Source: La Voz del Sandinismo
Leptospirosis
Erin Paul
Objectives
• Analyze an epidemic in Nicaragua for lessons
about dealing with leptospirosis in
emergencies and humanitarian crises.
• Describe the most common symptoms of the
infection
• Describe diagnosis techniques and treatment
• Name public health interventions to prevent
transmission
Recent Outbreaks in Nicaragua (1995, 2007, 2010)
• Three original patients with
pulmonary hemorrhaging
died.
• Doctors at the local Health
Center thought it was
dengue hemorrhagic fever.
• Other patients with high
fever, muscle aches,
headache, vomiting, and
diarrhea
• During hurricane season
after particularly heavy rains
Flooding before 2007 outbreak
Source: La Prensa
Leptospirosis
• Zoonotic disease passed from
many kinds of wild and domestic
animals
• Caused by a type of bacteria
called a spirochete (leptospira
interrogans)
Source: Dr. Scott Smith
History of the disease
• Severe form of
leptospirosis studied
by Adolf Weil
• Bacteria identified
by Stimson
• Some evidence that
incidence is
increasing
Photo of Adolf Weil. Source: Wikipedia Creative
Commons
Epidemiology
Source: cabi.org
Transmission
Symptoms
• Many cases are relatively
mild
• Fever, muscle and bone
pain, headache
• Conjunctival suffusion
indicates leptospirosis
• Severe form also known as
Weil’s disease
• Pulmonary problems are not
common
• Renal and liver failure in
severe cases
Differential Diagnosis
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Dengue
Malaria
Rickettsial disease (spotted fever)
Scrub typhus
Typhoid fever
Hantavirus
Influenza
Diagnosis
• Diagnosis via ELISA
or MAT tests
• Dipstick test
– Leptospira found in
blood for 7 – 10 days
– Then leptospira
move to the kidneys
and can be found in
urine
Source: Clpmag.com
Treatment – Hospitalized patients
• Penicillin is the antibiotic of choice
– 6 million units per day
– Alternatives include doxycycline, ceftriaxone,
cefotaxime.
• For children <8 years
– Azithromycin
– Clarithromycin
• Supportive care for dehydration, hypotension,
hemorrhage, etc.
Treatment -- Outpatients
• For outpatients (who can tolerate oral medications):
• Doxycycline 100 mg twice daily orally, for 10 days
– Not for children under 8 or pregnant women
– Amoxicillin 25 – 50 mg/kg divided in three doses
for children/pregnant women
• For patients allergic to penicillin:
– Erythromycin 250 mg, 4 times a day for 5 days
Treatment
• Give doxycycline to people at a high risk for a short
period of time
• Tetracycline is no longer recommended
– Contraindicated with renal insufficiency
– Renal insufficiency common in severe
leptospirosis
• Treat with doxycycline if rickettsial diseases are also
endemic
Prevention
• Public health measures
– Vector control (rodent control)
– Improved sanitation
• Storm water drainage in urban
areas
• Garbage management
– Disinfection of potable water
supplies
• Education for high risk
occupations
– Sewer workers, butchers, etc.
• Avoid contact with flood
waters and don’t swim in
areas that may be
contaminated
Relevant Sphere Standards to Control Leptospirosis
• Water quality
• Excreta disposal
• Solid waste
management
• Drainage
Sanitation and Hygiene Education
Challenges
• No highly effective, widely available vaccine
for humans
• Leptospirosis is frequently confused with
other illnesses
• Rapid diagnostic tests have low sensitivity
• Prevention is difficult
Conclusions – Leptospirosis in Complex Humanitarian Crises
• Most common symptoms are fever, headache,
jaundice
• Frequently follows heavy rains
• Treat with penicillin or doxycycline
• Control rodents and treat drinking water for
prevention
References
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Clark, L. G. et.al., “Leptospirosis in Nicaragua: A Preliminary Report After the
First Year of Study.” American Journal of Tropical Medicine and Hygiene 15
(1966): 735 -742.
Effler, Paul V. et.al. “Evaluation of Eight Rapid Screening Tests for Acute
Leptospirosis in Hawaii.” Journal of Clinical Microbiology 40 (2002): 1464 –
1469.
Epino, Henry. Personal Communication. 03/08/2012.
Everett, E. Dale. “Microbiology, Epidemiology, Clinical Manifestations, and
Diagnosis of Leptospirosis.” Up-to-Date. Online database. Mar 23, 2010.
Everett, E. Dale. “Treatment and Prevention of Leptospirosis.” Up-to-date.
Online database. Accessed 03/04/2012.
Faine, S. et. al. Leptospira and Leptospirosis. Melbourne: MediSci, 1999.
Farr, R. Wesley. “Leptospirosis.” Clinical Infectious Diseases 21 (1995): 1-6
“Leptospirosis Burden Epidemiological Reference Group”. World Health
Organization. Website. Accessed 03/01/2012.
References, cont.
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Levett, Paul. N. “Usefulness of Serologic Analysis as a Predictor of the Infecting
Serovar in Patients with Severe Leptospirosis.” Clinical Infectious Diseases 32
(2003): 447-452.
Melghem, Lorena. Escuela y Casa Saludable: Una Experiencia Exitosa en
Honduras. World Bank Water and Sanitation Program, 2003.
“Outbreak of Acute Febrile Ilness and Pulmonary Hemorrhage – Nicaragua,
1995.” Journal of the American Medical Association 974 (1995): 1668.
Ren, Shuang Xi, et.al. “Unique Physiological and Pathogenic Features of
Leptospira Interrogans Revealed by Whole Genome Sequencing.” Nature 422
(2003): 888-893.
The Sphere Project: Humanitarian Charter and Minimum Standards in
Humanitarian Response. The Sphere Project. 2011.
Zaki, S.R. and Shieh, W.J. “Leptospirosis Associated with Outbreak of Acute
Febrile Illness and Pulmonary Hemorrhage – Nicaragua, 1995.” The Lancet 347
(1996): 535 – 536.