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Leptospirosis is a spirochetal infection present worldwide but more common in tropical climates. Leptospirosis is actually a group of infections caused by the leptospira bacteria that includes Weil's syndrome, infectious (spirochetal) jaundice, and canicola fever.

Leptospirosis infects a variety of wild and domestic animals that excrete the organism, mainly in their urine. Some animals act as carriers and shed the bacteria in their urine, others become ill and die. Humans can become infected through exposure to water or soil contaminated by the infected urine. This may occur with canoeing, kayaking, wading and swimming in contaminated, untreated, open water.

Although leptospirosis is an occupational disease of farmers, sewer and slaughterhouse workers, most people become infected through coming into contact with contaminated water. Infection may occur through a cut in the foot or other part of the body, or in rare cases through rat bites.

There is no vaccine available to prevent leptospirosis. Minimize risk by immunizing domestic animals and controlling their access to water supplies. Travelers who might be at an increased risk for the disease should wear protective clothing and minimize contact with potentially-contaminated water. Such travelers also might benefit from chemoprophylaxis with doxycyline.

Prevalence in Indonesia

Significant increased risk occurs during times of flood. A rise in cases was seen following the February 2007 floods in Jakarta.

In Indonesia, there was an outbreak in Kalimantan traced to consumption of soft drinks. It was thought that the urine of rats soaked through cardboard box onto the cans and then into the mouth of people who did not wipe the top of their cans. Because leptospirosis typically causes vague flulike symptoms, many cases probably go unreported.

Hikers and other eco-tourists need to be especially careful if they develop sores on their feet, and be wary when they cross streams or standing water in rural areas.

Symptoms and Diagnosis

Infection may cause no symptoms. If symptoms do occur, people usually develop symptoms within 2 to 20 days of becoming infected with the leptospira bacteria. Symptoms may be mild (fever, headache, chills and severe muscle pains, nausea, diarrhea, cough and conjunctival redness) or more severe, including Weil's syndrome.

Symptoms involving the lungs (including the coughing up of blood) occur in 10 to 15 percent of infected people. Episodes of chills and a fever of 102° F often continue for 4 to 9 days. Pinkeye appears on the third or fourth day.

The fever clears for a few days, but reappears together with other symptoms between the sixth and twelfth day. At this time, inflammation of the lining of the brain (meningitis) usually occurs and other symptoms due to inflammation such as a stiff neck, headache, and occasionally stupor and coma may result. A pregnant woman who becomes infected with leptospirosis may miscarry.

Weil's syndrome is a severe form of leptospirosis that causes a continuous fever, stupor, and a reduced ability of the blood to clot, which leads to bleeding within tissues. This syndrome begins as the less severe forms of leptospirosis do, then progresses to jaundice, renal failure, neurologic disorders and hemorrhage. In more severe cases, patients may develop lung infection and circulatory collapse. Blood tests reveal anemia, and by the third to sixth day, signs of kidney damage and liver injury appear. Kidney abnormalities may cause painful urination or blood in the urine. Liver injury tends to be mild and usually heals completely.

A doctor can confirm the diagnosis of leptospirosis by identifying the bacteria in cultures of blood, urine, or cerebrospinal fluid samples or, more commonly by detecting antibodies against the bacteria in the blood.

Prognosis and Treatment

Infected people who don't develop jaundice usually recover. Jaundice indicates liver damage and increases the death rate to 10 percent or higher in people over age 60.

The antibiotic doxycycline can prevent the disease during an outbreak. Penicillin, ampicillin, or similar antibiotics are given to treat the disease. In severe cases, antibiotics may be given intravenously. People with the disease don't have to be isolated, but care must be taken when handling and disposing of their urine.

For more information, consult the Center for Disease Control.

If you have medical-related questions about living in Indonesia to ask of medical professionals, see Ask the Experts.

We trust this information will assist you in making correct choices regarding your health and welfare. However, it is not intended to be a substitute for personalized advice from your medical adviser.

Our appreciation to Dr. Andrew Jeremijenko of International SOS, an AEA Company who has contributed this article in response to a health threat faced by expatriates in Indonesia.

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