How do they get infected?
The reservoir of infection is animals in which leptospira live for years in the kidney tubules and are excreted in the urine. The bacterium persists for a long time in a humid environment: in the water of a pond, irrigation ditch, damp soil, or at the bottom of a basement. Human infection does not occur through the mouth, but more often through the skin and mucous membranes. A small abrasion on the leg and contact with water is enough. The risk increases sharply after floods and rainstorms, when the contents of cesspools and holes are washed away. The disease is practically not transmitted from person to person.
- Swimming and diving in standing ponds and ditches
- Working barefoot in irrigation, in rice paddies, in the garden
- Cattle care, slaughter, milking
- Cleaning basements and warehouses infested with rodents
- Floods and flooding
- Contact with sick dogs and their urine
Symptoms
The incubation period is often from five days to two weeks. The disease begins suddenly with chills and temperature up to 39–40 °C. A characteristic symptom is severe pain in the calf muscles, which makes it difficult to walk. After a few days, the temperature may drop briefly and then rise in a second wave. The severe version, known as Weil's disease, causes jaundice, kidney damage and bleeding. The danger is that the condition can worsen within a day.
- Sudden fever and chills
- Severe pain in calves and lower back
- Redness of the face, neck, hemorrhages in the sclera
- Headache, sometimes meningeal symptoms
- Yellowness of the skin and mucous membranes
- Decreased urine output
- Rash, bleeding gums, nosebleeds
- Coughing up blood due to lung damage
Complications
Leptospira damage the lining of small vessels, so several organs are affected at once. The kidneys stop removing fluid and metabolic products, the liver cannot cope with bilirubin, and hemorrhage develops in the lungs. Eye damage, which may appear after recovery, deserves special attention. Most complications are reversible with timely treatment, but require inpatient monitoring and test monitoring.
- Acute kidney injury requiring dialysis
- Liver failure and severe jaundice
- Pulmonary hemorrhage
- Serous meningitis
- Myocarditis and cardiac arrhythmias
- Uveitis and other eye lesions during the recovery period
Diagnostics
In the early stages, leptospira can be detected in the blood using PCR; later, antibodies can be detected in serum, and the increase in their titer in paired samples has diagnostic significance. A general blood test shows an increase in leukocytes and a decrease in platelets, protein, red blood cells and casts appear in the urine. Monitoring of creatinine, bilirubin and liver enzymes is mandatory, because these indicators determine severity. The doctor may start antibiotics before receiving the results if the clinical picture is typical.
- Blood PCR in the first days of illness
- Serological reactions in paired sera
- General clinical blood test with platelets
- General urine test
- Creatinine and urea
- Bilirubin, ALT and AST
- Chest X-ray for cough and shortness of breath
Treatment and prevention
The basis of treatment is antibiotics prescribed by a doctor, and the earlier they are started, the lower the risk of severe complications. Mild forms are treated on an outpatient basis, severe forms are treated only in a hospital, where fluids are replenished, electrolytes are adjusted and, if necessary, dialysis is performed. Self-medication with antipyretics without examination leads to loss of precious time. Prevention comes down to simple rules of conduct near water and on the farm, and for risk groups there is vaccination of animals and protection of workers.
- Antibiotic therapy as prescribed by a doctor
- Hospitalization for jaundice, decreased urine output, shortness of breath
- Infusion therapy and electrolyte correction
- Dialysis for acute renal failure
- Do not swim in stagnant ponds and ditches
- Rubber boots and gloves when watering and cleaning basements
- Rodent control, livestock and dog vaccination
- Drink only boiled or bottled water