LEPTOSPIROSIS - What is leptospirosis? What causes leptospirosis?
Last updated: 12 September 2014
Leptospirosis is a fairly uncommon bacterial infection caused Leptospira . It is most commonly transmitted Although more common in tropical areas, non-tropical urban conglomerations with low levels of sanitation are seeing more cases, especially during the summer and autumn months. Most of the urban areas affected involve large cities in the developing world. Types of Leptospirosis, there are two main types:
Mild Leptospirosis - the patient experiences muscle pains, chills and possibly a headache. 90% of cases are of this type.Severe Leptospirosis - can be life-threatening. There is a risk of organ failure and internal hemorrhaging. This occurs when the bacterium infects the kidneys, liver and other major organs. Experts are not sure why some patients develop the severe form - people who are already very ill, such as those with pneumonia, young children under five, and elderly individuals are more likely to suffer from severe Leptospirosis.
Leptospira 200 times enlarged with darkfield microscope
Where does Leptospirosis occur?
As mentioned above, leptospirosis is more common in the tropics, but may also occur in the poor parts of large cities in developing nations that are not in tropical areas. When cases do occur, they tend to be sporadic. Leptospirosis exists globally, but is more common in tropical and subtropical parts of the world. The bacterium thrives in hot and humid environments. The following areas and/or countries/continents are known to have the highest incidences of leptospirosis: Africa, India, China, Central America, Brazil, Caribbean, South East Asia, and Southern Russia. Cases of infection are also reported in the following tourist hotspots: New Zealand, Australia, Hawaii, and Barbados. After flooding, large outbreaks of leptospirosis may occur. According to WHO (World Health Organization), approximately 10 million people are thought to come down with leptospirosis annually. Death rates are hard to calculate, because they tend to occur in parts of the world with very basic public health services which do not routinely report many causes of deaths. Climate change, including more cases of flooding around the world, probably means that leptospirosis incidence globally will increase. WHO believes the leptospirosis death rate may be between 5% to 25% of infected patients. This does not mean that an infected person with access to proper healthcare has a similar risk of dying.
Leptospirosis in developed nations
In 1995, leptospirosis ceased being a notifiable disease in the USA, so nobody really knows what the true incidence numbers there might be. In 2009, in England, according to health authorities, there were 33 reported cases, of which 14 were acquired while the patients were abroad. In 2009 in France there were 209 cases. Experts believe the numbers in the USA could well be over 1,000 each year. Australia reported 141 cases in 2006. In the majority of cases, infection occurred in people who either worked in or were involved in:
Sewage works
Farms, and were regularly in contact with animals or infected water or soil
Sailing or canoeing
Death rates in developed nations are much lower than in poorer countries.
What are the signs and symptoms of leptospirosis?
A symptom is something the patient feels and describes, such as a pain, while a sign is something others can detect, such as a rash. Leptospirosis signs and symptoms usually appear suddenly, about 7 to 14 days after the person has become infected; in some cases they may appear earlier or later. Signs and symptoms of mild leptospirosis
Chills
Coughing
Diarrhea
Headaches, these can come on suddenly
High fever
Muscle pain, particularly lower back and calves
Nausea
Poor appetite
Red and irritated eyes
Skin pain
The patient usually gets better within one week without any treatment. A small proportion of them will not improve, and will go on to develop severe leptospirosis. Signs and symptoms of severe leptospirosis - these will appear a few days after mild leptospirosis symptoms have disappeared. Signs and symptoms depend on which vital organs have been affected. Signs and symptoms when the heart, liver and kidneys are affected
Fatigue
Irregular heartbeat, often accelerated heartbeat
Muscle pains
Nausea
Nosebleeds
Pain in the chest
Panting
Poor appetite
The hands, feet or ankles swell
Unexplained weight loss
Yellowing of the whites of the eyes, tongue and skin (jaundice)
Untreated patients may develop life-threatening kidney failure. Signs and symptoms when the brain is affected - meningitis refers to infection on the outer layer of the brain, while encephalitis refers to infection of brain tissue. The signs and symptoms for both meningitis and encephalitis are similar, and may include:
A blotchy rash appears on the skin. When a glass is pressed against it, it does not change color or fade
Confusion or disorientation
Drowsiness
Fits (seizures)
High fever
Nausea
Photophobia (sensitivity to light)
Problems with physical movements
Stiff neck
The patient is unable to speak
Vomiting
Aggressiveness, or unusual behavior
Untreated meningitis or encephalitis can result in serious brain damage, and may be life-threatening. Signs and symptoms when the lungs are affected - this is the most serious and life-threatening of all leptospirosis complications. Loss of lung function, when the patient cannot breathe, is a fatal condition. Signs and symptoms may include:
High fever
Panting
Coughing up blood - in severe cases there is so much blood that the patient chokes
What are the causes of leptospirosis?
