Let's learn more about Leptospirosis - How to stay safe from it!

Today we are going to talk about a somewhat scary disease that is often talked about during the rainy season in our country. Have you heard of 'bee fever' ? That's what it is. But in medical terms, it is called Leptospirosis. So today, let's talk about what this is, how it is caused, what are the symptoms, and how to protect yourself from it.

What is Leptospirosis? In simple terms...

Leptospirosis is an infection caused by a type of bacteria called Leptospira. This bacteria can enter your body through a small scratch or cut on your skin, or through open areas like your eyes, nose, or mouth. Think of it like a burglar breaking into your house.

This is a zoonotic disease . This means that you can get the disease if you come into direct contact with the urine (we call it urine ) or fluids from the reproductive system of an infected animal, or if you ingest water, soil, or food contaminated with this bacteria.

Who is most at risk of developing this?

Actually, anyone in the world can get leptospirosis. However, it is more common in hot, tropical countries, especially in areas with good rainfall throughout the year . Our country, Sri Lanka, is one of them. So, if you live in such an area, or if you travel, the risk is higher.

Think about it this way:

• Farmers working in the fields , people working in the swamps.
• People who clean drain systems , municipal workers.
• People who work closely with animals on farms (animals like cattle, goats, pigs, and dogs).
• For those wading in dirty water during natural disasters like floods , and for relief workers.
• Sometimes, this risk can be present even when swimming in a river, canal, stream, or lake for fun , especially in places where the water is considered to be dirty, or when doing water sports (such as white water rafting). This risk is even greater during the rainy season and after flooding.

Even in America, this disease has spread after floods in states like Hawaii and Florida. So this is not something to be taken lightly.

How common is this disease? How is it among people?

Worldwide, it is estimated that more than a million people get leptospirosis each year . Of these , nearly sixty thousand die . This means that this is a potentially fatal disease. That is why it is important for us to be aware of this.

What are the stages of leptospirosis?

There are two main stages of leptospirosis.

1. Leptospiremic phase or acute phase:This is the first stage. This stage can begin two to fourteen days after the `Leptospira` bacteria enter the body. It usually lasts about three to ten days. During this time, the bacteria circulate in your blood and travel to your internal organs . A blood test at this time can show signs of infection. Some people may have mild symptoms like a fever during this time, while others may have no symptoms at all.

2. Immune phase (late phase): At this stage, the bacteria have already spread from the blood to your organs. This bacteria accumulates in the kidneys, especially in the kidneys . (The kidneys are like a filter in our body that cleans the blood). So, if you do a urine test at this time, you can find signs of the bacteria. You can also see antibodies against the `Leptospira` bacteria in your blood.

It is during this immune response that some people develop a serious condition called Weil's syndrome . This can cause serious complications such as internal bleeding, kidney damage, and yellowing of the eyes and skin (jaundice).

What are the symptoms of leptospirosis?

Some people experience mild symptoms like fever, while others have no symptoms at all. In severe cases, symptoms include internal bleeding and organ damage.

Symptoms that appear suddenly in acute leptospirosis:

• Having a high fever
• Redness of the eyes (conjunctival injection)
• Headache
• Chills ( feeling cold )
• Muscle aches
• Abdominal pain
• Nausea and vomiting
• Diarrhea
• Yellowing of the skin and eyes (Jaundice) - This is a sign that you should pay some attention to.
• A skin rash, a rash

Symptoms of severe leptospirosis ``Weil's syndrome'' (may appear 3-10 days after the initial symptoms begin):

• Coughing up blood (hemoptysis)
• Chest pain
• Trouble breathing
• Dark yellowing of the skin and eyes
• Black , tarry stool - This could be a sign of internal bleeding.
• Blood in the urine (hematuria)
• Decrease in urination
• Flat red spots on the skin, resembling a rash (petechiae)

If you have any of these severe symptoms, you should go to the hospital immediately .

Causes and spread of leptospirosis

As we mentioned earlier, leptospirosis is caused by a bacteria called `Leptospira`. This bacteria enters your body through your mouth, nose, eyes, or a break in your skin. It then travels through your bloodstream to your organs, especially your kidneys. The kidneys are where our blood is "cleaned".

The kidneys excrete waste products and toxins through urine. So, these bacteria in the kidneys also exit the body through urine. That's how leptospirosis is transmitted to another person or animal.

Most often, humans are infected with this disease through the urine of animals that have the `Leptospira` bacteria. Rats are the main carriers, which is why it is called `rat fever'. But not only rats, but any mammal such as dogs, cattle, horses, pigs can get this disease, and we can get it from them. Some animals may not show symptoms when they get the disease.

So, if you come into contact with water (paddy field water, sewage water, flood water) or soil contaminated with the urine of these animals, you can get sick. Simply:

• Direct contact with the urine or other body fluids of an infected animal.
• By getting contaminated water or soil into your eyes, nose, or mouth, or by touching a broken skin .

After heavy rains or floods, many people can develop this disease at once. As floodwaters flow, this bacteria accumulates in rivers, streams, and lakes.

The most important thing is that leptospirosis is very rarely transmitted from one person to another. This means that it cannot be transmitted by talking to or shaking hands with a sick person.

How is this disease diagnosed? (Diagnosis)

If you have symptoms of leptospirosis, a doctor will examine you and ask about your symptoms, where you've been (especially if you've been exposed to contaminated water), and what you do. Then, the following tests may be done:

• Blood and urine tests: A small amount of blood is taken from your arm, or a urine sample is taken, and the test is done to check for signs of the Leptospira bacteria.
• Imaging tests: If you have severe symptoms, your doctor may do a chest X-ray or CT scan . These can check for damage to your internal organs.

