Thailand is a tropical country known for its scorching summers and heavy rains during the rainy season. Unfortunately, heavy rainfall can often result in flooding, causing many people to walk through contaminated water. This puts them at risk of contracting water-borne diseases, such as Leptospirosis.

Understanding Leptospirosis: Causes, Symptoms, and Risk Factors

Leptospirosis is an epidemic that typically occurs during the rainy season. Rainwater can wash various pathogens from the environment, which then flow into flooded areas. Leptospirosis is caused by a bacterial infection that affects both humans and animals.

Leptospira, the microscopic pathogen responsible for Leptospirosis, inhabits the kidneys and bladder of various animals that carry the disease, including rats, cattle, pigs, dogs, goats, and sheep. These animals can spread the disease without showing any symptoms. Rats are particularly common carriers of the disease as they live in large communities and excrete the germ with their urine, contaminating the environment, water, and wet areas. This allows the infection to enter the body through cuts, abrasions, or skin soaked in water for a prolonged period. Additionally, the infection can contaminate food and aerosols, further increasing the risk of transmission.

Those who are at high risk of infection with Leptospirosis

·       Those who live in flooded areas and walk through the flood waters

·       Those who work in agriculture such as farmers and animal husbandry such as fishpond workers, etc.

·       Workers dredging drains

·       Those who like hiking along rivers, lakes, waterfalls or engage in natural water sports

Human transmission

Even though animals are carriers, humans can get infected into the body both directly and indirectly.

·       Direct Infection - Direct contact with urine, blood or tissues of infected animals, such as those working in laboratories, scientists, researchers, veterinarians, animal care workers, etc.

·       Indirect transmission – this is transmitted indirectly through various contaminations. This type of transmission occurs in three ways:

o   Skin cuts or abrasions, or prolonged exposure of the skin to water

o   Various mucous membranes, including the eyes, nose, and mouth

o   Drinking contaminated water or eating food that has been contaminated with the pathogen.

The Two phases of Leptospirosis

Leptospirosis has two distinct phases, and the onset of symptoms can occur between 2 to 30 days after infection. Typically, symptoms appear within 7 to 14 days after infection, and their severity ranges from mild to severe, and may even be fatal. The patient's symptoms can be divided into two phases:

·       Phase one - This phase is a direct result of the infection and lasts approximately a week. During this phase, patients may experience any of the following symptoms or a combination of symptoms:

o   High fever, chills, and flu-like symptoms

o   Headache, muscle or joint pain, back pain, abdominal pain, thigh pain, calf pain

o   Sore throat, chest pain

o   Cough, nausea, and vomiting

o   Red eyes, swollen conjunctiva

o   Loss of appetite, diarrhea

o   Rashes

o   Enlarged lymph nodes, liver, or spleen

·       Phase two - This phase is a result of the patient's own immunity, and patients with low immunity may experience severe complications, such as:

o   Swollen hands, feet, or ankles

o   Chest pain

o   Difficulty breathing, shortness of breath, arrhythmia

o   Meningitis

o   Eye inflammation, vascular inflammation, pneumonia, myocarditis

o   Jaundice

o   Acute renal failure

o   Coughing up blood

o   Bleeding in the lungs and other organs, leading to organ failure and life-threatening conditions.

Diagnosis and Treatment of Leptospirosis

Diagnosis of Leptospirosis:

Leptospirosis may present symptoms similar to other diseases such as colds, making it difficult to diagnose. A thorough diagnosis by a doctor is necessary, especially for patients who have recently been in contact with animals, freshwater sources, or in an area with a high prevalence of the disease. The doctor will perform a physical examination and send blood and urine samples for laboratory testing. Chest X-rays and other tests may be done for patients with severe symptoms.

Treatment of Leptospirosis:

Most cases of Leptospirosis heal on their own or with a course of antibiotics such as Penicillin or Doxycycline for 5-7 days. Pain relief medication like Ibuprofen or Paracetamol may also be prescribed. However, for patients with severe symptoms, hospitalization is necessary to receive intravenous antibiotics and other treatments, such as the use of a ventilator for respiratory distress or dialysis for kidney damage.

The duration of treatment depends on the severity of symptoms and the patient's response to medication. Pregnant women with Leptospirosis require close monitoring in the hospital to avoid infection spreading to the fetus.

Regenerative Response to Leptospirosis

Complications of Leptospirosis

Patients with severe Leptospirosis may experience a range of complications, with acute renal failure being the most common. In addition, serious pulmonary conditions like pulmonary hemorrhage can also occur, which can be fatal. Other potential complications may include:

o   Abortion in pregnant women

o   Thrombocytopenia

o   Liver failure

o   Blood clotting in the arteries

o   Stomach bleeding

o   Rhabdomyolysis (skeletal muscle breakdown)

o   Eye diseases like iritis

o   Respiratory emergencies in adults

o   Low blood pressure

o   Hemorrhagic cerebrovascular disease in the middle cerebral cortex encephalitis

o   Kawasaki disease

o   Allergic reactions that cause fever or rashes on the legs

o   Myocarditis

o   Heart attack

Preventing Leptospirosis

o   Maintain a clean living environment to prevent rodents or carriers from entering your home.

o   Avoid touching areas that are at risk of infection without wearing protective equipment, such as walking in water or working in water sources.

o   Wear protective clothing, such as boots, rubber gloves, and rubber shoes, when working with animals.

o   Immediately clean up after coming into contact with water that may be contaminated with bacteria.

o   If the patient is at home, there is no need to separate the bedroom. Just be careful about excretion. The patients should pour clean water and wash their hands after every errand. They should also avoid sexual intercourse and breastfeeding.

Contagious diseases that come with rain are common in Thailand. However, by following proper prevention measures, we can protect ourselves from these diseases. For Krungthai-AXA Life Insurance customers interested in healthcare, they can find additional health articles at https://www.krungthai-axa.co.th/th/health-advisories.

References

·       Synphaet Hospital
http://bitly.ws/CfNv

·       Siriraj Hospital
http://bitly.ws/CfNK

·       Phyathai Hospital
http://bitly.ws/CfNR

·       Bangkok Hospital
http://bitly.ws/CfNV

·       Pobpad website
http://bitly.ws/CfP4