Overview
Leptospirosis is an infection caused by Leptospira bacteria. It passes to people from animals, usually through water or soil contaminated with the urine of infected animals. It is a particular worry after heavy rain and floods.
Most people have no symptoms or only a mild, flu-like illness. A smaller number become seriously ill. The severe form, which affects the kidneys, liver and other organs, is often called Weil's disease. Treated early, it is much less likely to become severe.
Symptoms
Symptoms usually begin one to two weeks after contact, but can take up to a month. The early illness looks like flu:
- Fever and chills
- Headache
- Muscle aches, often in the calves
- Red eyes
- Nausea, vomiting or diarrhoea
- A rash, in some people
Some people seem to recover and then become ill again. This second stage can be serious, with yellow skin and eyes (jaundice), very little urine, breathing trouble, or a severe headache with a stiff neck. The early illness resembles dengue and malaria, so tell the doctor about any contact with dirty water or animals.
When to see a doctor
See a doctor soon for a fever, headache, body aches or red eyes after wading through floodwater, working with animals or cleaning drains. Say where you have been. work best when started early.
Causes
Leptospira bacteria live in the kidneys of many animals, including rats, cattle, pigs and dogs, and pass out in their urine. Infected animals may look healthy. The bacteria survive for weeks to months in the water and soil that the urine contaminates.
People are infected when contaminated water or soil gets into a cut, the eyes or the mouth, or when they swallow contaminated water or food.
Risk factors
- Wading, swimming or bathing in floodwater, ponds or canals
- Walking barefoot through waterlogged streets or muddy fields
- Work with animals, such as farming, dairy work or butchering
- Work in drains or sewers, or clearing up after floods
- Cuts or sores on the skin, and living where rats are common
Complications
Without treatment, leptospirosis can cause:
- Kidney damage or kidney failure
- Jaundice and liver failure
- Meningitis, an inflammation of the lining of the brain
- Breathing trouble, including bleeding in the lungs
- Failure of several organs, and death
Prevention
- Avoid wading or swimming in floodwater. If you must, wear waterproof boots and cover cuts with waterproof dressings
- Wash with soap and clean water after contact with floodwater, mud or animals
- Do not drink river, pond or canal water unless it has been boiled or treated
- Control rats around the home
- There is no for people. A doctor may advise a preventive antibiotic for someone at high risk, but it should not be started without that advice
Diagnosis
Doctors suspect leptospirosis from the symptoms and a history of contact with floodwater, animals or soil. Blood tests help to tell it apart from dengue, malaria and other fevers, and to check the kidneys and liver.
It is confirmed by PCR tests for the bacterium's genetic material, which work best in the first week, and by antibody tests, which turn positive after about a week. Treatment often starts before the results are back.
Treatment
are the main treatment and work best when started early. Mild illness is usually treated at home with tablets such as doxycycline, and the full course must be finished even after the fever settles.
Signs of kidney, liver, lung or brain involvement need hospital care, with antibiotics through a drip and support for any failing organ, including breathing support. Do not take painkillers or antibiotics on your own, because some medicines can strain the kidneys and liver.
Myths and facts
Things people often say about this. Open each one to see what is true.
Myth“Only rats spread it.”What is true?
Fact
Rats and mice are the best-known source, but cattle, pigs, dogs and other animals can carry the bacteria and pass them in their urine too, often without looking ill. The bacteria can live for weeks to months in water and soil that the urine has contaminated, so the water or mud can be the risk even when no animal is in sight.
Myth“You can only catch it if you have a cut and walk through the water.”What is true?
Fact
A cut is one way in, but the bacteria can also get in through the eyes or the mouth, or by swallowing water or food contaminated with infected urine. Working with sick or dead animals can spread it too.
Myth“Once the fever settles, the illness is over.”What is true?
Fact
In some people the fever eases and then returns as a second stage, which is the one that can affect the kidneys, liver or the lining of the brain. See the doctor again if you get worse, and finish the full course of antibiotics even when you feel better.
Myth“It spreads from person to person like flu.”What is true?
Fact
Spread between people is rare. People catch it from the urine of infected animals, or from water and soil that the urine has contaminated.
Questions to ask your doctor
Tick the ones you want answered and take them with you.
Common questions
Can I catch leptospirosis from my dog or from a rat bite?
It is very rare to catch it from pets, from other people or from bites. The bigger risk is contact with water or soil that animal urine has contaminated. Dogs can be vaccinated against it, but there is no vaccine for people.
How soon after wading through dirty water might I fall ill?
Illness usually starts within one to two weeks, but it can begin as early as two days or as late as a month. A fever in that period is worth showing to a doctor, and the doctor should be told about the contact.
Will I recover fully?
Most people recover within days or weeks. Severe illness needs hospital care, and the earlier treatment starts, the better the outlook. Without treatment, recovery can take months.
Should I take a preventive antibiotic after wading through floodwater?
Whether it helps depends on how much contact there was and on your own health, so ask a doctor. Do not start one on your own. Whatever you decide, see a doctor if a fever begins.
