Are you aware of a fever that comes from leeches? Let's talk about Rocky Mountain Spotted Fever (RMSF)!

Have you ever wondered how much of a disease a small animal like a leech can cause? Today we are going to talk about a disease transmitted by such leeches, which can be a bit serious, but if treated properly, you can recover quickly. This is called Rocky Mountain Spotted Fever . You may not have heard of this name, but it is very important to know about it.

What is Rocky Mountain Spotted Fever (RMSF)?

Simply put, this is a bacterial infection. That means this disease is caused by a small germ entering the body. This bacteria is called Rickettsia rickettsii. But this bacteria does not just come and enter our body. It has a carrier. That carrier is the leech. Not every leech, but if we are bitten by a leech infected with this bacteria called `(Rickettsia rickettsii)`, we get this disease. It is just like the dengue mosquito, not every mosquito spreads dengue, only a mosquito with the dengue virus does. That is how it is.

Although this disease is called 'Rocky Mountain', it is not only found in mountainous regions, but can also be seen in other parts of the world, especially North and South America. This disease is rarely reported in Sri Lanka, but it is good to be aware of this because there are other diseases transmitted by leeches and for those who travel abroad .

How is this disease transmitted? How are leeches involved?

Okay, now let's see how this leech spreads this. A leech, especially the type of leech that carries this disease, carries the bacteria `(Rickettsia rickettsii)` on its body. When this leech comes and attaches itself to the body of a person, or sometimes an animal like a dog, and sucks blood, that bacteria enters our bloodstream along with the leech's saliva.

Think of it like a small syringe. When a leech sucks blood, it injects the germs it has into our bodies. But the disease does not spread immediately after the leech is attached. Usually, the leech has to be attached to the body for several hours (maybe 4-6 hours or more) to suck blood for the bacteria to enter the body. That is why it is recommended to remove a leech immediately if you see it attached to your body.

This disease is most common in the spring and summer months . That is, usually from March to September. This is because leeches are most active during that time. They are most common in forests, grassy areas, and areas with lots of trees. So if you work or walk outdoors, especially in forested areas, parks, or even in your own garden, it is very important to be careful of leeches.

What are the symptoms of Rocky Mountain Spotted Fever (RMSF)?

This disease does not show major symptoms immediately. It usually takes between 2 and 14 days after being bitten by a leech.This is when symptoms begin to appear. Most often, symptoms appear within 5-7 days.

First come the following features:

• Very hot. Suddenly, my body gets hot and I get a fever.
• Severe headache . You may feel a throbbing pain in your head.
• Body aches, muscle aches. Just like when you have a viral fever.
• Nausea and vomiting. You may feel sick to your stomach and vomit.
• Stomach ache.
• Redness of the eyes .
• Loss of appetite.

When these symptoms come alone, we may think that this is a normal viral fever. That is the only danger in this. Because it may be too late to make an accurate diagnosis.

But this disease has a very specific characteristic. That is the rash that appears on the skin . This is why it is also called 'spotted fever'.

• These lesions first appear around the wrists and ankles as small red dots or spots.
• Then these lesions gradually spread to the palms and soles . This is a bit special, because not all diseases cause lesions on the palms and soles.
• After that, these lesions begin to spread up the arms and legs, towards the trunk .
• Initially, these spots are red, but after a few days, they can sometimes turn purple with small hemorrhages. This is also called `` petechiae ''.

The important thing is that not everyone gets these symptoms. Some people, especially the elderly and sometimes children, may not get these symptoms and just have a fever and other symptoms. In that case, it becomes even more difficult to diagnose the disease.

These symptoms usually appear within 2-5 days of the onset of fever. So if you have a fever, body aches, and these symptoms, especially if you have been in an area where there are leeches, you should definitely see a doctor right away.

When should we see a doctor?

If you have the symptoms I mentioned earlier – high fever, headache, body aches , nausea, and that specific rash – especially if you remember being bitten by a leech or if you have been in an environment where leeches may be present , it is best to seek medical advice without delay.

Imagine, you've just returned from playing in the garden with your child, or you've gone on a short hike in the woods. A few days later, your child has a fever, complains of body aches, and then starts developing small red spots on his hands and feet. In that case, you should definitely see a doctor.

Early recognition and treatment of this disease is important for life safety, as delayed treatment can lead to serious complications.

How do doctors diagnose this disease?

A doctor will mainly look at your symptoms, whether you've been exposed to leeches, and a physical examination to diagnose this disease. It's a big help if you have that specific rash pattern.

But it's hard to tell if this is Rocky Mountain Spotted Fever (RMSF) based on symptoms alone, because the early symptoms are similar to other flu-like illnesses.

Therefore, doctors usually order several blood tests. There are tests that look for antibodies that our body produces against this bacteria. But because these antibodies take several days to develop, the results of these tests can be negative in the early stages of the disease.

Sometimes, a small sample (skin biopsy) can be taken from the lesions and tested to see if bacteria are present.

The most important thing is that doctors start treatment as soon as they suspect this disease, without waiting for the results of blood tests. Because quick treatment is very important in this case.