Leptospira , a bacterium, may exist in raccoons, bats, sheep, dogs, mice, rats, horses, cattle, buffaloes, and pigs. They inhabit the animals' kidneys and are expelled when they urinate, and infect the soil or water supplies. Contamination can persist in soil or water for months. People can become infected by:
Drinking contaminated water
Coming into contact with contaminated water or soil if they have unhealed cuts in their skin
Their eyes, nose or mouth come into contact with contaminated water or soil
Coming into contact with the blood of an infected animal (less common)
Fresh water where some types of animals have urinated may become contaminated Humans are not commonly infected. Outbreaks may occur when there are floods. Humans rarely infect other humans, but might do so during sexual intercourse or breastfeeding.
How is leptospirosis diagnosed?
In its early stages, mild leptospirosis is hard to diagnose, because many of the symptoms are similar to flu and other common infections. Diagnostic procedures for flu are not good at identifying leptospirosis. It is only when severe leptospirosis is considered, that targeted diagnostic tests are ordered. If the patient is in an industrialized nation, the doctor will ask about any recent travel abroad, especially to areas where leptospirosis is common. The doctor may also ask whether the patient swam in a lake, pond, canal or river. The patient should inform the doctor about any activities that occurred in a slaughterhouse, farm, animal care, or anything that might have involved contact with animal urine or blood. If the doctor wants to confirm or rule out leptospirosis, a series of blood and urine tests will be ordered.
What are the treatment options for leptospirosis?
Acute leptospirosis - the doctor may prescribe a 5 to 7 day course of some tetracycline antibiotic. Severe leptospirosis - the patient will need to be hospitalized and given antibiotics intravenously. Depending on which organs are affected a ventilator to assist in breathing may be required, as might dialysis if the kidneys are affected. Intravenous fluids may be needed to hydrate the patient and provide essential nutrients. Hospital stays may range from just a few weeks to several months. Duration of stay mostly depends on how the patient responds to antibiotic treatment, and how severely their organs are affected or damaged.
Preventing leptospirosis
In non-tropical developed nations the risk of leptospirosis is negligible and most people do not need to avoid doing water sports. According to the National Health Service, UK, the chances of developing the infection in the UK is 1 in 10 million. Experts say that those who regularly swim in freshwater should make sure that any skin cuts are covered with a waterproof dressing (also to protect against other infections, such as hepatitis A or giardiasis). After swimming in fresh water areas, you should shower thoroughly. Prevention at work - those who are in contact with animals, or potentially contaminated water or soil should make sure they wear protective clothing and comply with local or national rules and regulations; this may involve wearing gloves, masks, boots and/or goggles. Travelling to other countries - in areas where leptospirosis is common, do not swim in fresh water, and only come into contact with fresh water areas if you are wearing protecting clothing. Drink sealed bottled water, or boiled fresh water. Make sure any skin lesions are covered in a waterproof dressing. If you cut yourself, clean it and bandage it immediately. Emergency workers or military personnel in disaster zones might have to take antibiotics as a precautionary measure (prophylaxis). Written by Christian Nordqvist Source: http://www.medicalnewstoday.com/
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