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Leptospirosis

Leptospirosis is caused by the bacteria leptospira, classified as spirochetes because of their spiral or coiled shape.

Leptospirosis is also called waterborne fever or mud fever. It is a common disease especially in tropical countries like the Philippines. World Health Organization estimates show that every year, there are more than 800,000 cases worldwide, with more than 48,000 deaths. In the Philippines, there is an average of 680 cases and 40 deaths from the disease every year. It peaks during the months of July to October.

Last July 5, the Department of Health declared a leptospirosis outbreak in some parts of Manila since the number of cases is higher than the average in the last five years. At least 234 cases have been reported since January compared to 146 cases during the same period in 2017.

Leptospira infects wild and domestic animals, especially rats, cattle, swine/pigs, dogs, horses, sheep, and goats. Infection in these animals may be mild but it can also lead to abortion or death. Infection rarely occurs in cats.

Rodents are the most important carriers and source of infection for humans. Infection occurs in wild or domestic rats during their infancy and once infected, they shed leptospira in their urine, leading to contamination of the environment, particularly water. Leptospira can stay alive for days to months in soil and water.

Human infection results from exposure to animal urine, contaminated water or soil, or infected animal tissue. Points of entry include cuts or abrasions in the skin, mucous membranes, or conjunctivae of the eyes. It may also be acquired by ingestion of food contaminated with urine or aerosols.

Increased rainfall or flooding increases human exposure to contaminated water. Among infected pregnant women, leptospira can pass through the placenta and infect the baby. Spontaneous abortion, death of the fetus, or active infection in the infant can occur.

Infection in humans develops two to 26 days (average of 10 days) after exposure. It can vary from mild and self-limiting to severe and fatal. Illness usually presents with sudden onset of fever, chills, muscle pains, and headache. So-called conjunctival suffusion and subconjunctival hemorrhage (presenting as redness of the eyes) are findings that occur in more than half of patients with leptospirosis.

Other signs and symptoms are cough, nausea and vomiting, and loose bowel movement, pain in the muscles, sore throat, swelling of lymph nodes (kulane), skin rashes, and abdominal pain.

Leptospira harms the body through direct invasion of body tissues or through immune reaction immune reaction elicited in the infected person. Meningitis, which is the inflammation of tissues that cover the brain, is thought to be due to immune reaction but in some cases leptospira particles were present in the fluid that bathes the brain.

Leptospirosis may lead to a combination of liver inflammation and kidney failure.

Weil’s Disease is a severe form of disease. Bleeding in the lungs, acute inflammation of the lungs or heart can also occur.

It is anticipated that leptospirosis will continue to be a health problem in the country because of rapid urbanization, deforestation, poor sanitation, and typhoons.

Preventive measures include the following:

Stay away from water or soil that might be infected like ponds, lakes where water does not move; avoid water that could have animal waste in it like flood water or water from farms.

Keep rats and mice away from the house or yard. Do not touch rats or mice.

Keep food and drinks away from animals.

Early medical consult is advised if leptospiral infection is suspected.

(Sources: Philippine College of Physicians Data and Guidelines, Philippine Society of Nephrology Data and Guidelines, Department of Health, and UptoDate)

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Medical questions or concerns may be emailed to baguiomidlandcourier@yahoo.com or yourmedicalcorner@yahoo.com

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