Adventure Doc
Erik McLaughlin MD, MPH
Affiliates
LEPTOSPIROSIS
Basics:
A spirochaete infection that is found worldwide and associated with skin contact with water contaminated with infected urine. Approximately 200 different serotypes are know and severity of disease seems to vary depending on the causative type/serovar. Symptoms include a sudden onset of fever, headache, and leg myalgias. Symptoms may persist for up to a month. This disease typically infects local rice or sugarcane workers and hikers/backpackers/campers. May also be known as Weil’s disease.
LEPTOSPIROSIS
Location:
Worldwide distribution
Transmission/ Incubation:
Transmitted via skin contact with infected animal urine. Broken skin such as skinned knees or scrapes increase transmission. Incubation is generally around 10 days but may take up to a month.
Prevention:
Avoid swimming or wading in contaminated water, use of protective boots and/or clothing and there is some theory that a prophylactic does of doxycycline 200 mg once per week may prevent disease in high risk populations.
PRODUCT REVIEWS
Diagnosis:
Leptospire agglutination titers (4 fold rise) or isolation of leptospires from blood.
Treatment:
Prompt recognition and early treatment is key. Penicillin is first line and 1.2 grams given every 4-6 hours is where to start. Docycycline (100 mg orally twice per day) or Erythromycin for those allergic to penicillin. If using PCN, watch for a potential Jarisch-Herxheimer reaction.
Leptospirosis may also be known as Weil Disease. This is an illness that features headache, fatigue, muscular pain (especially in calves and legs), fevers and jaundice (yellowing of the skin and eyes due to accumulation of waste products in the body). Some other thing to look for are meningitis (an inflammation of the tissue that surrounds the brain) and easy bruising. The illness generally lasts 5 days to 1 month.
Leptospire
People get Leptospirosis from contacting infected animal urine. Rats, wild pigs, dogs and raccoons carry the spirochetes (microscopic worm like creatures) and excrete them in their urine. Most people don’t have direct contact with rat urine, unless the animals urinate into water such a puddles and streams. The people who have a problem with this are hikers and backpackers with open cuts or blisters on their legs. They walk or get splashed by the infected water and the cuts on the legs provide easy entry into the blood stream. The disease likes to attack the kidneys, which lowers the patient’s ability to excrete waste products in the urine. What results is jaundice. The mortality of this disease is low, but does require treatment with antibiotics such as penicillin or doxycycline, preferably within 5 days of infection. Studies have shown that doxycycline 200 mg q week may prevent the disease in high-risk persons. Leptospirosis is found worldwide.
