The Sri Lanka Epidemiology Unit reports nearly 7,000 leptospirosis cases have been reported so far this year, prompting officials to issue a special notice to the public to remain vigilant to prevent a further increase in infections amid the expected rainy weather.
According to health officials, the highest numbers of leptospirosis cases reported so far this year have been recorded in the Ratnapura, Kegalle, Galle and Matara districts.
Health officials noted that leptospirosis cases generally increase during two periods of the year, from April to June and from September through January, coinciding with rainy seasons and agricultural activities.
The risk of infection is particularly high among farmers engaged in paddy cultivation and others involved in outdoor activities, especially during rainy periods and floods.
Leptospirosis is caused by the spirochete bacterium, Leptospira. It is transmitted through exposure to water or soil that has been contaminated with urine or bodily fluids from infected animals. The bacteria can survive in water or soil for weeks to months. Risk factors for infection include contact with contaminated water or soil, directly touching body fluids from an infected animal, and eating food or drinking water contaminated by the urine of an infected animal.
People usually contract leptospirosis through mucous membranes, open wounds or abrasions. High risk activities for transmission include swimming or boating in freshwater or floodwater that may be contaminated with animal urine; gardening, yardwork and outdoor cleaning/maintenance; hiking; and work or activities that include direct contact with animals or animal urine or other body fluids.
The incubation period after exposure is typically 5–14 days but can range from 2–30 days. Most patients present with a non-specific febrile illness. Symptoms commonly include fever, chills, body aches (especially in the calves and lower back), nausea, vomiting, diarrhea, abdominal pain, cough, conjunctival suffusion and sometimes, skin rash. Illness may be biphasic, and the patient may briefly recover, only to develop severe symptoms thereafter.
About 10% of cases progress to severe disease. Symptoms of severe disease include renal failure, pulmonary hemorrhage, jaundice, respiratory failure, meningitis, cardiac arrythmias and circulatory collapse. Weil’s disease is a severe manifestation of leptospirosis marked by renal and hepatic failure.
The severe form of leptospirosis is fatal in 5–15% of cases, and much higher when severe pulmonary hemorrhagic syndrome is present (>50%). Additionally, leptospirosis can cause complications in pregnancy, including spontaneous abortion or fetal death.
Prompt use of antibiotics may decrease the severity and duration of illness. In patients for whom there is a high clinical suspicion of leptospirosis, initiate antibiotic treatment before confirmatory test results are available. Oral doxycycline can be given for mild illness, and IV penicillin or ceftriaxone are indicated for severe disease.
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