Published Date: 1997-10-31 23:50:00
Subject: PRO/AH/EDR> Leptospirosis - India (Valstad & Surat)
Archive Number: 19971031.2218

LEPTOSPIROSIS - INDIA (VALSTAD & SURAT)
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A ProMED-mail post

See Also

Leptospirosis, human mortality - India (Gujarat) 970829151704

[1
Date: Mon, 27 Oct 97 16:26:39 GMT
From: owner-wer-reh@sun1.who.ch
WHO WER and Epidemiological Bulletin E.Mail subscription service
Item(s) published on World Wide Web
(<http://www.who.ch/programmes/emc/news.htm>)

27 October 1997
Leptospirosis in India

In 1997 leptospirosis spread to Surat district Gujarat State from Valsad
district south of Surat where the diseases has been reported for many
years. Cases started occurring in mid-July. As of 11 September, 281 cases
and 34 deaths (case-fatality rate, CFR 12%) had been reported in Valsad
district and 132 cases with 14 deaths (CFR 11%) in Surat district. Cases
are still being reported. Investigations at the Medical College, Surat
showed that more than 40% of the clinically suspected cases had IgM
antibodies and almost 60% of cases tested at the National Institute of
Communicable Diseases in Delhi had IgG antibody.
Virtually all the patients are adults and from rural areas; 60% are males.
Almost all families and most of the affected villages have reported only
single cases. Valsad, Chikhali and Gandevi taluks in Valsad district, and
Vyara and Mahuva taluks in Surat district are the worst affected areas.
However, a high rate of seropositivity detected in persons without any
illness or only mild fever in the last 3 months, also in villages
considered unaffected during the present outbreak, indicates that the
infection is much more extensive and widespread. Based on a report from the
National Institute of Communicable Diseases, Delhi, India.
--
ProMED-mail
promed@usa.healthnet.org
[My WHO informant tells me that they still have not received any
information on the serovar or serovars involved and animal source(s).
Further information is sought from informed ProMED members.
The above report is sparse and not yet complete. From the brief information
supplied it strikes me that we have an occupational exposure related to a
specific form of agriculture, which does not involve large numbers of
children. The 40F:60M sex ratio could depend on the sample size (small) or
be real. It would really help to know the serovar(s) as that would explain
much. Outbreaks of leptospirosis can be weather dependent (ie rainfall &
water temp.) such that chronic background exposures / shedding can suddenly
become very dangerous. A common rural form of epidemic leptospirosis in hot
climates is related to sugarcane harvesting ... firstly, preharvest burning
of the cane fields drives infected rodents into nearby villages and farm
buildings to be followed a week or so later by human and peridomestic
animal clinical cases of leptospirosis; then the cane cutters get infected
when harvesting the cane (aided by cuts on arms and legs from the cane)." -
Mod. MHJ

[2
Date: Mon, 27 Oct 1997 08:36:30 -0400
From: Dorothy Preslar <dpreslar@fas.org>
Source: Media sources [edited

October 14, 1997
The blood sample of a 12-day-old baby admitted to a private hospital in
Chennai for birth-related complications was sent to the Lister Laboratory
for analysis. When the investigations showed positive for leptospirosis,
the laboratory director immediately called the doctor concerned and alerted
him about the infection so that treatment could be started straightaway.
Twenty-four hours later, even as the doctors debated whether the baby
should be given antibiotics for treating leptospirosis, the infant died.
While leptospirosis does not always develop into Weil's Disease, it is
important to start treatment as soon as possible to prevent deaths from the
latter condition.
In the initial stages there are no antibodies. The diagnosis for
leptospirosis is done first by the dark field microscopy for the presence
of leptospires. The second stage is to use the microscopic agglutination
test for antibodies. The latter will not appear in the early part of the
illness. But unfortunately, many doctors depend only on the MAT test,
which gives a negative in the early stage.
Diagnosis is further confused because with the incidence of malaria and
typhoid being high in India, most doctors not only look for these diseases
in the investigations they ask for, but also start putting the patients on
antibiotics straight away. But leptospirosis in such patients can then be
missed because the antibiotics will blunt the response of the laboratory
tests to initially demonstrate leptospires or the later antibodies.
The increase in incidence is claimed to be "the problem of infrastructure
... flooded streets and pools of stagnant water everywhere. Add to this
people using streets like open toilets and you have the perfect combination
of factors which cause leptospirosis. Till we cease to have problems of
infrastructure, just like malaria and the mosquitoes, this problem too will
remain."
Comprehensive information on leptospirosis/Weil's disease is available on
.
--
Dorothy Preslar
ProMED-mail
[When in Jamaica last year, similar concerns were voiced to me by their
senior public health officials of the local hospital physicians missing
leptospirosis (Weil's) cases with lethal consequences. Leptospirosis is a
relatively common condition on that island, especially in the rural areas.
Perhaps those better informed than I can provide guidance on how to provide
rapid & reliable early diagnosis of this infection in humans and
appropriate actions to facilitate clinical implementation. - Mod.MHJ
..............................................dp/mhj/es
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