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Alan Spira, M.D., DTM&H

This article introduces an unusual infection, which is on the rise around the world, and from which travelers, especially adventure travelers, are at increasing risk. Leptospirosis is a zoonosis - that is, an infection of animals (mainly rats, occasionally dogs or cattle) - of which humans are an incidental host. Leptospira (no relation!) are corkscrew-shaped bacteria which penetrate human skin when they come into contact with water contaminated by animal urine or by direct contact with the body fluids of infected animals. It is quite common in freshwater bodies such as ponds or rivers where rats may urinate. Leptospira can survive in fresh water (as long as the pH is neutral) for up to four weeks. In the United States it is most commonly found in Hawaii, but Puerto Rico and other Caribbean islands also are frequent sites where this infection may be acquired. In fact, the actress Jayne Seymour contracted Leptospirosis while filming a movie in Puerto Rico during 1997. In some places it is known as swamp fever; in others, cane fever or Fort Bragg fever.

The bacteria can easily penetrate skin; they enter the bloodstream and rapidly invade nearly all organs. Most infections are mild or inapparent. Approximately one to two weeks after the infection occurs, symptoms begin with fevers, chills, headache, muscle aches, loss of appetite, rashes and red eyes, which can last a week. The symptoms may be indistinguishable from influenzae and are so non-specific that Leptospirosis is rarely diagnosed at this stage. From one to two days later, a second phase may develop with headache, meningitis (the bacteria invade the central nervous system), abdominal pain, along with lung or heart involvement. Kidney and liver damage may then occur.

A severe form of infection, called Weil's Disease manifests itself with jaundice (yellowing of the eyes and skin), hepatic (liver) & renal (kidney) failure and cardiovascular collapse, which can include shock and myocarditis (infection of the muscle of the heart) - which has a poor prognosis for survival . Those who suffer from renal failure may require dialysis. The disease may last 3-4 weeks.

Early in the infection the only way to diagnose the disease is by direct microscopic examination of body fluids or bacterial culture in the lab; with the second phase serology is helpful - (examination of the blood for antibodies to the offending organism). Also during the second phase the spirochetes can be found in the urine.

Leptospirosis is treatable: mild cases can be treated with oral doxycycline or amoxicillin; serious cases require intravenous penicillin or ampicillin. There is no human vaccine available.

© 1998 Alan Spira M.D., The Travel Medicine Center Beverly Hills, California.

Document Date: January 27, 1998

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