- This bacteria is excreted when these mammals urinate and ends up in soil and water
- The initial acute or septicaemic phase lasts about one week
Leptospirosis, commonly known as rat fever, is mainly a disease infecting people working outdoors. This is a disease that occasionally causes serious consequences and even death.
It’s a bacterial infection brought by animals. Though it’s called rat fever, the germ is carried by other mammals like cattle, pig, goats, dogs, raccoons and bats. This bacteria is excreted when these mammals urinate and ends up in soil and water. The germ can enter humans through abraded skin (scratches, wounds, eczema and shoe cuts or through intact mucous membrane/mouth, genitals)
This disease is a biphasic illness. The initial acute or septicaemic phase lasts about one week. The second phase is an immune phase with circulating antibodies (IgM) accompanied by excretion of the bacteria in the urine.
Contest in Sri Lanka
Leptospirosis is a zoonotic disease and one of the main communicable diseases in Sri Lanka. The disease is endemic in Sri Lanka with occasional outbreaks.
Consultant Transfusion Physician Dr. Kumudini Gonsalkorale told the Daily Mirror that the farming community and those who spend much time with animals were susceptible to the disease in Sri Lanka.
“In the rural areas, it’s the farmers and agricultural workers who are mostly affected. In the urban areas the disease often affects the slum dwellers,” Dr. Gonsalkorale said.
“The situation in Sri Lanka is pathetic. The death of the breadwinner makes the whole family destitute. Their voices are never heard. The illness never receives prominence because it mainly affects the lower income group. A death of a poor farmer never affects others. It is only the kith and kin of these poor people who suffer,” Dr. Gonsalkorale affirmed.
“In Sri Lanka, leptospirosis is reported throughout the year. Annually there are two peaks in the disease incidence; at the time of the monsoons, a smaller one during March -May and a larger one during October - December,” she added
Even with ICU care, 70% or more of those with lung haemorrages cause death. No definitive treatment is available for these patients with pulmonary haemmorrages
Dr. Gonsalkorale
According to the Epidemiology Unit, there had been a significant increase in reporting and identifying leptospirosis cases over the past few decades since identification of the first confirmed leptospirosis case in 1953. In the year 2008 Sri Lanka reported the largest outbreak of leptospirosis with 7423 suspected cases and 204 deaths. Subsequently, 4980 cases and 145 deaths were reported in 2009 and in 2010 the number of cases was 4553 with 121 dying.
The highly endemic areas are Colombo, Gampaha, Matale, Kurunegala and Kalutara which are known to be overcrowded with agricultural communities and changing weather and environmental factors.
The factors affecting prevalence of the leptospirosis in Sri Lanka can’t be investigated in to. Seasonal analysis is needed in the wet and dry zones corresponding with the main Yala and Maha agricultural seasons. The annual rainfall is mainly associated with the prevalence of leptospirosis in the wet zone while the agricultural environment associated with the prevalence of leptospiros is in the dry zone.
The new procedure has been effective that it has reduced the number of deaths reported from the sever form of the rat fever
Dr. Welivitiya
New procedures of control
Dr. Gonsalkorale said that the pulmonary haemorrages (bleeding into the lungs) which is the severe form of this disease had a very high mortality rate.
This is also called ‘Weil’s disease’ and it can develop after the acute phase as the second phase of the biphasic illness or can simply present as a single progressive illness. The outcome can become very severe.
“Even with ICU care, 70% or more of those with lung haemorrages cause death. No definitive treatment is available for these patients with pulmonary haemmorrages,” Dr. Gonsalkorale said.
“After considering the high percentage of deaths reported due to the cause of pulmonary haemmorrages, the National Blood Transfusion Service has commenced a procedure called Therapeutic Plasma Exchange (TPE) to control pulmonary haemorrages. This procedure was initiated by the Teaching Hospital of Karapitiya in 2016,” she said.
Therapeutic plasma exchange (TPE) is a treatment that removes plasma from the blood. The removed plasma is then replaced with a substitute. Plasma is the liquid portion of blood. It helps carry blood cells and other substances throughout the body.
Consultant Transfusion Physician of the Blood Bank Dr. Theshanthi Welivitiya said they had carried out plasma exchanges for more than 150 patients since 2016 with pulmonary haemorrhage and percentage of recovery was 70%.
“The new procedure has been effective that it has reduced the number of deaths reported from the sever form of the rat fever,” Dr. Welivitiya said.
“The only issue is that the Colombo South Teaching Hospital is an overcrowded hospital and once again accommodating patients in an ICU becomes a huge problem. The main problem faced is that this expensive machine used for the procedure has to be pushed from place to place in order to treat these patients,” Dr. Welivitiya added.
Symptoms
Leptospirosis may present with a wide variety of clinical manifestations. It may also mimic many other diseases such as dengue fever, influenza, meningitis, and hepatitis. Jaundice (yellow discoloration of the skin) is a relatively common symptom in leptospirosis, but is also found in many other diseases involving the liver. However, following symptoms are common when it comes to leptospirosis.
Preventive measures
The disease can be prevented to some extent by taking precautionary measures, yet many folks are unaware of the disease or the preventive methods. If you are involved in occupations such as farming, mining, cleaning drains and canals etc. please be alert. The following specific measures can help to prevent leptospirosis.
- Removal of rubbish and keeping areas around human habitation clean.
- Keep animals away from gardens, playgrounds, sandboxes, and other places where children play.
- Appropriate, protective clothing, knee-high boots, gloves etc should be worn and wounds should be covered with waterproof dressing
- Use boiled water for drinking (chlorination is seldom useful, as virulent organisms withstand up to 4 Parts per million (ppm); filtered water is also not safe)
- Avoid walking in flood water
- Use the medicine called Doxycyclin which is distributed free by the health ministry to be taken as a preventive drug.
