Leptospirosis

Doc, can I be infected with Leptospirosis by just wading through the floodwaters? Leptospirosis is a disease that is caused by pathogenic spirochetes of the genus Leptospira, often acquired by human via contact with fresh water contaminated by rat, bovine, or canine urine. The disease is also acquired during adventure travel or vacations that involve water sports or hiking, or even as a consequence of flooding (by wading through floodwater) which is the usual case here in the Philippines. Pathogenic spirochetes is passed via infected animals urine (commonly rats in flooded places) which penetrates broken skin, wounds, mucus membranes and even conjunctiva.Persons at high risk are primarily those expose to fresh water flooding , rescuers during flood calamities, workers working in flooded construction sites, fresh water activities like farming, hiking and swimming across streams.Sign and symptoms of persons infected with Leptospirosis follows a 7-12 day incubation period, wherein in 90% of cases are Anicteric Leptospirosis . High fever( Temperature > 38 centigrade), headache, muscle pain, conjunctivitis(red eyes), skin rash are the most common complaints. Patients may also exhibit hepatomegaly and splenomegaly.In the other 10% of cases, persons may suffer a more severe Icteric Leptospirosis (Weil's Syndrome) wherein there is usually fever , jaundice(yellow skin),icteric sclera, hypotension, azotemia, hemorrhagic vasculitis.The PSMID or Philippine Society for Microbiology and Infectious Diseases, Inc. came out with antibiotic chemoprophylaxis that may be given to persons at risk.A) LOW RISK individuals are those with a single history of wading in flood or contaminated water and absence of wounds, cuts or open lesions of the skin.Doxycycline (hydrochloride or hyclate) at 2 capsules of 100 mg single dose within 24 to 72 hoursB) MODERATE RISK individuals are those with a single historyof wading in flood or contaminated water and the presence of wounds, cuts,or open lesions of the skin, OR accidental ingestion of contaminated water.Doxycycline (hydrochloride or hyclate) at 2 capsules of 100 mg OD for 3-5 days to be started immediately within 24 to 72 hours from exposure.C) HIGH RISK individuals are those with continuous exposure(defined as those having more than a single exposure or several days such as those residing in flooded areas, rescuers and relief workers) of wading in flood or contaminated water with or without wounds, cuts or open lesions of the skin. Swimming in flooded water and ingestion of contaminated water are also considered high risk.Doxycycline (hydrochloride or hyclate) at 2 capsules of 100 mg once weekly until the end of exposureIt should be emphasized that before taking such prophylaxis , the patient should consult a physician so that contraidications and side-effects of the drug be fully explained and also be it known that antibiotic prophylaxis are not 100% effective.The most effective preventive measure is avoid wading in floods and contaminated water and if this can not be avoided, wear boots, goggles, overalls and rubber gloves, and also wash with soap and water, and if possible apply disinfectant after exposure.Leptospirosis treatment is primarily with antimicrobial therapy and supportive treatments (eg. Paracetamol for fever). In uncomplicated infections that do not require hospitalization, oral Doxycycline has been shown to decrease duration of fever and most symptoms. Patients admitted in hospitals should be treated with intravenous penicillin G therapy.
Images from Google, DOH Website