Leptospirosis

In humans, leptospirosis can cause a wide range of symptoms. The common symptoms of leptospirosis include:

• Fever
• Nausea and vomiting
• Sore throat
• Loss of appetite
• Abdominal pain
• Conjunctivitis (irritation and redness of the eyes)
• Cough
• Short-lived rash
• Jaundice (yellow skin and eyes)
• Muscle aches
• Shivering

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Symptoms in severe cases:

• Extreme fatigue
• Hearing loss
• Respiratory distress
• Meningitis (an infection of the meninges, protective tissue of the brain that causes stiff neck, headache, and fever)
• Pulmonary hemorrhage (bleeding into the lower respiratory tract)

Note: The time between a person’s exposure to a contaminated source and becoming sick is 2 days to 4 weeks. The illness can last from a few days to 3 weeks or longer.

Phases of Leptospirosis

Leptospirosis usually presents in the following phases:

1. Anicteric syndrome - It is the most common form which is not very severe and shows symptoms similar to the flu. It starts suddenly and can cause a headache, cough, rash that doesn't itch, fever, shivering, muscle pain, loss of appetite, and diarrhea.
2. Immune phase - It refers to the progression of the disease where the body's immune system responds to the infection caused by the Leptospira bacteria. The anicteric syndrome can also have recurrence several days later, and this phase is called the immune stage. During this stage, aseptic meningitis (inflammation of the brain meninges with negative cerebrospinal fluid (CSF) bacterial cultures) can occur.
3. Icteric phase - Also known as Weil's disease, it is a very serious infection that can last for several months and can cause a range of symptoms such as high fever, kidney failure, jaundice, bleeding in the lungs, and respiratory distress.

Leptospirosis is caused by a bacteria called leptospira, which is found in the urine of infected animals. Animals such as rodents, cattle, buffaloes, horses, sheep, goats, pigs, and dogs are considered common reservoirs of this bacteria.

The bacteria can survive for weeks to months in urine-contaminated water and soil.

The common modes of infection include:

• Direct contact with infected animals or their urine, reproductive fluids, or body tissues.
• Contact with urine-contaminated water from floods, rivers, streams, and sewage, especially during high rain or monsoon seasons that facilitate the spread of bacteria.
• Contact with urine-contaminated wet soil.
• Intake of food or water contaminated by urine or urine-containing water.

Transmission occurs through mucous membranes, conjunctiva, and non-intact skin, such as cuts or abrasions. The incubation period is usually 5–14 days, with a range of 2–30 days.

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Understanding the risk factors of leptospirosis is crucial for preventing this bacterial infection. They include:

1. Occupation
   Direct contact with animals and activities that can lead to skin abrasions and exposure to contaminated water or soil, such as clearing brush, trekking, and gardening, are associated with a high risk of leptospirosis. The occupations that are more susceptible include:
   • Sewage workers
   • Butchers
   • Farmers
   • Veterinarians
   • Hunters
   • Fish workers
   • Dairy farmers
   • Military personnel
2. Outdoor activities
   Swimming, rafting, kayaking, wading, or boating in floodwater or freshwater (rivers, streams, lakes) that may be contaminated with animal urine increases the risk of leptospirosis. Prolonged immersion, submerging the head, or swallowing contaminated water can particularly increase this risk.
3. Household exposure
   Potentially contaminated sources such as pet dogs, domesticated livestock, rainwater catchment systems, and infestations by infected rodents can elevate the risk of leptospirosis.
4. Low socioeconomic status
   Living in overcrowded urban areas with poor sanitation is a known risk factor for contracting this infection.
5. Travel to endemic areas
   Traveling to regions with heavy rainfall or flooding can also lead to leptospirosis.
6. Mother-to-child transmission
   An infected mother can transmit the infection to her baby during pregnancy or childbirth. It is important to seek medical care and take preventive measures to reduce the risk of transmission and protect both the mother and the baby.

Did you know?
Leptospirosis in pregnancy may be misdiagnosed as it can mimic other pregnancy-associated conditions, including infections, pregnancy-associated hypertension, acute fatty liver, and HELLP (hemolysis, elevated liver enzymes, and low platelet count syndrome).

