Leptospirosis shows mild symptoms but can be deadly

Tantri Yuliandini, The Jakarta Post, Jakarta

An increase in the number of leptospirosis victims hit headlines recently with nine people reportedly dead and at least 27 people infected with the disease known as "black jaundice" or "Weil's disease" in Jakarta alone.

The recent heavy flooding in the capital was blamed for the spreading of leptospire-contaminated water and causing widespread contagion.

The disease is common in a warm and damp tropical country like Indonesia, and although potentially dangerous, the symptoms are usually mild and easily treated.

"It's a common disease, but rarely detected. It's only now that the disease gets attention because many people have been treated too late," Director of Infectious Diseases at the Ministry of Health Thomas Suroso said.

Leptospirosis is caused by leptospira interrogans, a corkscrew-shaped bacterium (spirochete), which is transmitted by the urine of infected wild and domestic animals.

Rodents are usually blamed for transmitting the disease but cats, dogs and farm animals such as cows and sheep have also been known to spread leptospirosis, which was first detected in 1886 in Germany. The bacteria can live for a long period in fresh water, damp soil, vegetation and mud.

Even people can pass contaminated urine, and those recovering from leptospirosis should be very careful about their hygiene and should not urinate in the open, lest they infect someone else.

The disease is more common in adult men but women and children have also been known to contract it.

People get leptospirosis through contact with fresh water, wet soil, or vegetation that has been contaminated by the urine of the infected animal.

The bacteria enters the body through abraded skin, mouth or eyes, and also when a person swallows contaminated food or water, including water swallowed during water sports.

Although it is rare, it is also possible to get leptospirosis through contaminated food and milk.

Once in the bloodstream, the bacteria reaches all parts of the body and causes the illness.

"The problem is that the symptoms are similar to many other illnesses, being mistaken for chills or flu," Thomas said, adding that the symptoms usually begin about three to 19 days after infection.

The symptoms of leptospirosis include fever, headache, chills, nausea and vomiting, eye inflammation and muscle aches. In severe cases, it can result in liver damage and jaundice, kidney failure and internal bleeding.

These very common symptoms lead to difficulties in detecting the disease, and leptospirosis can only be accurately diagnosed through a blood examination.

In its early stages, leptospirosis can be treated with antibiotics such as penicillin, streptomycin, tetracycline and erythromycin. In Indonesia, patients who complain about fever, flu and chills are often given antibiotics.

"It's a good thing that doctors in Indonesia prescribe antibiotics easily, it's a blessing in disguise really, so that until now we can suppress the spreading of this disease," Thomas said.

However, in its later, severe stages, kidney dialysis and intravenous antibiotic treatment may be necessary. Urgent medical attention is needed if a person has persistent vomiting, dark urine, passes much less urine than usual, or if their eyes become yellow.

"In the early stages, the eyes usually turn red, if they turn yellow then the disease has reached the dangerous stage," Thomas said.

People exposed to flooding or damp places after the floods, and who acquire even the mildest of such symptoms, are advised to immediately consult a doctor, he added.

"They should also inform the doctor they have been in contact with water and should be checked for leptospirosis," Thomas said.

He also advised people to wear shoes or rubber boots when cleaning out their house after the floods, and always wash with disinfectant afterward.

Things to do to prevent leptospirosis:

* Minimize contact with fresh water, mud, and vegetation that might be contaminated with the urine of infected animals, especially rodents.

* Wear boots and gloves when cleaning drains. Always wear covered shoes or boots when the ground is wet and wear gloves when gardening, especially if you keep pets.

* Cover all cuts with waterproof plasters.

* If you are at risk for leptospirosis, consider taking antibiotics to help prevent infection from short-term or high- risk exposures.

* Keep food under hygienic conditions and thoroughly wash uncooked vegetables in clean water. Drink only pasteurized milk.