Published Date: 2009-02-07 13:00:46
Subject: PRO/AH/EDR> Leptospirosis - Fiji (02)
Archive Number: 20090207.0554
LEPTOSPIROSIS - FIJI (02)
A ProMED-mail post
ProMED-mail is a program of the
International Society for Infectious Diseases
Date: Sat 07 Feb 2009
Source: Fiji Times Online [edited]
There have been 2 confirmed deaths [from] leptospirosis with a 3rd
unconfirmed at this stage. Health Ministry permanent secretary Dr.
Sala Saketa said it was likely the 3rd death was due to
leptospirosis. Dr Saketa said there have been 9 cases of
leptospirosis reported in the country.
She said those who died were adults and were originally from Nadi but
died at Lautoka Hospital. "Leptospirosis is a disease that can kill
people if they are not treated as early as possible," she said. She
said the ministry was always concerned and trying to control these
diseases even though this is the disaster-free period. Dr. Saketa
said these conditions could occur during this time.
She's advising the public to see a doctor as soon as they feel unwell
with symptoms such as fever, generalised body pains or severe back
pain. "If people go to the doctors early, they can be treated before
the complications occur," she said. She said the complications
related to leptospirosis include kidney and liver failure. "It goes
to all parts of the body so if they are not treated early they can
die," she said.
She urged the members of the public, particularly those in
flood-affected areas, to see a doctors as soon as they fall sick.
[Byline: Riteshni Singh]
[The following is extracted from Mod.ML's comments on leptospirosis
in ProMED-mail Leptospirosis - China (Hong Kong) 20070821.2725:
"The initial [non-specific] symptoms are abrupt onset of chills,
fever, myalgias -- most prominently in the calves and back -- cough,
nausea, vomiting, diarrhea, and headache. Conjunctival suffusion and
muscle tenderness may characteristically occur. A 2nd phase of the
disease may occur after a short period of relative well-being that is
thought to result from an immunologic response to the infection and
presents with aseptic meningitis, myocarditis with arrhythmias,
hemorrhagic pneumonia, uveitis, nephritis and hepatitis. More than 90
percent of patients have a self-limited illness, but some develop a
more severe illness with renal and hepatic failure (Weil's disease)
that may be fatal in 5-40 percent. Early treatment, initiated as soon
as the diagnosis is suspected, for example, based on clinical and
epidemiologic findings and a presumptive positive result for
leptospirosis on a serological assay, can reduce duration and
severity of symptoms.
Leptospirosis is usually treated with penicillin or ceftriaxone
intravenously for severe disease and doxycycline or amoxicillin for
milder disease; penicillin therapy may be complicated by a
Jarisch-Herxheimer reaction. Efficacy of antibiotic therapy when used
late in the course of the disease may be limited by the immunologic
causation of the 2nd phase of this illness."
For a review of leptospirosis, see Levett PN: Leptospirosis. Clin
Microbiol Rev 2001;14:296-326 (<http://cmr.asm.org/cgi/content/full/14/2/296>).
Because most patients with leptospirosis have mild, self-limited
disease, the fact that there are 2 confirmed deaths due to
leptospirosis in Fiji suggests that there is a large, as yet
unrecognized, leptospirosis outbreak.
Doxycycline (200 mg orally, once weekly) has been shown to be
effective for short-term prophylaxis in high-risk environments
(Takafuji ET, Kirkpatrick JW, Miller RN, et al. An efficacy trial of
doxycycline chemoprophylaxis against leptospirosis. N. Engl. J. Med.
1984; 310:497-500, available at
For the interactive HealthMap/ProMED map of Fiji with links to other
recent ProMED-mail reports on events of interest in Fiji and
neighboring countries, see
<http://healthmap.org/promed/en?v=-18,178,5>. - Mod.MPP]