Accurate diagnosis of leptospirosis is crucial for timely treatment and management of the disease, as early recognition allows for appropriate interventions and helps prevent potential complications. It consists of the following:

1. Medical history and physical examination
   A doctor will inquire whether a person may have acquired leptospirosis through contact with the urine of infected animals, directly or via contaminated food, water, or soil. The doctor will also assess the patient's occupation.
2. Blood tests
   The various blood tests available for the detection of leptospirosis include:
   • Erythrocyte sedimentation rate (ESR): A simple blood test that measures inflammation or infection in the body. The ESR rate is elevated in cases of leptospirosis.
   • Peripheral blood smear: A basic test used to identify abnormalities in the blood, which may help differentiate leptospirosis from other common acute febrile illnesses.
   • Liver function tests: A group of tests to evaluate liver function. In icteric leptospirosis, liver function tests generally show a significant rise in bilirubin and other liver enzymes.
   • Kidney function tests: A group of tests performed together to assess kidney (renal) function. The kidneys are usually impaired by raised plasma creatinine in leptospirosis.
3. Urine analysis
   This test is used to detect leptospires in the urine, which may be absent from the blood during the immune phase.
4. Lumbar puncture
   Also known as a spinal tap, this procedure collects a sample of cerebrospinal fluid (CSF) for testing to isolate leptospirae from the CSF.
5. Polymerase chain reaction (PCR)
   This method enables rapid and direct diagnosis of leptospirosis DNA, even in the early and convalescent stages of infection.
6. Serological and other indirect methods
   Serological tests are diagnostic methods used to identify antibodies and antigens in a patient's sample. They include:
   • Microscopic agglutination test (MAT): MAT has been widely used as the reference test for antibody detection in leptospirosis but is not useful in the early stages of the disease.
   • Enzyme-linked immunosorbent assay (ELISA): A modern molecular technique for detecting antigen-antibody interactions. Studies have shown ELISA to be more sensitive than MAT for early detection in acute illness.
   • Indirect haemagglutination assay (IHA): IHA detects both IgM and IgG classes of antibodies produced in response to leptospira.
   • Leptodipstick assay: A newly developed test for diagnosing leptospirosis by detecting antibodies.

Although human vaccines have been used in some countries with varying degrees of success, there are no WHO-prequalified vaccines currently available. The measures to prevent transmission of leptospirosis include the following:

• Avoid exposure: Avoid walking, swimming, bathing, swallowing, or submerging your head in potentially contaminated water bodies, especially during monsoons, periods of heavy rainfall, or flooding.
• Cover open wounds: Use waterproof dressings.
• Ensure safe drinking water:
  • Drink only filtered or boiled water.
  • Use filtered or boiled water to prepare food, brush teeth, and make ice.
  • Avoid using water bottles without a seal.
  • Store water in a clean and covered container.
• Cook and consume food vigilantly:
  • Prepare food with filtered or boiled water.
  • Wash fruits and vegetables with filtered or boiled water.
  • Consume fruits and vegetables after peeling.
• Use of PPE (Personal Protective Equipment):
  • Animal handlers should treat all animals as if they are infected and wear full protection (waterproof coveralls/clothing, gloves) at all times.
  • Wear full-cover, waterproof boots or shoes that do not allow water to enter from the top.
  • Farm, agricultural, and horticultural workers should treat all wet soil and vegetation as if it is contaminated and wear full protection, particularly after heavy rain.
• Chemoprophylaxis: Administration of doxycycline 200 mg, once a week, during the peak transmission season may be given to agricultural workers or high-risk individuals.
• Rodent control: Rats are the main reservoirs for the leptospirosis bacterium in India. Controlling these reservoir species with proper strategy planning and management will reduce the incidence of the disease. This includes:
  • Determining the host species responsible for the infection in the affected region.
  • Defining specific areas for implementing rodent control measures.
  • Conducting necessary activities before the onset of the monsoon season.
  • Utilizing suitable technology for effective rodent control, ensuring accurate inputs and proper application methods.
  • Establishing a proper drainage system.
  • The mapping of water bodies and human activities in water-logged areas should be carried out. Farmers should be educated to drain out the urine from the cattle shed into a pit, instead of letting it flow and mix with rivers, ponds, etc.
• Tips to protect your pets:
  • Keep your pets out of contaminated water, especially after heavy rainfall or flooding.
  • Keep your pets away from other animals’ urine.
  • Ensure your pets only drink clean filtered or boiled water.
  • Keep your pets away from rodents and wild animals.
  • Vaccinate livestock and dogs. Vaccines are available for cattle, dogs, and pigs that provide short-term protection.
  • Install suitable fencing that separates livestock from access to potentially contaminated bodies of water (e.g., valley dams, rivers, ponds) and surrounding areas.

