Combatting Leptospirosis in the Philippines

Leptospirosis is an increasing issue affecting public health. Since it’s a disease masked in the guise of mild flu-like symptoms, it’s often overlooked by the public until it gets severe. So, to better raise awareness of this infection, it’s important to understand what leptospirosis is, its causes, symptoms, and the treatment and prevention techniques available. That way, you can protect yourself and your community from this affliction, and effectively help minimize the prevalence of leptospirosis in the Philippines.

What is Leptospirosis?

Leptospirosis is an infectious disease caused by bacteria belonging to the genus Leptospira. It’s an endemic in many countries across the world, often seen in tropical climate regions including the Philippines. Usually, leptospirosis is seasonal and only escalates with higher temperatures or as rainfall increases. However, the disease can occur throughout the year.

In the Philippines, leptospirosis continues to be an annual health problem. From the beginning of 2023 until July 1 alone, there has been a recorded 2,079 new cases of leptospirosis and 225 deaths. These numbers show an 83% increase from the cases that were documented in 2022.

The onslaught of this disease can be associated with changes in human behavior, water contamination by animals or sewage, changes in animal reservoir density, and natural disasters such as cyclones and floods. It’s known to primarily spread through animal-to-human transfer, with only rare cases of human-to-human infections.

How is Leptospirosis Transmitted?

Leptospires can gain entry into your body through cuts and abrasions in the skin, contact with your nose, mouth, and eyes, and through waterlogged skin. But exposure to or ingesting contaminated water, food, and soil from rats, cattle, pigs, horses, and dogs can still spread the disease. Because of this behavior, leptospirosis poses an occupational hazard for many people who work outdoors or with animals such as:

• Fish workers
• Dairy farmers
• Sewer workers
• Slaughterhouse workers
• Veterinarians and animal caretakers
• Grain and vegetable farmers
• Military personnel
• Mine workers

Other than that, this disease can also be associated with swimming, kayaking, wading, and rafting in contaminated rivers and lakes. So, it’s a recreational hazard if you’re a camper or if you participate in outdoor sports.

As mentioned earlier, human-to-human transfer of the disease is uncommon. However, infection of leptospirosis can still happen through sexual intercourse, transplacentally from a pregnant woman to the fetus, or through breastmilk to a child. It can also be transferred from the urine of a patient suffering from the disease or cultured from their blood––assuming the exposure happens during the first 7 to 10 days of the patient’s illness.

The Signs and Symptoms of Leptospirosis

Leptospirosis can manifest with a range of symptoms and its severity can vary. If you’ve been exposed to the bacteria, here are some of the symptoms to look out for:

• High fever
• Headache
• Chills
• Muscle aches
• Vomiting
• Jaundice (yellow skin and eyes)
• Red eyes
• Abdominal Pain
• Diarrhea
• Rash

As you may notice, many of these symptoms can be mistaken for other diseases. However, the difference between leptospirosis infection against other illnesses is in its progression.

The Phases of Leptospirosis

The time between your exposure to a contaminated source and becoming sick typically lasts two days to four weeks and occurs in phases:

1. Incubation Period (7-10 days)

   At this phase, the bacteria enters your body through cuts on your skin or through your mouth, eyes, and nose.

2. Septicaemic Phase (2-14 days)

   After the incubation period, you feel an abrupt onset of symptoms such as fever, headache, muscle pain, and nausea. In this phase, the Leptospira bacteria in your bloodstream move to your organs.

3. Interphase (1-3 days)

   During this stage, you can recover from the fever and other symptoms. However, there’s still a chance of them becoming more severe.

4. Immune phase (0-30 days)

   If your symptoms worsen, it’s possible for you to get Weil’s syndrome––which can cause kidney or liver failure, internal bleeding, or jaundice.

In most cases, leptospirosis is a self-limiting illness, and individuals recover with supportive care. However, critical forms of the disease such as leptospirosis hemorrhagic fever (LHF) and leptospirosis shock syndrome (LSS) can lead to life-threatening complications and require immediate medical intervention. It’s advisable to seek medical assistance if you’re symptoms are getting worse.

Diagnosing Leptospirosis

Checking for leptospirosis involves several methods to confirm the presence of the Leptospira bacteria. The usual tests doctors do are:

1. Clinical Evaluation

   Generally, healthcare providers start by assessing your symptoms, medical history, and potential exposure to contaminated environments. If you present with high fever, chills, redness of the eyes, headache, muscular pain, and yellow discoloration of the skin, they usually include leptospirosis in the diagnosis. However, it’s more difficult to check for the disease if you have a cough, difficulty breathing, nausea, vomiting, abdominal pain, diarrhea, joint pains, and a skin rash.

