Leptospirosis is a disease caused by bacteria Leptospira. These bacteria can be spread through the urine or blood of infected animals. Some animals that can be an intermediary for the spread of leptospirosis are rats, cattle, dogs, and pigs.
Leptospirosis is spread through water or soil that has been contaminated with the urine of animals carrying the bacteria Leptospira. A person can get leptospirosis, if exposed to the urine of these animals, or contact with water or soil that has been contaminated.
Leptospirosis has symptoms similar to the flu. However, if not treated properly, leptospirosis can cause damage to internal organs, even life threatening.
Causes of Leptospirosis
Leptospirosis is caused by bacteria Leptospira interrogans carried by animals. Leptospira can live for several years in the kidneys of these animals without causing symptoms.
Some animals that can be a means of spreading bacteria Leptospira is:
- Dog
- Pig
- Horse
- Cow
- Mouse
While in the animal's kidney, bacteria Leptospira at any time can be out with urine so that it contaminates water and soil. In the water and soil, bacteria Leptospira can last for months or years.
Transmission to humans can occur as a result of:
- Direct contact between the skin and the urine of animals carrying bacteria Leptospira
- Skin contact with water and soil contaminated with animal urine carrying bacteria Leptospira
- Eating food contaminated with animal urine carrying bacteria that cause leptospirosis
Bacteria Leptospira can enter the body through open wounds, both small wounds such as abrasions, or large wounds such as lacerations. These bacteria can also enter through the eyes, nose, mouth, and digestive tract.
Leptospirosis can be transmitted between humans through breast milk or sexual contact, but these cases are very rare.
Leptospirosis risk factors
Leptospirosis is commonly found in tropical and subtropical countries, such as Indonesia. This is because the hot and humid climate can make bacteria Leptospira survive longer. In addition, leptospirosis is also more common in individuals who:
- Spends most of his time outdoors, like miners, farmers, and fishermen
- Frequent interactions with animals, such as breeders, veterinarians, or pet owners
- Have a job related to sewers or sewers
- Live in a flood prone area
- Often do sports or water recreation in the wild
Symptoms of Leptospirosis
In some cases, the symptoms of leptospirosis do not appear at all. However, in most patients, symptoms of this disease appear within 2 days to 4 weeks after exposure to the bacteria Leptospira.
Symptoms of leptospirosis vary greatly from patient to patient and are often initially thought of as symptoms of another illness, such as the flu or dengue fever. Early signs and symptoms that appear in patients with leptospirosis include:
- High fever and chills
- Headache
- Nausea, vomiting and no appetite
- Diarrhea
- Red eye
- Muscle pain, especially in the calves and lower back
- Stomach ache
- Red spots on the skin that don't go away when pressed
The above complaints usually recover within 1 week. However, in some cases, the patient may develop a second stage of leptospirosis, known as Weil's disease. This disease occurs due to inflammation caused by infection.
Weil's disease may develop 1-3 days after symptoms of leptospirosis appear. Complaints that appear vary, depending on which organs are infected. Symptoms and signs of Weil's disease include:
- Fever
- Jaundice
- Difficult to urinate
- Swelling of the hands and feet
- Bleeding, such as nosebleeds or coughing up blood
- Chest pain
- Hard to breathe
- Heart pounding
- Weak and cold sweat
- Headache and stiff neck
When to go to the doctor
Consult a doctor if you experience the symptoms mentioned above. Symptoms of leptospirosis are sometimes similar to the symptoms of other infectious diseases, so an examination is necessary to determine the exact cause before complications occur.
Go to the emergency room immediately if you experience more severe symptoms of leptospirosis, such as jaundice, difficulty urinating, swollen hands and feet, chest pain, shortness of breath, and coughing up blood.
If you are diagnosed with leptospirosis, have regular check-ups during treatment. The goal is for doctors to monitor the progress of the disease condition and the success of therapy.
Diagnosis of Leptospirosis
To diagnose leptospirosis, the doctor will ask the patient's complaints and symptoms, as well as the patient's medical history. The doctor will also ask about the travel history, the patient's living conditions, and the activities the patient has done during the past 14 days.
Next, the doctor will perform a thorough physical examination and several supporting tests to confirm the diagnosis and determine the severity of leptospirosis. These supporting tests include:
- Blood tests, to check liver function, kidney function, and white blood cell levels
- Test Enzyme-linked immunosorbent assay (ELISA) or rapid test, to detect antibodies in the body
- Polymerase Chain Reaction (PCR), to detect the presence of bacterial genetic material Leptospira in the body
- Microscopic agglutination test (MAT), to confirm the presence of antibodies specifically associated with bacteria Leptospira
- Scanning with CT Scan or Ultrasound, to see the condition of organs that may be affected by inflammation due to leptospirosis infection
- Blood and urine cultures, to confirm the presence of bacteria Leptospira in blood and urine
Leptospirosis Treatment
Leptospirosis infections generally do not require special treatment. In mild conditions, leptospirosis infection can heal by itself in seven days. Treatment is generally aimed at relieving symptoms and preventing complications.
The following are some treatment steps that can be taken for people with leptospirosis:
Administration of drugs
If symptoms have arisen, the doctor will give medicines to relieve symptoms and to treat bacterial infections. Some of the drugs that will be given are:
- Antibiotic drugs, such as penicillin, amoxicillin, ampicillin, doxycycline, or azithromycin
- Fever-lowering and pain relievers, such as paracetamol or ibuprofen
Hospital treatment
Hospitalization is carried out when the infection has progressed to more severe and attacks the organs (Weil's disease). In this condition, antibiotics will be given through an IV.
In addition, doctors can also perform the following additional treatments:
- Fluid infusion, to prevent dehydration in patients who cannot drink a lot of water
- Giving vitamin K, to prevent bleeding
- Installation of a ventilator, if the patient has respiratory failure
- Monitoring of the work of the heart
- Blood transfusion, if there is heavy bleeding
- Hemodialysis or dialysis, to help kidney function
The chances of recovering from Weil's disease depend on the organ affected and its severity. In patients with severe leptospirosis, death can occur due to bleeding or from complications in the lungs or kidneys.
Complications of Leptospirosis
Although it can get better on its own, untreated leptospirosis can lead to Weil's disease. Complications that can occur due to Weil's disease include:
- Acute kidney injury
- Thrombocytopenia
- Gastrointestinal bleeding
- Lung bleeding
- hemorrhagic stroke
- heart failure
- Kawasaki disease
- Rhabdomyolysis or skeletal muscle breakdown
- Chronic uveitis
- Blood clots scattered all over the body
- ARDS or acute respiratory distress syndrome
- Septic shock
- Heart failure
- Miscarriage in pregnant women
Prevention of Leptospirosis
There are several ways that can be done to prevent and reduce the risk of spreading leptospirosis infection, namely:
- Wear protective clothing, gloves, boots and eye protection when you work in areas where there is a risk of transmitting bacteria Leptospira
- Cover the wound with a waterproof plaster, especially before coming into contact with water in the wild
- Avoid direct contact with contaminated water, such as swimming or bathing
- Consuming clean drinking water
- Wash your hands before eating and after coming into contact with animals
- Keeping the environment clean and ensuring the home environment is free from mice
- Vaccination of pets or livestock