How is leptospirosis treated?

Doctors treat leptospirosis with antibiotics . If you have simple, mild symptoms, they may tell you to see if you get better without treatment, but you should keep an eye on your symptoms.

If you have severe leptospirosis (such as Weil's syndrome), you will definitely need to be hospitalized.Antibiotics are then given directly into the bloodstream through a saline solution (IV). Depending on which of your organs are affected, additional medications or treatments may be needed.

Drugs and methods used for treatment:

• Antibiotics: Antibiotics such as doxycycline, amoxicillin , ampicillin, penicillin-G, and ceftriaxone are used for this. The doctor will decide which medicine to give you based on how bad your condition is and your health history.
• Mechanical ventilation: If the infection has spread to your lungs and you are having difficulty breathing, you may need to be given a machine to breathe. During this time, you will be put to sleep.
• Plasmapheresis: Also called plasma exchange, this treatment can help people who are at risk of organ damage from leptospirosis. This involves taking your blood through a tube connected to a vein, using a machine to separate the plasma from your blood, replacing it with a plasma substitute, and then reinjecting the blood back into your body.

How to manage symptoms?

If you have mild symptoms, your doctor will tell you what to do to help relieve them. For fever and body aches, you can take over-the-counter pain relievers such as ibuprofen (e.g., Advil®, Motrin®) or acetaminophen (e.g., Tylenol®, Panadol®). But do not take any medication continuously without your doctor's advice .

How to protect yourself from leptospirosis? (Prevention)

There is currently no vaccine for this in the United States, and the same is true in our country. So, the best way to protect yourself from leptospirosis is to avoid swimming in or wading in water that may be contaminated with animal urine . Especially stay away from floodwaters.

Here are some other ways you can reduce your risk:

• Taking Prophylaxis: If you are traveling to a high-risk area or doing a high-risk job (e.g., flood relief work), ask your doctor if you can take a medication (e.g., doxycycline) to prevent the disease from developing.
• Stay away from animals that may have leptospirosis. Don't go anywhere where rats are.
• If you work with animals or are in an environment that involves animals, wear protective clothing and footwear (e.g., boots when going into the field).
• If you have to put your hands in water or soil that may be contaminated, wear protective shoes and clothing.
• Stop bathing and playing water sports in lakes, rivers, and streams after a flood.
• Drink only purified water. Do not drink water directly from lakes, rivers, or streams. At least boil it well and drink it.
• If you have to handle dead animals, wear gloves. Do not touch them with bare hands, and wash your hands thoroughly with soap afterward.
• Cover open wounds and scratches on your skin with a waterproof dressing.

What happens if you get leptospirosis? (Prognosis)

Most cases of leptospirosis are mild, and sometimes resolve without treatment . However, a doctor will monitor your symptoms.

If your symptoms get worse, or if you develop new symptoms, tell your doctor right away. If you have any symptoms of Weil's syndrome, go to the emergency room at your nearest hospital.

How long does leptospirosis last?

Mild leptospirosis can last from a few days to a few weeks. If you have severe leptospirosis, you will need to stay in the hospital for about two weeks. Severe cases can take several months to fully recover.

When can I go back to work/school?

Leptospirosis is very rarely transmitted from one person to another, so once you are well and feeling better, you can go back to work or school.

Do people survive leptospirosis?

Yes, absolutely. Most people who get leptospirosis have no symptoms, or very mild symptoms, and they resolve on their own.

Only about 1% of people who get leptospirosis develop the severe condition known as `Weil's syndrome.` Weil's syndrome can be fatal if not treated promptly or if treatment is delayed. However , if recognized early and treated properly, there is a good chance of a full recovery.

How do I take care of myself?

If you have been diagnosed with leptospirosis, keep a close eye on your symptoms. Tell your doctor if they get worse or if you develop new symptoms. Drink plenty of fluids and rest.

When should I see a doctor?

If you have been exposed to potentially contaminated water or soil and then develop any symptoms of leptospirosis, see a doctor.

When should you go to the Emergency Treatment Unit (ETU) ?

If you have these symptoms, go to the nearest hospital immediately:

• If you cough and bleed
• If you have chest pain
• If you have difficulty breathing
• If the eyes and skin turn yellow
• If you have black, tarry stools
• If there is blood in the urine
• If the amount of urine produced has decreased
• If you have red spots on your skin (like a rash)

What questions should you ask the doctor?

When you see your doctor, you can ask these questions:

• How did I get this disease?
• When should I see the doctor again?
• What symptoms should I look out for, and should I talk to you if they occur?
• What symptoms should I go to the emergency room for?

Finally, things to remember (Take-Home Message)

Leptospirosis, or 'rat fever' as we call it, is an infection that usually causes mild symptoms, but can sometimes be severe. It's important to know if you're at risk of exposure due to your job or hobbies.

But that doesn't mean you should stop paddling your canoe and paddling in the fields. By knowing the risks, taking precautions, and being aware of the symptoms, you can stay healthy and safe. Be especially careful during the rainy season and during flooding. Keeping your surroundings clean is also a good way to stay safe from these diseases.

` Rat fever, Leptospirosis, Leptospirosis, Bacterial infections, Animal diseases, Kidney diseases, Prevention