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تاريخ التسجيل: Jan 2018
Leptospirosis: What You Need to Know
Leptospirosis: What You Need to Know
Last updated Mon 22 January 2018
By Christian Nordqvist
Reviewed by Alana Biggers, MD, MPH
Leptospirosis is a relatively rare bacterial infection that affects people and animals. It can pass from animals to humans when an unhealed break in the skin is exposed to water or soil that has been contaminated with animal urine. Leptospirosis is caused by a strain of the Leptospira bacterium, and it can progress to potentially fatal conditions such as Weil's disease or meningitis.
The condition is not usually transmitted between people.
The bacteria can enter the body through broken skin, the eyes, or mucous membranes. Animals that transmit the infection to humans include rats, skunks, opossums, foxes, and raccoons.
Leptospirosis is more common in tropical areas, where it affects 10 or more people in every 100,000. In temperate climates, the incidence is estimated between 0.1 and 1 per 100,000. In an epidemic, it can affect 100 or more in every 100,000.
People traveling to tropical areas have a greater risk of exposure.
Fever and chills are signs of leptospirosis.
For mild cases, the doctor may prescribe antibiotics, such as tetracycline or penicillin.
Patients with severe leptospirosis will need to be hospitalized and given antibiotics intravenously.
Depending on which organs are affected, the patient may need a ventilator to assist in breathing or dialysis, if the kidneys are affected.
Intravenous fluids can provide hydration and essential nutrients.
Hospital stays may range from a few weeks to several months, mostly depending on how the patient responds to antibiotic treatment, and how severely their organs are affected or damaged.
During pregnancy, it is possible for leptospirosis to affect the fetus, so a woman who has the infection while pregnant will need to be hospitalized for monitoring.
The signs and symptoms of leptospirosis usually appear suddenly, about 5 to 14 days after infection, but the incubation period can range from 2 to 30 days.
Signs and symptoms of mild leptospirosis include:
Signs and symptoms of severe leptospirosis will appear a few days after mild leptospirosis symptoms have disappeared.
They depend on which vital organs have been affected.
If the heart, liver, and kidneys are affected, the person will experience:
If the brain is affected, meningitis, encephalitis, or both may develop.
Meningitis is an infection of the outer layer of the brain, while encephalitis refers to infection of brain tissue. Both conditions have similar signs and symptoms.
These may include:
If the lungs are affected, the person cannot breathe. This is the most serious and life-threatening of all leptospirosis complications.
Signs and symptoms include:
Early-stage, mild leptospirosis is hard to diagnose, because the symptoms can resemble those of flu and other common infections, and reliable diagnostic tests are lacking.
If a physician suspects severe leptospirosis, the patient may undergo specific diagnostic tests.
The doctor will ask about any recent travel, especially to areas where leptospirosis is common.
They may ask if the person has been swimming in a lake, pond, canal, or river, about any activities that occurred in a slaughterhouse, on a farm, relating to animal care, or anything that might have involved contact with animal urine or blood.
A number of blood and urine tests can confirm or rule out leptospirosis.
Leptospirosis is an infectious disease that can have serious complications.
There are two main types of leptospirosis:
Mild leptospirosis accounts for 90 percent of cases. Symptoms include muscle pain, chills, and possibly a headache.
Between 5 percent and 15 percent of cases can progress to severe leptospirosis. Organ failure, internal hemorrhaging, and death can result if the bacterium infects the liver, kidneys, and other major organs. The Centers for Disease Control and Prevention (CDC) puts the fatality rate between 1 percent and 5 percent.
Leptospirosis is less likely to be fatal in countries with more effective health care systems.
Those more likely to develop severe leptospirosis tend to be those who are already sick, for example, with pneumonia, those under the age of 5 years, and those in older age.
Who is at risk?
Leptospirosis is more common in the tropics, but it may also occur in the poor parts of large cities in developing nations that are not in tropical areas. The bacterium thrives in hot and humid environments. It tends to be sporadic.
Higher incidences of leptospirosis are found in parts of Africa, India, China, Central America, Brazil, Caribbean, South East Asia, and Southern Russia.
In some countries, wide sections of the population are at risk, for example, when working in rice fields or sugarcane plantations, using river or lake water for washing and cooking, or following a natural disaster.
Tourist hotspots where leptospirosis sometimes occurs include New Zealand, Australia, Hawaii, and Barbados.
Flooding increases the risk of an outbreak. If climate change leads to more cases of flooding around the world, leptospirosis may become more common.
Leptospirosis in developed nations
In 1995, leptospirosis ceased being a notifiable disease in the United States, but it was reinstated in January 2013. The biggest outbreak was in 1998 when 110 people became infected. Between 100 and 200 people are identified in the U.S. each year, according to the CDC. Around half of the cases in the U.S. occur in Hawaii.
In developed countries, those most at risk are:
In non-tropical, developed nations, the risk of leptospirosis is very small, and most people do not need to avoid doing water sports.
Fresh water leisure activities can increase the risk in tropical climes.
However, those who regularly swim in freshwater should make sure that any skin cuts are covered with a waterproof dressing, to protect against a range of infections, including hepatitis A and giardiasis. After swimming in fresh water, it is a good idea to shower thoroughly.
Those who work with animals or potentially contaminated water or soil should wear protective clothing and comply with local or national rules and regulations. They may need to wear gloves, masks, boots, and goggles.
People who travel to areas where leptospirosis is common should take the following steps:
People can become infected through:
The Leptospira bacteria can exist in raccoons, bats, sheep, dogs, mice, rats, horses, cattle, buffaloes, and pigs.
The bacteria inhabit the animals' kidneys and are expelled through urination, infecting the soil or water supplies.
Soil or water can remain contaminated for months.
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