Right now, I am in the United States, and as I write this column, I am enjoying the summer season. In addition to summer, there are three other seasons: autumn (commonly referred to as fall), winter, and spring.
In contrast to the United States, we experience only two seasons: the wet season (from May to October) and the dry season (from November to April). As it is now June, we are in the period of the year characterized by continuous rainfall. With the rain comes an abundance of water, which can lead to flooding.
When there’s flood, there are diseases looming. One of these is leptospirosis, an infection commonly transmitted to humans from water that has been contaminated by animal urine, and comes in contact with lesions in the skin, eyes, or with the mucous membranes.
Dr. Sofia Corazon Zafra, of the City Health Office (CHO) in Davao City, said during an interview with the Madayaw Program on the city-owned Davao City Disaster Radio, that individuals can contract leptospirosis regardless of whether they have wounds on their feet.
Dr. Zafra, who is the Medical Coordinator for the CHO’s City Emerging and Re-emerging Infectious Diseases, advised Dabawenyos who have come into contact with flood waters to thoroughly cleanse the affected areas and seek medical attention at the nearest health center for prophylaxis within 24 hours.
Post-exposure prophylaxis medications are provided free of charge at all barangay and district health centers. “If you have been exposed to flood waters, it is crucial to promptly visit the nearest health center to obtain prophylaxis,” Dr. Zafra emphasized.
Dabawenyos should heed the call. The CHO’s City Epidemiology and Surveillance Unit (CESU) recorded a total of 94 cases of leptospirosis in the city as of May 24, 2024. Out of this, 25 died of the disease.
Aside from floodwaters, a person can also get leptospirosis by contact with fresh water, damp soil, or vegetation contaminated by the urine of infected animals, especially rodents and dogs. People who swim in contaminated swimming pools, rivers, lakes, and streams can also get leptospirosis. Farmers, particularly those who work in contaminated rice fields, are also prone to the disease.
The disease was first described by Adolf Weil in 1886. Leptospira interrogans, a corkscrew-shaped bacterium that caused the disease, was first observed in 1907 but it was the following year that it was declared as the cause of it.
The leptospirosis-causing bacteria are common around the world, but more so in tropical countries with heavy rainfall.
“Leptospirosis occurs in many wild and domestic animals,” explains The Merck Manual of Medical Information. “Some animals act as carriers and pass the bacteria in their urine; others become ill and die. People acquire these infections through contact with infected animals, their urine, or soil and water contaminated by infected urine.”
Aside from getting in contact with contaminated water and other media, leptospirosis bacteria also enter the body when a person swallows contaminated food or water.
Once in the bloodstream, the bacteria can reach all parts of the body and cause signs and symptoms of illness. “Because mild leptospirosis typically causes vague, flu-like symptoms, many infections probably go unreported,” the Merck manual states.
Studies have shown that leptospirosis causes mild disease in about 90% of infected people, whereas 10% have severe, potentially fatal, disease that affects many organs.
There are two phases of leptospirosis. “The first phase starts two to 20 days after infection with Leptospira,” the Merck manual informs. “Symptoms begin abruptly with a fever, headache, severe muscle aches, and chills. The eyes usually become red on the third or fourth day. Nausea and vomiting are common.”
Symptoms involving the lungs (including coughing up of blood) occur in 10 to 15 percent of infected people, studies reveal. Episodes of chills and fever, which often reaches 102 degrees Fahrenheit, continue for four to nine days.
The fever clears for a few days, marking the beginning of the second phase. “During the second phase,” the Merck manual informs, “the body’s immune reaction against the bacteria causes inflammation, producing many symptoms. The fever returns, and there is often inflammation of the tissues covering the brain (meningitis), causing a stiff neck, headache, and sometimes stupor and coma.
“In severe forms of the infection, people may also have inflammation of the liver, kidneys, and lungs, resulting in jaundice, kidney failure, and bloody cough. Sometimes the heart is inflamed, causing palpitations and dangerously low blood pressure (shock). A pregnant woman who develops leptospirosis may miscarry.”
The severe form of leptospirosis is called Weil’s disease, which causes a continuous fever, stupor, and a reduction in the blood’s ability to clot leading to bleeding within tissues. “By the third to sixth day, signs of kidney damage and liver injury appear,” the Merck manual says. “Kidney abnormalities may cause blood in the urine and painful urination. Liver injury tends to be mild and usually heals completely.”
Only a doctor can confirm the diagnosis of leptospirosis. The doctor does this by identifying Leptospira in cultures of blood, urine, or cerebrospinal fluid samples or, more commonly, by detecting antibodies against the bacteria in the blood.
According to the Merck manual, infected people who do not develop jaundice (yellowing of the skin and white of the eyes) usually recover. Jaundice indicates liver damage and increases the death rate to 10% or higher in people older than 60.
Leptospirosis is not a contagious disease. “People with the disease do not have to be isolated, but care must be taken when handling and disposing of their urine,” the Merck manual points out.