2. Blood Tests

   To confirm if you have leptospirosis, blood tests like enzyme-linked immunosorbent assay (ELISA) and polymerase chain reaction (PCR) are used to detect the genetic material of the Leptospira bacteria.

3. Urine Tests

   Urine tests, particularly the microscopic agglutination test (MAT), is used to identify the presence of Leptospira antibodies. It’s usually done hand-in-hand with the blood tests to ensure accurate results.

4. Culture

   In some cases, bacterial culture can be used to isolate and identify the Leptospira bacteria. But, this method can take several weeks to yield results––delaying the diagnosis.

Once your doctor receives your test results and confirms your leptospirosis infection, they can prescribe medications for you to combat the disease. With an accurate diagnosis, they can recommend treatment plans suited to your needs.

Available Treatments for Leptospirosis in the Philippines

The treatment of leptospirosis primarily involves supportive care and, in some cases, antibiotics. The main treatment options usually include:

Supportive Care

Managing the symptoms and complications of leptospirosis through supportive care is important for your recovery. This healthcare regimen includes hydration, pain relief, and extensive rest to ensure your healing.

As for pain relief treatments, you can use paracetamol to manage the pain and reduce the fever. However, nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin, ibuprofen, and Naproxen sodium must be avoided due to the risk of bleeding.

Antibiotics

In cases where leptospirosis is confirmed or strongly suspected, healthcare providers can prescribe you antibiotics such as doxycycline and penicillin. Early antibiotic treatment can help reduce the duration and severity of the disease. However, antibiotics are most effective when administered in the early stages of the leptospirosis.

Hospitalization

In severe cases, admission to a hospital is necessary. If you’re experiencing complications like acute kidney injury, liver damage, or pulmonary hemorrhage, aggressive supportive care with strict attention to fluid and electrolyte balance can help you manage the disease. Plus, critical conditions can involve treatments like blood transfusions, oxygen therapy, and other medical measures.

Monitoring

Regular monitoring of vital signs, kidney function, and other clinical parameters is crucial during the course of the disease. This helps healthcare professionals identify if your condition is worsening and intervene as needed.

Preventing Leptospirosis

Preventing and controlling leptospirosis involves a combination of your actions and public health measures. It can be a complicated task as it also depends on your environment’s conditions. Key prevention strategies that can help you include:

• Rodent Control: As much as possible, reduce the presence of rodents since they are common carriers of the Leptospira bacteria. This includes proper waste disposal, securing food sources, and using traps if necessary.
• Drainage: Ensure your house has proper drainage to minimize standing water that can become contaminated with urine from infected animals.
• Flood Mitigation: In flood-prone areas, tap your communities or local government units to implement flood control measures to prevent widespread contamination of floodwaters.
• Protective Clothing: When working or engaging in activities that involve contact with potentially contaminated environments, make sure to wear appropriate protective gear such as gloves, boots, and waterproof attire. This can limit your contact with infected areas.
• Hygiene: Practice good hygiene like regular handwashing with soap and water, especially before eating, after using the toilet, and after contact with contaminated surfaces. This can effectively remove bacteria from your skin, reducing the risks of disease affliction.
• Recreational Activities: Refrain from swimming, wading, or playing in floodwaters or areas where the water quality is questionable, especially during and after heavy rainfall.
• Food and Water Safety: Consume only properly cooked food and clean potable water to avoid ingestion of contaminated substances.
• Immediate Medical Attention: If you suspect that you’ve been exposed to contaminated water or develop symptoms of leptospirosis, seek immediate medical attention. Early diagnosis and treatment can significantly improve your infection’s outcomes.
• Veterinary Measures: Practice responsible pet ownership and ensure that your pets are vaccinated and free from leptospirosis. Since they can transmit to humans, it’s best to keep their vaccination records updated and keep your household disease-free.
• Drain and Clean: Regular cleaning and disinfection of potentially contaminated areas can minimize or eliminate the breeding grounds of Leptospira. Draining areas with stagnant water sources and cleaning areas with rodent activity can minimize the risk of contamination.

Leptospirosis is a widespread health concern with significant implications for affected individuals. In tropical regions like the Philippines where the environment is conducive to transmission, understanding the disease can collectively shield us from affliction. Through early diagnosis, appropriate medical care, and proactive implementation of these control and prevention strategies, you can contribute to the overall societal health efforts to combat leptospirosis.