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Leptospirosis

Overview

Leptospirosis, also called Weil disease, is the most common zoonotic infection in the world. One can get leptospirosis after getting water or soil contaminated by animal pee (urine) in your nose, your mouth, your eyes or a break in your skin. Leptospirosis risk often increases after a hurricane or flood when people have contact with contaminated water or soil. leptospirosis in people can lead to kidney damage, meningitis (inflammation of the membrane around the brain and spinal cord), liver failure, trouble breathing, and even death.

You can get leptospirosis no matter where you live, but it’s most common in tropical areas and warmer climates with lots of rainfall each year. You’re at an increased risk for leptospirosis if you live in or travel to these areas.

It generally takes 2-30 days to get sick after having contact with the bacteria that cause leptospirosis. The disease may occur in two phases:

  • In the first phase, people may have fever, chills, headache, muscle aches, vomiting, or diarrhea. The person may feel better for a while but become ill again.
  • Some people may suffer a more severe second phase with kidney or liver failure, or inflammation of the membrane around the brain and spinal cord (meningitis).

The illness can last from a few days to several weeks. Without treatment, getting better may take several months.

Weil’s syndrome is often deadly if not treated or if you delay treatment. But if treated promptly, it’s very likely you’ll recover.

Signs and symptoms

In people, leptospirosis can cause a wide range of symptoms, including:

  • Fever
  • Headache
  • Chills
  • Body or muscle aches
  • Vomiting or nausea
  • Yellowed skin and eyes (jaundice)
  • Red eyes
  • Stomach pain
  • Diarrhea
  • Rash

Many of these symptoms can be mistaken for other diseases. Some people have no symptoms.

 Phases of leptospirosis

Leptospirosis consists of two phases: the leptospiremic (acute) phase and the immune (delayed) phase.

Leptospiremic phase

During the leptospirosis phase (also called the septicemic phase) you may experience a sudden onset of flu-like symptoms. This usually starts within two to 14 days after a Leptospira infection. It lasts between three and 10 days.

In this phase, bacteria are in your bloodstream and moving to your organs. Blood tests will show signs of infection.

Immune phase

In the immune phase, Leptospira bacteria has moved from your blood to your organs. The bacteria is most concentrated in your kidneys, which make pee (urine). Urine tests will show signs of the bacteria and you’ll have antibodies to Leptospira in your blood.

A small number of people will get very sick with Weil’s syndrome in this phase. Weil’s syndrome causes internal bleeding, kidney damage and severe yellowing of your skin and eyes (jaundice).

Diagnosis and Tests

Your healthcare provider diagnoses leptospirosis with a physical exam, blood tests and urine tests.

  • Blood or urine tests:  A blood sample or  a urine sample under the lab investigation will help diagnose Leptospirosis.
  • Imaging. If you are showing signs of severe leptospirosis, you may use a chest X-ray, CT scan or other imaging. They’ll use a machine to take pictures of the inside of your body to look for damage to your organs.

 Treatment and Prevention

If you have severe leptospirosis, you’ll stay in the hospital. Your provider will give you antibiotics directly through an IV. Depending on which of your organs are affected, you may need additional medications or procedures.

  • Antibiotics. Types of antibiotics that treat leptospirosis include doxycycline, amoxicillin, ampicillin, penicillin-G and ceftriaxone. Your provider will decide which to use based on how sick you are and your medical history.
  • Mechanical ventilation. If your lungs are infected with bacteria, you may have a hard time breathing and need the help of a machine to breathe for you. Your provider will give you medication to keep you asleep while you’re connected to the machine.
  • Plasmapheresis. Also called plasma exchange, plasmapheresis might help you if you’re at risk for organ damage from leptospirosis. During this procedure, your provider removes your blood using a tube attached to a vein. A machine separates your plasma from your blood and replaces it with a plasma substitute. Your blood is then returned to your body through another tube.

The best way to prevent leptospirosis is by not swimming or wading in water that might have animal pee in it. This includes floodwaters. Other ways you can reduce your risk include:

  • Taking preventative medication. If you’re traveling and at high risk for leptospirosis, ask your provider about taking medication to keep from getting sick.
  • Avoiding animals that could have leptospirosis.
  • Wearing protective clothing and shoes if you work with or around animals.
  • Wearing protective shoes and clothing if you have to be in contact with water or soil that might be contaminated with bacteria.
  • Avoiding water sports and swimming in lakes and rivers after floods.
  • Drinking only treated water. Don’t drink water from lakes, rivers and canals without boiling it first.
  • Wearing gloves if you have to touch dead animals. Don’t touch them with your bare hands and wash your hands thoroughly afterwards.
  • Covering open cuts or wounds with waterproof dressing.

Can humans survive leptospirosis?

Yes, you can survive leptospirosis. Most cases of leptospirosis have no symptoms or have very mild symptoms that go away on their own. Weil’s syndrome is often deadly if not treated or if you delay treatment. But if treated promptly, it’s very likely you’ll recover.

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