Leptospirosis and other waterborne diseases

CEBU, Philippines – With the current rainy season, aggravated by the string of weather disturbances, flooding has become quite commonplace, especially in densely populated areas. In Cebu City, in

particular, school and businesses frequently get interrupted during even just light drizzles as the streets quickly get flooded. But the

inconvenience caused on the life routines of the city is not the whole story.

The problem of waterborne diseases soon follows. It's not only the skin diseases that often result from immersing in dirty floodwaters that people should be on guard against. A host of other diseases emerge when contaminated water is used for various purposes, like drinking, making ice cubes, washing uncooked fruits and vegetables, making baby formula, brushing teeth and washing dentures or contact lenses.

The possible outcomes are Travellers' Diarrhea, Giardia and Cryptosporidium, Dysentery, Salmonella, Escherichia coli (E. coli), Typhoid Fever, Cholera, Hepatitus A and E, Campylobacter and others. But what has of late been the most popular scare is leptospirosis, from bacteria spread through the urine of infected animals - especially rats - and carried by floodwaters. The bacteria can get into the water or soil and can survive there for weeks to months.

Aside from rats, the leptospirosis bacteria can also infect cattle, pigs, horses, dogs and wild animals. But when these animals are infected, they may have no symptoms of the disease. Infected animals may continue to excrete the bacteria into the environment for a few months up to several years.

Humans can become infected through contact with urine (or other body fluids, except saliva) from infected animals, contact with water, soil, or food contaminated with the urine of infected animals. The bacteria can enter the body through skin or mucous membranes (eyes, nose, or mouth), especially if the skin is broken from a cut or scratch.

Drinking contaminated water can also cause infection. But outbreaks of leptospirosis have often been traced to contaminated floodwaters. Person to person transmission is rare.

In humans, leptospirosis can cause a wide range of symptoms, including high fever, headache, chills, muscle aches, vomiting, jaundice (yellow skin and eyes), red eyes, abdominal pain, diarrhea, and rash. Many of these symptoms can be mistaken for other diseases. In addition, some infected persons may have no symptoms at all.

The time between a person's exposure to a contaminated source and becoming sick is two days to four weeks. Illness usually begins abruptly with fever and other symptoms. Leptospirosis may occur in two phases. After the first phase - with fever, chills, headache, muscle aches, vomiting, or diarrhea - the patient may recover for a time but become ill again. The second phase, once it occurs, is more severe; the person may have kidney or liver failure or meningitis. This phase is also called Weil's disease.

The illness lasts from a few days to three weeks or longer. The treat is with antibiotics, such as doxycycline or penicillin, given early in the course of the disease. Intravenous antibiotics may be required for persons with more severe symptoms. Without treatment, recovery may take several months. Thus, persons with symptoms suggestive of leptospirosis should contact a health care provider immediately.

The risk of acquiring leptospirosis can be greatly reduced by not swimming or wading in water that might be contaminated with animal urine, or eliminating contact with potentially infected animals. Protective clothing or footwear should be worn by those exposed to contaminated water or soil because of their job or recreational activities.

Leptospirosis has also been associated with swimming, wading, kayaking, and rafting in contaminated lakes and rivers. As such, it is a recreational hazard for campers or those who participate in outdoor sports. The risk is likely greater for those who participate in these activities in tropical or temperate climates. In addition, incidence of Leptospirosis infection among urban children appears to be increasing.

To keep away from other waterborne diseases, take precautions as applicable when faced with any water that may be unsafe. Don't trust bottled water. Reports of locals filling bottles with tap water, sealing and then selling as purified water have come out.

If you're visiting or living in an area with poor sanitation, be especially wary of the water.

If your local Medical Health Officer has issued a Boil Water Advisory for your community, take the advice seriously.

Do not drink untreated water from a spring, stream, river, lake, pond or shallow well. Assume it is contaminated with animal, bird or human feces; disinfect by boiling for five minutes. Ask for drinks without ice unless the ice is made from clean bottled or boiled water. Avoid popsicles and flavored ices that may have been made with contaminated water.

In many places, the food can be as risky as the water. Avoid eating raw fruits and vegetables unless peeled in your presence. Avoid raw milk and products made from raw milk. Drink only pasteurized or boiled milk.

Practice good hygiene such as frequent hand washing and disinfection of cutlery, cutting boards, etc. Wash hands thoroughly and frequently using soap, in particular after contact with pets or farm animals, or after having been to the toilet.

Remember: Prevention is much easier than seeking medical treatment once infected.

(Main References: www.cdc.gov; globalhydration.com)