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Leptospirosis

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Leptospirosis is a group of infections-including Weil's syndrome, infectious (spirochetal) jaundice, and canicola fever-that are caused by Leptospira bacteria.

Leptospirosis occurs in many wild and domestic animals. Some animals act as carriers and shed the bacteria in their urine; others become ill and die. People acquire these infections through contact with the animal or its urine.

Although leptospirosis is an occupational disease of farmers and sewer and slaughterhouse workers, most people become infected during such activities as swimming in, walking through or otherwise coming into contact with contaminated water. Infection can enter through a cut in the foot or other part of the body.

In Indonesia, there was recently an outbreak in Kalimantan from drinking soft drinks. It is thought the urine of rats soaked through the cardboard box onto the soft drinks and then into the mouth of people who did not wipe the top of their cans. Because leptospirosis typically causes vague flulike symptoms, many cases probably go unreported.

In Indonesia, the disease is most commonly spread through the urine of infected cattle (who have not been vaccinated for the disease as they commonly are in more developed countries) and rats. Periods of flooding also increase the incidence of leptospirosis.

Hikers and other eco-tourists need to be especially careful if they get or develop sores on their feet ... so that they are protected as they cross streams in rural areas.

Symptoms and Diagnosis

People usually develop symptoms within 2 to 20 days of becoming infected with the Leptospira bacteria. The disease usually starts abruptly with a fever, headache, severe muscle aches, and chills. Symptoms involving the lungs (including the coughing up of blood) occur in 10 to 15 percent of infected people. Episodes of chills and fever, which often reaches 102° F., continue for 4 to 9 days. Pinkeye appears on the third or fourth day.

The fever clears for a few days, but reappears together with other symptoms between the sixth and twelfth day. At this time, inflammation of the lining of the brain (meningitis) usually occurs, causing a stiff neck, headache, and sometimes stupor and coma. These symptoms don't result from infection of the brain lining, however, but rather from inflammation caused by the toxic effects of the body's attempts to destroy the bacteria. A pregnant woman who becomes infected with leptospirosis may miscarry.

Weil's syndrome is a severe form of leptospirosis that causes a continuous fever, stupor, and a reduced ability of the blood to clot, which leads to bleeding within tissues. This syndrome begins as the less severe forms of leptospirosis do. Blood tests reveal anemia, and by the third to sixth day, signs of kidney damage and liver injury appear. Kidney abnormalities may cause painful urination or blood in the urine. Liver injury tends to be mild and usually heals completely.

A doctor can confirm the diagnosis of leptospirosis by identifying the bacteria in cultures of blood, urine, or cerebrospinal fluid samples or, more commonly, by detecting antibodies against the bacteria in the blood.

Prognosis and Treatment

Infected people who don't develop jaundice usually recover. Jaundice indicates liver damage and increases the death rate to 10 percent or higher in people over age 60.

The antibiotic doxycycline can prevent the disease during an outbreak. Penicillin, ampicillin, or similar antibiotics are given to treat the disease. In severe cases, antibiotics may be given intravenously. People
with the disease don't have to be isolated, but care must be taken when handling and disposing of their urine.

For more information consult the Center for Disease Control

We trust this information will assist you to make correct choices for your health and welfare. However it is not, and is not intended to be, a substitute for personalized advice from your medical advisor.

Our appreciation to Dr. Andrew Jeremijenko of International SOS, An AEA Company who has contributed this article in response to a health threat faced by expatriates in Indonesia.

If you have medical-related questions about living in Indonesia to ask of medical professionals, see Ask the Experts.

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