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by Dr. Viraj Peramuna

Last holiday you went for hunting birds in an abandoned paddyfield. There was some stagnant water collections. You had a small wound in your leg. After about 10 days, you developed a high fever, severe headache and body aches. You waited for 3-4 days, but the condition was worsening. Therefore you visited your doctor. With the above history of working in a paddy field and contact with stagnant water, he suspected it as 'Leptospirosis' and asked you to admit.

(1) What is Leptospirosis?

* It is an occupational disease caused by a bacteria named 'Leptospira icterohaemorrhagiae', causing high fever, severe headache and body aches.

* The disease has several other names:

. rice-field workers disease

. cane-cutters disease

. fish-handlers disease

. swine-herds disease

. weil's disease.

(2) How does it transmit?

* Infected rats excrete lots of bacteria in the urine, and stagnant water collections get contaminated with urine.

* If somebody contacts this water, bacteria enters the body through a skin wound or through the mouth.

* The risk is low with flowing water as no retention of the bacteria.

(3) What happens after the bacterial entry?

* Bacteria multiplies in the blood stream for about 10 days, during which period no any symptoms (incubation period).

* Then bacteria reach multiple organs - liver, kidney, lungs and brain.

* Majority of people don't develop fever or any other symptoms. (This is called sub-clinical infection). Some people develop mild non-specific fever. Only about 10 per cent of people develop severe disease.

(4) What are the features of severe disease?

* high fever, severe headache and body aches

* loss of appetite and malaise

* Some patients develop jaundice (yellow discolouration of eyes, skin and nails)

* red eyes (bleeding in to eyes)

* joint pains

* rash (some patients)

* kidney failure with low urine output

* Hepatitis

* Meningitis (brain infection)

* disease is more severe in elderly

(5) What is the fate of the disease?

* Majority of patients recover without any complications.

(6) What are the helpful investigations?

* Blood tests

* Blood culture

* Urine tests (blood and albumin in urine).

(7) What is the treatment?

* Penicillin injections for one week.

(8) Who are the high risk people?

* agricultural workers

* animal husbandry, abattoir workers, pet owners and veterinarians

* sewer workers and miners

* people who swim in rivers or do water sports

(9) How to prevent?

* avoid bathing or contact with stagnant waters

* avoid contact with rats, rat proofing of buildings, especially meat and fish stalls.

* high risk people (above mentioned) should wear protective clothing

* careful in water sports - swimming, canoeing, wind surfing and water skiing.

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