What is the treatment for this?

This disease is treated with antibiotics. The antibiotic doxycycline is most often used for this. It is suitable for both adults and children.

It is essential to take the exact dose prescribed by the doctor for the full duration. Do not stop taking the medication just because your fever has subsided in two or three days and you feel better. You must finish the entire course of medication.

If treatment is started early, that is, within 5 days of the onset of symptoms, most people recover completely within a few days.

Sometimes, if the disease is a little severe, it may be necessary to be hospitalized and given intravenous (IV) antibiotics. In addition, additional care is provided, such as saline to prevent dehydration and medication to reduce fever.

What happens if treatment is not given? (Complications)

This is the issue we need to focus on the most. Rocky Mountain Spotted Fever (RMSF) is a disease that can be life-threatening if left untreated.

If treatment is delayed or left untreated, this bacteria can spread throughout the body and damage various organs.

• Damage to blood vessels: This can cause bleeding inside the body.
• Effects on the brain: Severe symptoms such as brain swelling (encephalitis), seizures, and coma can occur.
• Effects on the respiratory system: Pneumonia and pulmonary edema may occur.
• Kidney failure.
• Effects on the heart.
• Sometimes, blood flow to the limbs is disrupted, and those parts can even die (gangrene). If that happens, those parts may have to be surgically removed.

That's why I've said before that if you have these symptoms, especially if you think you've been bitten by a leech, you should see a doctor immediately. If you take medicine on time, you can avoid these dangerous situations.

How do we protect ourselves from leeches and RMSF? (Prevention)

The best way to protect yourself from this disease is to avoid tick bites. There are several things we can do to do this:

• Avoid places where leeches are: Avoid walking in forests, tall grass, and areas with lots of trees as much as possible. If you must go to such places, try to walk in the middle of the roads and in open areas.
• Wear protective clothing: Wear long pants and long-sleeved shirts. Tuck your pants into your socks. Put your shoes on over your socks. Wear light-colored clothing so that leeches can be seen more easily if they are on your clothes.
• Use insect repellents: Apply insect repellents containing chemicals like `(DEET)` and `(Permethrin)` to your skin and clothes. However, you should follow the instructions when using these. Seek medical advice, especially when using them on young children. `(Permethrin)` should only be applied to clothes and equipment like tents, not directly to the skin.
• Check your body after coming home from outdoors: When you return home from a place where leeches are present, change all your clothes and check your entire body thoroughly. Pay special attention to areas like the scalp, ears, neck, armpits, groin, and behind the knees. Also check your children thoroughly.
• Wash clothes: Wash clothes that you have worn outdoors in hot water. If possible, dry them in a clothes dryer. This will kill any leeches that may be present.
• Check your pets: If you have pets like dogs and cats at home, check them for leeches regularly. Use leeches-free products for them. Because leeches on animals can come into your home and bite you too.
• Clean up your garden: Cut the grass in your garden short. Remove any dry leaves. This will reduce the number of hiding places for leeches.

What to do if a leech is attached to your body?

If you see a leech attached to your body, don't panic. The important thing is to remove it properly.

1. Use fine-tipped tweezers.

2. Use the forceps to grab the leech as close to the skin as possible, holding it by the side of its head.

3. Pull straight up, slowly and carefully, at a steady pace. Do not twist or squeeze. Doing so may cause the leech's head to become stuck in the skin, or it may spread germs further into the body.

4. After removing the leech, wash the area thoroughly with soap and water, and then clean it with something like alcohol.

5. Flush the removed leech down the toilet, or place it in a container with alcohol. Or tape it and throw it in the trash. Don't just crush it with your hands.

6. Remember the date the leech was removed. If you develop symptoms such as fever or chills in the next few weeks, tell a doctor and tell them that you were bitten by a leech.

Finally, take-home message

Okay, so we've talked a lot about Rocky Mountain Spotted Fever (RMSF) now, haven't we? This is a disease transmitted by leeches, and although it can be a bit serious, it can be completely cured if recognized and treated early.

• Protection from leeches is the most important thing. Wear protective clothing when going to wild or grassy areas, use insect repellent, and check yourself when you get home.
• If you have a rash that starts on your wrists and ankles and spreads along with fever, headache, and body aches, especially if you suspect you have been bitten by a leech, seek medical advice immediately.
• If doctors suspect this disease, they will not delay in starting treatment. So if you have symptoms, don't delay in seeing a doctor.
• Take the antibiotics exactly as prescribed, for the full duration.

Although this disease is not common in Sri Lanka, there are other diseases that are transmitted by leeches. Also, if someone has traveled abroad and shows these symptoms, it is good to be suspicious of this disease as well.

If you have any further questions about this, don't hesitate to ask your family doctor. Stay healthy!

` Rocky Mountain Spotted Fever, RMSF, leeches, leech-borne diseases, fever, skin lesions, bacterial infection, Rickettsia rickettsii, antibiotics, doxycycline( Doxycycline ) , tick-borne disease, tick bite prevention