Leptospirosis is a disease caused by Leptospira bacteria. This bacterium can spread through the urine or blood of infected animals. Some animals that can become intermediaries for the spread of leptospirosis are rats, cows, dogs and pigs.

Leptospirosis spreads through water or soil that has been contaminated with the urine of animals carrying the Leptospira bacteria . A person can get leptospirosis if they are exposed to the animal's urine, or come into contact with contaminated water or soil.

Leptospirosis has symptoms similar to the flu . However, if not treated properly, leptospirosis can cause internal organ damage, even life threatening.

Causes of Leptospirosis

Leptospirosis is caused by the Leptospira interrogans bacteria carried by animals. Leptospires can live for several years in the animal's kidneys without causing symptoms.

Some animals that can be a means of spreading Leptospira bacteria are:

  • Dog
  • Pig
  • Horse
  • Cow
  • Rat

While in the animal's kidneys, Leptospira bacteria can come out with the urine at any time, thereby contaminating the water and soil. In this water and soil, Leptospira bacteria can survive for months or years.

Transmission to humans can occur due to:

  • Direct skin contact with the urine of animals carrying Leptospira bacteria
  • Skin contact with water and soil contaminated with the urine of animals carrying Leptospira bacteria
  • Eating food contaminated with the urine of animals carrying the bacteria that causes leptospirosis

Leptospira bacteria can enter the body through open wounds, both small wounds such as abrasions and large wounds such as lacerations. These bacteria can also enter through the eyes, nose, mouth and digestive tract.

Leptospirosis can be transmitted between humans through breast milk or sexual contact, but this case is very rare.

Leptospirosis risk factors

Leptospirosis is commonly found in tropical and subtropical countries, such as Indonesia. This is because the hot and humid climate can make the Leptospira bacteria survive longer. In addition, leptospirosis is also more common in individuals who:

  • Spends most of his time outdoors, such as miners, farmers and fishermen
  • Frequent interactions with animals, such as breeders, veterinarians, or pet owners
  • Have a job related to sewers or gutters
  • Live in a flood prone area
  • Often do water sports or recreation in nature

Symptoms of Leptospirosis

In some cases, the symptoms of leptospirosis do not appear at all. However, in most sufferers, symptoms of this disease appear within 2 days to 4 weeks after exposure to Leptospira bacteria .

The symptoms of leptospirosis vary greatly for each patient and are often mistaken for symptoms of another disease, such as the flu or dengue fever. Early signs and symptoms that appear in people with leptospirosis include:

  • High fever and chills
  • Headache
  • Nausea, vomiting and no appetite
  • Diarrhea
  • Red eye
  • Muscle pain, especially in the calves and lower back
  • Stomach ache
  • Red spots on the skin that don't go away when pressed

The above complaints usually recover within 1 week. However, in some cases, sufferers can experience the second stage of leptospirosis, which is called Weil's disease. This disease occurs due to inflammation caused by infection.

Weil's disease may develop 1–3 days after leptospirosis symptoms appear. Complaints that appear vary, depending on which organs are infected. Symptoms and signs of Weil's disease include:

  • Fever
  • Jaundice
  • Difficulty urinating
  • Swelling of the hands and feet
  • Bleeding, such as a nosebleed or coughing up blood
  • Chest pain
  • Hard to breathe
  • Heart pounding
  • Weakness and cold sweat
  • Headache and stiff neck

When to see a doctor

Check with your doctor if you experience the symptoms mentioned above. The symptoms of leptospirosis are sometimes similar to the symptoms of other infectious diseases, so it is necessary to do an examination to find out the exact cause before complications occur.

Immediately go to the emergency room if you experience more severe symptoms of leptospirosis, such as jaundice, difficulty urinating, swollen hands and feet, chest pain, shortness of breath, and coughing up blood.

If you are diagnosed with leptospirosis, check it regularly during treatment. The goal is for doctors to monitor the progress of disease conditions and the success of therapy.

Diagnosis of Leptospirosis

To diagnose leptospirosis, the doctor will ask about the patient's complaints and symptoms, as well as the patient's medical history. The doctor will also ask about travel history, the patient's living conditions, and the activities carried out by the patient in the past 14 days.

Next, the doctor will carry out a thorough physical examination and several supporting tests to confirm the diagnosis and determine the severity of leptospirosis. These supporting tests include:

  • Blood tests, to check liver function, kidney function , and white blood cell levels
  • Enzyme-linked immunosorbent assay (ELISA) test or rapid test , to detect antibodies in the body
  • Polymerase Chain Reaction (PCR), to detect the presence of Leptospira bacteria genetic material in the body
  • Microscopic agglutination test (MAT), to confirm the presence of antibodies specifically associated with Leptospira bacteria
  • Scanning with a CT scan or ultrasound, to see the condition of the organs that may be affected by inflammation due to leptospirosis infection
  • Blood and urine cultures, to confirm the presence of Leptospira bacteria in the blood and urine

Leptospirosis Treatment

Leptospirosis infection generally does not require special treatment. In mild conditions, leptospirosis infection can heal by itself in seven days. Treatment is generally aimed at relieving symptoms and preventing complications.

The following are some treatment steps that can be taken for sufferers of leptospirosis:

Administration of drugs

If symptoms have arisen, the doctor will give medicines to relieve symptoms and treat bacterial infections. Some of the drugs that will be given are:

  • Antibiotic medications, such as penicillin, amoxicillin, ampicillin, doxycycline, or azithromycin
  • Fever-reducing and pain relievers, such as paracetamol or ibuprofen

Hospital treatment

Treatment in hospital is carried out when the infection has progressed and invaded the organs (Weil's disease). In this condition, antibiotics will be given through an IV.

In addition, doctors can also perform the following additional treatments:

  • Fluid infusion, to prevent dehydration in patients who cannot drink much water
  • Giving vitamin K , to prevent bleeding
  • Installation of a ventilator , if the patient has respiratory failure
  • Monitoring of the work of the heart
  • Blood transfusion, if there is heavy bleeding
  • Hemodialysis or dialysis , to help kidney function

The chance of recovery from Weil's disease depends on the organ affected by the infection and its severity. In patients with severe leptospirosis, death may occur due to bleeding or due to complications in the lungs or kidneys.

Leptospirosis complications

Although it can heal by itself, leptospirosis that is not treated properly can lead to Weil's disease. Complications that can occur due to Weil's disease include:

  • Acute kidney injury
  • thrombocytopenia
  • Gastrointestinal bleeding
  • Lung hemorrhage
  • Hemorrhagic stroke
  • Liver failure
  • Kawasaki disease
  • Rhabdomyolysis or skeletal muscle breakdown
  • Chronic uveitis
  • Blood clots that are spread throughout the body
  • ARDS or acute respiratory distress syndrome
  • Septic shock
  • Heart failure
  • Miscarriage in pregnant women

Prevention of Leptospirosis

There are several ways you can do to prevent and reduce the risk of spreading leptospirosis infection, namely:

  • Wear protective clothing, gloves, boots and eye protection when you work in an area where there is a risk of transmitting Leptospira bacteria
  • Cover the wound with a waterproof plaster, especially before contact with water in nature
  • Avoid direct contact with contaminated water, such as swimming or bathing
  • Consume drinking water that is guaranteed to be clean
  • Wash hands before eating and after contact with animals
  • Keeping the environment clean and ensuring the home environment is free of rats
  • Vaccinating pets or livestock
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