Top 5 regions with the highest reported cases of leptospirosis were Western Visayas (Region 5) with 227 cases, Caraga with 170, Metro Manila with 94, Davao Region (Region 11) with 87, and Zamboanga Peninsula (Region 9) with 81.

In 2009, over 2,000 cases with 178 deaths were reported in the weeks following Tropical Storm Ondoy, which resulted in overcrowding in many hospitals in Metro Manila.

“The experience from this outbreak lead to strengthening of hospital services networking and referral and improving the standards of care to save more patients, including new guidelines for the prevention, diagnosis, and treatment of leptospirosis and research studies to describe the epidemiology of human and animal infections in the Philippines,” said DOH Assistant Secretary Eric Tayag.

Truth about the illness

Bernardo said leptospirosis is an infectious disease caused by a bacteria that resembles a screw, spiral, or a spring, which is why it is considered a “spirochetes.”

“There are two species known in the Philippines by the medical community. The Leptospira Interrogans and the Leptospira i ct er oh a em oragica,”h es aid.

“Humans get infected through contact with the mucosal surfaces of their body like the mouth, lips, or by ingestion, or through breaks in the skin like wounds, abrasions, or infected skin diseases,” Bernardo added.

“It thrives in the body fluids, urine of infected animals, not necessarily rats although many blame exposure to the urine of rodents as the main source,” he further said.

Signs and symtoms

The bacteria penetrates the skin or mucous membrane of the person. After that, the microorganism or “leptospires” invades the blood stream and spreads throughout the body. Those infected can have low grade fever at first but the fever becomes very high with chills as the leptospires multiply and spread throughout the body.

“The pathogenicity of leptospirosis is the result of the enzymes, toxins [endotoxins] and other metabolites released by the lysed spirochetes. Studies show that the destruction of the body capillaries is the result of mechanisms related to the release of toxins. With the destruction of the capillaries, hemorrhage follows but this hemorrhage is limited to the skin or mucosal surfaces,” Bernardo said.

The high fever and symptoms are referable to damaged organs involving the liver, the kidneys, lungs, and even the brain.

“Interestingly, predominantly males are exposed and brought down with illness,” said Tayag.

Bernardo added that in severe cases, death may follow from massive gastrointestinal bleeding or hemorrhage, affecting vital organs like the kidneys.

“Yellowish discoloration of the skin or the sclera of the eyes are noted in severe infections. When the urine is examined, the presence of albumin or albuminuria is noted. Even changes in the liver are noted with abdominal discomfort that is why inexperienced physicians sometimes thought that it is a form of hepatitis or an infectious liver disease,” he added.

The manifestation of the disease will depend on the exposure and the spread of the disease in the body of the person. The signs and symptoms could be fast but once renal and hepatic manifestations occur, the damage to the body might be very difficult to cure and treatment might last for a lifetime, especially when the function of a vital organ or organs have been compromised.

Further absolute symptoms and cures

Most infections are without symptoms, the reason why it is underreported or not recognized immediately. The usual illness manifests in as short as five days and up to 14 days after exposure. Illness may also last up to a month.

“Aside from high fever, one suspects of illness when this is accompanied by headaches, chills, muscle pains especially in the calf and lower back areas, eye redness without discharges, abdominal pain, loss of appetite, nausea, and vomiting. Severe symptoms occur and can include liver failure with the skin turning yellow [jaundice] or putting out tea-colored urine, kidney failure, cough with bloody sputum, irregular heart rate, severe headache with delirium. These complicate course of illness can lead to high death rates,” Bernardo said.

Long-term complications can occur months or years after illness on very rare occasions. There is uveitis or inflammation of the middle area of the eye than can lead to permanent blindness, expert said.

Although antibiotics currently recommended as treatment of choice include penicillin given by intravenous route or third generation cephalosporins, and oral doxycycline for mild cases. However, it is still highly recommended that treatment be started very early after onset even without blood testing.

Kidney failure from leptospirosis can be reversed after dialysis. Pulmonary complications can benefit from extra corporeal membrane oxygenation to obviate prolonged use of ventilators.

Prevention and mitigation

Maintaining a clean environment and avoiding exposure to water that may harbor the bacteria causing leptospirosis is still the best measure to avoid getting the disease.

“Protective footwear such as boots limit exposure to contaminated flood waters where individuals usually wade to continue with their daily activities. Footbridges prevent exposure. Swimming in flood waters is not a good idea as swallowed water can be a vehicle for the exposed mucosa,” Tayag said.

When floods subside longer and exposure is unavoidable, some doctors will recommend several doses of oral doxycycline to reduce risk of infection though the medicine cannot be given to pregnant women or young children because of possible side effects.