With the floods come lethal leptospirosis – Well being and Way of life
By Rafael Castillo MD
Due to the heavy rains and floods, COVID-19 will temporarily take a back seat as concerns about leptospirosis mount. With the inevitable flood wading during the heavy downpour typhoon “Ulysses” (international name: Vamco), the incidence of this flood-borne disease is expected to increase dramatically.
Leptospirosis is usually transmitted to humans through the urine of rats. The flood leptospirosis bacteria infect people who wade in the floods by entering through people’s cuts and abrasions. After a short incubation period, the patient will show flu-like symptoms such as fever, muscle aches and headaches. This presents a diagnostic dilemma as it is difficult to differentiate from COVID-19 in the early stages.
Therefore, the history of wading in the tide is very important to suspect leptospirosis, especially if kidney and liver symptoms such as jaundice or yellowish discoloration of the skin are already occurring. If some cases of leptospirosis are not detected and treated early enough, they can worsen and lead to kidney and liver failure, and death.
Easy to prevent
The good news is that leptospirosis can be easily prevented with prophylactic antibiotics. Dr. Dolores Banzon of the Philippine Society of Nephrology sent me this advice from their society.
1. If you have only waded once in high water (single exposure) and have no cuts or skin lesions, this is considered a low risk. You only need to take a single dose of doxycycline 100 milligrams, two capsules single dose within 24 to 72 hours.
2. If you have some cuts or lesions in your skin, it is considered a moderate risk. Take Doxycycline 100 mg, two capsules for 3-5 days. Start as soon as possible and no later than 72 hours later.
3. Continuous exposure, with or without cuts or lesions, puts you at high risk of infection. Take 200 mg prophylactic doxycycline once a week until you stop wading in the tide.
Leptospirosis is a real and potentially serious threat during the rainy season, no thanks to our lack of sanitary waste disposal and the increasing rat population. This underscores the need for an effective rodent control program in areas prone to flooding. It’s still the best way to prevent leptospirosis. I’m not sure the Department of Health (DOH) has budgeted for this. However, the DOH does provide free doxycycline through the health centers.
The death rate from leptospirosis is much higher than that of COVID-19. In a published report by Dr. Al-Shere T. Amilasanthe was written in collaboration with the Centers for Disease Control and Prevention, 51 (10.8 percent) of 471 patients admitted to San Lazaro Hospital after a typhoon a few years ago died.
The risk of death was much higher in the elderly and in those with hemoptysis (coughing up from the blood), anuria (scanty urine output), jaundice (yellowing of the skin), and delayed treatment with antibiotics such as doxycycline.
The authors wrote that deaths could have been reduced if these risk factors had been identified and appropriate management given early without waiting for confirmatory laboratory tests. Confirming the laboratory can be challenging in resource-poor environments, especially during outbreaks. Doctors only need to use their clinical instincts and have a high suspicion index during the monsoon season with the recent flooding events.
Another thing the authors noted was that the leptospirosis patients were predominantly male. This has also been shown in previous reports, but it could also be due to the higher exposure of men to contaminated floods.
Those who died were the ones who had admitted to themselves when their leptospirosis was already at an advanced stage. Although they also received antimicrobial therapy, some of them died of acute respiratory distress syndrome and acute kidney failure within just two days of being admitted to the hospital. Once a certain threshold is reached, a patient can quickly deteriorate and die, which is also the case with COVID-19.
The World Health Organization recommends starting doxycycline or other effective antimicrobial therapy before the fifth day of the onset of the disease. If given later, patients may advance to a complicated stage and die.
As if COVID-19 wasn’t enough, leptospirosis is adding to our list of concerns these days. Wading in high water is a reality that most of us just have to face. It’s perfectly fine as long as we wash and soap our bodies thoroughly as soon as we get home and take the prophylactic doxycycline as recommended.