Leptospirosis

Leptospirosis is an illness that begins with flu like symptoms but can progress to meningitis, liver failure, kidney failure and death if untreated.

It is caused by the bacteria leptospira.

The bacteria are harbored by a variety of animals, most notably rats. Animals excrete the bacteria in their urine and contaminate soil and water. Humans contract the infection upon contact with these sources.

Where does it occur?

Leptospira bacteria are present worldwide, but are most common in tropical countries.

How is it transmitted?

Leptospira is transmitted primarily from infected water through contact with skin (cuts/abrasions/sores), mucous membranes (eyes/nose/lips) or swallowing of water. Rarely eating food contaminated with animal urine or breathing air dusted with urine can also result in transmission.

Is it contagious from person to person?

It is very rarely contagious from person to person, the bacteria is excreted in urine for weeks after infection.

What is the risk for travelers?

Travelers to tropical countries engaged in water activities like rafting, kayaking, canoeing and swimming are at risk for contracting leptospirosis. Nearly all cases in travelers have been in this setting. The risk is elevated during heavy rains and floods.

How soon after exposure will one develop symptoms?

One generally develops symptoms within a week of exposure, however symptoms can be seen anywhere from 48 hours to a month after exposure.

What are the signs and symptoms?

Symptoms develop with sudden onset of fever, chills, headache, severe muscle pain especially of lower legs/back and blood shot eyes. These symptoms last for 4-5 days and then subside for 1-2 days.

Subsequently the second phase of illness develops with evidence for multi-organ involvement with meningitis – headache, nausea, stiff neck, bleeding, skin rash, jaundice; progressing to liver, kidney and respiratory failure. This phase is associated with a 10% mortality and referred to as Weil’s syndrome.

Is there any treatment?

Antibiotics like Penicillin G and Doxycycline are effective. Good supportive care in the intensive care is essential.

Are there any lab tests to diagnose illness?

The leptospira bacteria can be cultured from blood and body fluids during the first 10 days of the illness. More commonly blood antibody tests (leptospiral IgM Ab) are done to diagnose illness.

What preventive measures can be taken?

Avoid fresh water activities in tropical countries.

If you are engaged in fresh water activities like kayaking, canoeing, rafting and swimming consider taking Doxycycline 200 mg once a week as preventive measure.

If you do develop symptoms start taking Doxycycline 100 mg twice a day and seek medical attention.

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