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Published Date: 2011-07-16 14:31:42
Subject: PRO/AH/EDR> Leptospirosis - Philippines: (Manila, ZN)
Archive Number: 20110716.2154

LEPTOSPIROSIS - PHILIPPINES: (MANILA, ZAMBOANGA DEL NORTE)
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A ProMED-mail post
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International Society for Infectious Diseases
http://www.isid.org

******
[1]
Date: Tue 12 Jul 2011
Source: Examiner.com [edited]
http://www.examiner.com/infectious-disease-in-national/manila-hospital-reports-6-leptospirosis-deaths-so-far-this-month

With leptospirosis cases skyrocketing in the Philippines due to
flooding throughout the archipelago, health officials are expressing
alarm over the outbreak and warning citizens to avoid floodwaters or
take precautions if they can't avoid it.

Officials from the San Lazaro Hospital in Manila reported Tuesday [12
Jul 2011] that they have seen 6 people die due to the bacterial
disease since 1 Jul 2011. The hospital has seen 37 total cases in the
time frame.

The outbreak is large and growing. ABS-CBN News reports that Dr.
Lyndon Leesuy, program director of the Department of Health (DOH)
Emerging and Re-emerging Infectious Diseases, said a total of 521
leptospirosis cases and 38 deaths were reported from 1 Jan to 25 Jun
2011.

The Philippines health department is warning citizens of the
bacterial dangers that lurk in the floodwaters and what can be done to
prevent potentially deadly infection. Health officials are advising
people to not to wade in floodwaters or if it cannot be avoided, to
wear protective gear like rubber boots to prevent leptospirosis.

Leptospirosis is a bacterial zoonotic disease caused by the corkscrew
shaped organism, _Leptospira interrogans_. It goes by several other
names depending on the locale; mud fever, swamp fever, sugar cane and
Fort Bragg fever, among others. It is a disease of both humans and
animals.

The rat is the main carrier of _Leptospira_. However, other animals,
such as cattle, pigs, horses, and dogs, [can also be asymptomatic
carriers]. People become infected by direct or indirect contact with
the urine of these animals. Contact with urine-contaminated water is
extremely important. Contaminated food and soil containing animal
urine are other potential sources of infection. The bacterium enters
through contact with skin. Especially through cuts or breaks in the
skin and through mucous membranes like the eyes. Found worldwide, it
was long considered an occupational disease (miners, farming, vets,
and sugarcane harvesting and sewer workers); it is increasingly
associated with recreational water sports and camping.

The symptoms and disease if present appear in up to 4 weeks after
exposure. Sometimes the person will show no symptoms or mild flu-like
symptoms. According to the Centers for Disease Control and Prevention
(CDC), Leptospirosis may occur in 2 phases; after the 1st phase, with
fever, chills, headache, muscle aches, vomiting, or diarrhea, the
patient may recover for a time but become ill again. If a 2nd phase
occurs, it is more severe; the person may have kidney or liver failure
(jaundice) or meningitis. This phase is also called Weil's disease.

The infection can be treated with antibiotics (penicillin and
doxycycline), especially if started early in the disease. For very ill
patients, intensive care support and intravenous (IV) antibiotic may
be necessary.

[Byline: Robert Herriman]

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

******
[2]
Date: Fri 15 Jul 2011
Source: Philippine Daily Inquirer [edited]
http://newsinfo.inquirer.net/24327/'mystery'-disease-in-zamboanga-del-norte-identified-as-leptospirosis

Health officials have finally identified what was earlier thought to
be a mysterious disease that killed at least 4 people in a fishing
village in Sibuco, Zamboanga del Norte, over the last few months. [see
ProMED-mail Undiagnosed disease, fatal - Philippines: (ZN)
20110703.202 and Undiagnosed disease, fatal - Philippines (02): (ZN)
20110707.2053.]

In a press conference Friday [15 Jul 2011], Health Secretary Enrique
Ona announced that it was a "variant of leptospirosis," which had
symptoms different from those normally associated with the disease.
Most of the patients stricken ill by the supposed "mysterious disease"
showed symptoms of coughing, fever, blurring of vision, headache,
stomach pains and mild paralysis of the lower extremities. The usual
symptoms of leptospirosis, commonly transmitted to humans from water
contaminated by animal urine, include fever, chills and intense
headache.

In extreme cases, complications like meningitis, renal failure and
respiratory distress may arise and lead to death, according to the
Department of Health.

