Drats!
I was in my first year in college and classes were suspended because of the heavy rainfall. Wanting to go home early, I decided to brave the waters of Padre Faura to catch a jeepney ride home from Kalaw rather than wait for my sister at 5 p.m. Traversing the sidewalk of the Philam building, it got a little tricky midway to my destination. The water had risen to knee level, and I had to make sure to have a death grip on my rolled-up denim jeans, lest they get wet and add to the chilly feeling from the cool wind, which was further heightened by thoughts of what I could possibly get from the murky water, and the real possibility of disappearing into an open manhole. If this is giving you goosebumps, a younger colleague shared that my experience was nothing compared to hers. Her university was famous for being flood-prone. It was not uncommon for her to submerge herself in waist-deep water, and on occasion, have rats as travel companions happily swimming against the current.
Was leptospirosis top of mind for both of us? We don’t recall. What we knew then was that because we didn’t have any open wounds, we were safe. The fact that exposure of other mucosal surfaces was another avenue for getting the disease didn’t weigh as heavily as the first. Now that matters have gone from bad to worse, we should be aware so as to be better prepared. Even in the cushy confines of your car, in the event of flooding that causes roads to be impassable, the probability that you might have to abandon your vehicle in the name of safety is there.
So who can be deadlier, the two-legged vermin who have managed to crawl into the depths of the underground, or the four-legged ones who have become a part of your household? I leave you to decide and will choose to expend my energy toward the latter. It would be best to avoid getting into the cesspool of current events.
While I have written about this disease previously, it wouldn’t hurt to have a review.
What is leptospirosis? Leptospirosis is classified as a zoonosis, which simply means that infection can transfer from animals to humans. The causative agents are leptospires, which are organisms that have the ability to survive outside the host and cause a chronic carrier state in rodents. These are factors that contribute to its persistence and survival. Humans are dead-end and accidental hosts.
Is the Philippines endemic for the disease? Definitely. Unfortunately, despite being a reportable disease, we don’t have the exact incidence, largely because of the unavailability of data. Poor living conditions, inadequate sanitation, and may I add, the lack of urban planning, on top of having conducive weather conditions from increased rainfall, aggravated by global warming, make us highly vulnerable.
How does one get leptospirosis? While brown rat (Rattus norvegicus) are the culprits, other mammals can get infected and harbor the bacteria (i.e., pigs, dogs, cats, sheep, goats, buffaloes). Humans acquire infection from exposure of mucous membranes or non-intact skin to contaminated urine via soil or water, even through ingestion from contaminated water sources, or from direct contact with an infected animal’s body fluids or tissues. Epidemics have occurred from seasonal flooding and as an offshoot of natural disasters. The incubation period is usually from five to 14 days but may range from two to 30 days.
What are the signs and symptoms? Once infected, signs and symptoms may range from being mild to severe. Patients may present with non-specific signs, such as fever, myalgia, headache, rash, nausea, and vomiting, or present with jaundice, shock, myocarditis, decreased urine output, renal failure, or pulmonary hemorrhage. A history of exposure, conjunctival suffusion, calf and lumbar pain—which are quite distinct—increases the index of suspicion.
Is there treatment? Prompt recognition is crucial. While most cases are mild, severe cases may need fluid replacement therapy, dialysis, or even mechanical ventilation, in addition to appropriate antibiotics, which can shorten the duration of the illness.
What are preventive measures? Currently, there is no vaccine available for humans. Wear appropriate protective clothing and gear if the chances of exposure are high. Avoid engaging in activities that likewise increase the risk of exposure. If you have open wounds, wash thoroughly with soap and water after direct contact.
Who gets to receive post-exposure prophylaxis? Receipt of prophylaxis, as well as its duration, is dependent on the level of exposure, whether low, moderate, or high, as well as the age of the patient. It is important to note that prophylaxis is not a guarantee that infection may not occur.
Seek an early and immediate consult with health professionals and avoid self-prescription, which may be detrimental.
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timgim_67@yahoo.com