The following points help in the management of mild cases of leptospirosis:

• Ensure plenty of rest to aid in recovery and conserve energy.
• Maintain adequate fluid intake, such as water and electrolyte-rich beverages like coconut water, to support hydration and overall health.
• Take pain relievers like paracetamol, ibuprofen, or naproxen as advised by the physician.

Medical treatment depends on the severity of the symptoms and includes:

1. Medications

In outpatient cases, antibiotics that may be used include:

• Doxycycline
• Amoxicillin
• Azithromycin
• Ampicillin

If the infection is severe, intravenous medications such as:

• Penicillin G
• Ceftriaxone
• Erythromycin

Patients with severe leptospirosis usually require admission to the intensive care unit, as multiple organs can be involved. In cases of kidney failure, corticosteroids may be administered.

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2. Medical therapies

At the hospital, depending on your clinical condition and severity, you may require additional medical interventions, such as:

• Mechanical ventilation: Respiratory distress due to lung involvement may require mechanical ventilation.
• Dialysis: In advanced cases, dialysis helps filter toxins out of the blood and allows the kidneys to recover from the effects of the disease.
• Additional therapies: These include the use of ophthalmic drops, diuretics, inotropic agents (medications that affect the contraction of the heart muscle), and renal-dose dopamine (prescribed worldwide for the prevention and treatment of acute renal failure).

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Treatment in Pets

Leptospirosis can be effectively managed using antibiotics. Administering early treatment to an animal can lead to a faster recovery and potentially reduce the severity of organ damage. In some cases, additional treatment approaches like dialysis and hydration therapy may be necessary.

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Some home remedies can augment conventional medical treatment. These include:

• Turmeric (Haldi): Studies suggest that turmeric is a potent antioxidant, anti-inflammatory, antimutagenic, and antimicrobial agent that can help combat infections. You can consume it by adding a pinch of turmeric powder to a glass of milk and drinking it twice a day.
• Ginger (Adrak): Various studies indicate that ginger extracts decrease anti-inflammatory components that can cause organ damage due to leptospirosis. You can add freshly grated ginger to your meals, such as soups and stir-fries, or brew a cup of ginger tea by steeping freshly sliced ginger in hot water for 5-10 minutes.
• Milk Thistle: It is a powerful antioxidant, and research suggests that milk thistle extract not only prevents damage to the liver caused by leptospirosis but also helps repair it. Note: This is a herbal supplement, so consult your doctor regarding the dosage and frequency of consumption.

If untreated for a prolonged period, leptospirosis may lead to:

• Damage to the kidneys
• Severe lesions of the kidneys and heart
• Inflammatory disease causing swelling and damage to the eye tissue
• Pulmonary or lung complications
• Heart failure
• Liver damage
• Death of a fetus or abortion in pregnant women
• Hemodynamic collapse (shock)

Did you know? COVID-19 infections can mimic leptospirosis symptoms. Studies suggest that COVID-19 can present signs and symptoms similar to other infectious diseases, potentially confusing doctors in their search for a confirmatory diagnosis.

Alternative treatments alongside conventional medical treatment for leptospirosis have proven to be beneficial in some cases. It includes:

• Ayurveda: According to Ayurveda, leptospirosis is referred to as Krumi Roga (worm infestation). Common Ayurvedic herbs used are:
• Ashwagandha: A potent herb that helps alleviate pain and muscle aches associated with leptospirosis.
• Mahashankh Vati: This herb aids in re-establishing digestive fire, enhances appetite, and removes digestive endotoxins produced in leptospirosis.