The Research Institute for Tropical Medicine (RITM) on Friday [15 Jul
2011] confirmed that at least 10 blood samples taken from the patients
afflicted by the so-called mystery disease were positive for
leptospirosis, said Assistant Health Secretary Dr. Eric Tayag, also
head of the National Epidemiology Center. "So it's not a mystery
anymore," Tayag told reporters after receiving a call from the RITM on
Friday.

Preliminary reports reaching the DOH showed that the fishing village
had experienced regular rains over the past few months, which could
have possibly caused the spread of leptospirosis in the area, said
Tayag. "There are also many animals, including rats, in the area,
which explains why there were residents infected by leptospirosis,"
added the health official.

[Byline: Jocelyn R. Uy]

--
Communicated by:
Ronan Kelly
FluTrackers.com
<ronankelly@comcast.net>

[Leptospirosis is a disease associated with freshwater flooding. The
Philippines is regularly battered by tropical cyclones that bring
flooding to large portions of the country
(http://blogs.voanews.com/breaking-news/2011/06/25/15-missing-thousands-displaced-in-philippines-flooding/).
The typhoon season normally runs from late May to early December.

Leptospirosis is caused by swallowing _Leptospira_ in contaminated
water or on food, or by absorbing it through cuts in the skin.
Doxycycline has been found to offer some protection against severe
illness. In a flood-affected area, leptospirosis chemoprophylaxis is
doxycycline 200 mg, once a week for those exposed to contaminated
floodwater or soil. Each 200 mg dose provides a benefit for up to 7
days, so the dose may be repeated if high-risk conditions persist
longer than this.

People exposed in flooded fields should be cautioned against direct
contact with contaminated water or mud and should be advised to use
rubber shoes or boots and gloves. Broken skin should be protected with
a waterproof dressing. All food and drinking water should be protected
against contamination. All drinking water should be boiled unless it
is known to be absolutely safe. Fresh vegetables and fruit should be
washed in clean water and then cooked or peeled. _Leptospira_ exist in
the urine of several 'reservoir' species, most commonly rats, but also
other rodents, cattle, pigs, sheep, and horses. It is usually spread
by the urine of a carrier animal that contaminates water or food.
Because rodents are the major reservoir of _Leptospira interrogans_,
rodent control measures should be undertaken.

Clinical diagnosis is difficult because of the varied and
non-specific presentation. According to the Centers for Disease
Control and Prevention (CDC)
(http://www.bt.cdc.gov/disasters/disease/leptoclin.asp): "The
diagnosis of leptospirosis should be considered in any patient
presenting with an acute febrile illness with fever, chills,
conjunctival suffusion, headache, myalgias and/or jaundice. The
diagnosis is more difficult when patients present with symptoms of
cough, dyspnea, nausea, vomiting, abdominal pain, diarrhea,
arthralgias and a skin rash. Conjunctival suffusion and muscle
tenderness, most notable in the calf and lumbar areas, are the most
distinguishing physical findings.

"Any patient meeting the following clinical criteria with exposure to
flood waters [possibly contaminated with animal urine, such as
exposure to floodwaters following a hurricane] should be tested.

"Clinical criteria for leptospirosis:
Fever > 38.0 deg C (100.4 deg F)
and at least 2 from COLUMN A or one from COLUMN B
COLUMN A / COLUMN B
Headache / Aseptic meningitis
Myalgias / Acute renal failure
Jaundice / Hemorrhagic pneumonitis
Chills/Rigors / Cardiac arrhythmias, EKG abnormalities
Skin rash / Liver failure
Conjunctival suffusion without purulent discharge / Jaundice with
acute renal failure (Weil's disease)"

However, because of the relatively nonspecific nature of the clinical
presentation of leptospirosis, its diagnosis cannot be made
confidently without laboratory confirmation. The U.S. CDC can provide
Leptospira Dip-S-Tick (DST) IgM dot-ELISA test kits (PanBio Integrated
Diagnostics) to local laboratories for serological testing of
suspected leptospirosis cases in support of the response to a
disaster. The DST is suitable for in-the-field testing of suspected
patients. Confirmatory testing uses the microscopic agglutination test
(MAT).

Zamboanga del Norte is a province of the Philippines located in the
Zamboanga Peninsula region along the western coast of Mindanao. For a
map of this province, see
http://en.wikipedia.org/wiki/File:Ph_locator_map_zamboanga_del_norte.png.
The interactive HealthMap/ProMED map of the Philippines can be found
at
http://healthmap.org/r/00Wi. - Mod.ML]

See Also