Animal-to-man leptospirosis on upswing

[Shiloh]

Source: http://www.redwoodcitydailynews.com/article/2008-8-27-health-matters

Wednesday Aug 27

Animal-to-man leptospirosis on upswing
By LJ Anderson / Daily News Columnist

On the face of it, it sounded like the adventure of a lifetime: compete in the Eco-Challenge-Sabah 2000 multi-sport endurance race in the Segama River in Borneo, Malaysia. And, it might well have been, but the results from the race also included confirmation by the Centers for Disease Control and Prevention (CDC) of a leptospirosis outbreak, with 80 of 189 athletes contacted by the CDC (304 competed) meeting the case definition for leptospirosis, and 29 of those hospitalized. It pays to know what pathogens might be in the water when you engage in adventure travel, and especially if you immerse yourself in unfamiliar waters.

Leptospirosis is a disease caused by exposure to Leptospira, bacteria that live freely or attach to an animal host. Passed from animals to humans, people may contract it via skin abrasions or the nose, eyes and mouth from contaminated fresh water or soil where infected rodents have excreted urine. In the developing world, leptospirosis is primarily a rural disease seen in humid and tropical regions, but increasingly, it is appearing in residents of rat-infested urban slums. The resulting disease causes a flu-like illness, ranging from mild to severe. It is often misdiagnosed, and if left untreated, may lead to serious problems, including renal failure, and can be potentially fatal. Leptospirosis is an underreported disease whose true prevalence is unknown.

For Americans, it tends to be associated with recreational exposure but leptospirosis in U.S. slums has also been reported. Several states, including Hawaii and California, voluntarily collect data, although notification to the CDC is not required. Nationally, it affects less than 100 to 200 people per year, and half of those cases are in Hawaii. For example, in 2004 heavy rains caused overflow from a nearby stream to flood a lab at the University of Hawaii. After wading into his flooded laboratory in sandals, a professor developed fever, chills and vomiting - common symptoms of leptospirosis. Surfers swimming near the mouth of rivers have also contracted the disease, and warnings regarding leptospirosis are posted at freshwater streams throughout Hawaii. Cases in California have mostly been associated with freshwater recreational exposure, and include settings such as swimming in muddy ponds to duck-hunting in flooded rice fields. Sometimes cases are discovered after travelers return from exotic locations. For example, several Americans who had river-rafted in Costa Rica were diagnosed with leptospirosis after exhibiting symptoms upon their return home.

Alan Katz, MPH, MD, is graduate chair and professor of epidemiology in the Department of Public Health Sciences at the University of Hawaii in Honolulu. His research interests include leptospirosis.

Q: Why is leptospirosis a reportable disease in Hawaii?

A: From the mid-1970s until the cessation of national surveillance for leptospirosis in 1995, Hawaii consistently had the highest annual incidence rate of leptospirosis in the United States. Since we have long recognized the occurrence of leptospirosis in Hawaii, we have continued to keep it reportable so we can keep track of trends in disease occurrence.

Q: How big of a public health problem is leptospirosis in the rest of the United States, and worldwide?

A: Leptospirosis is considered the most widespread zoonotic illness - an illness transmitted from animals to people - in the world. The World Health Organization recently classified leptospirosis as a "re-emerging" infectious disease. There have been recent outbreaks in Nicaragua, Borneo, Ireland, Israel, Costa Rica, Brazil and India. In the summer of 1998, there was an outbreak in Illinois among triathletes who were exposed to water in Lake
Springfield.

Q: How does leptospirosis usually present itself in a patient, and is it difficult to diagnose?

A: This is one of the key challenges. Leptospirosis has protean (ed note: changes form) manifestations and may go unrecognized due to its nonspecific signs and symptoms.

Confirmation of the diagnosis is also difficult because of problems associated with isolating the organism, and with serological testing during the acute phase of the illness.

Common presentations are flu-like symptoms: fever, chills, headache, muscle ache, decreased appetite, nausea and vomiting. It can also present as meningitis or pneumonia.

Q: Are there typical situations in which people have been initially exposed to Leptospira?

A: Most of the cases we see in Hawaii relate to recreational exposures: swimming in fresh water (the organism doesn't survive well in brackish water so the ocean is safe), hiking (from exposures to wet mud that contains infected animal (usually rat urine), or occupational exposures.

Taro farmers are at increased risk in Hawaii, and rice farmers are at increased risk in Asian countries due to the way the crops are surrounded with increased amounts of fresh water.

Q: Do you have any advice for visitors to Hawaii with regard to preventive measures?

A: Some general prevention measures listed on our Department of Health Web site (http://hawaii.gov/health/about/reports/leptobrochure.pdf) include: "Do not swim or wade in freshwater streams or ponds in Hawaii, especially when you have open cuts or sores. Swimming with your head underwater also increases your risk of infection through the eyes, nose and mouth. Do not drink pond or stream water without boiling or chemically treating it."

The incubation period for leptospirosis is usually seven to 12 days, so if you become ill after swimming or hiking in Hawaii, let your doctor know. Early antibiotic treatment can help shorten the course of the illness.

 

[Treyfish]

Re: Animal-to-man leptospirosis on upswing

Animal lover dies six days after being scratched by a trapped rat she was trying to free


By Beth Hale
Last updated at 3:03 AM on 13th September 2008

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Tragic: Carol Colburn died six days after she was scratched by a rat

A mother-of-three paid with her life for her love of animals.
Carol Colburn, 56, rushed to help a rat trapped in her garden bird feeder.
But she scratched her hands and contracted a rare and deadly infection from the animal. She died in hospital less than a week later.

An inquest heard that Mrs Colburn had ignored her husband Peter's pleas to wear gloves. He had even tried to pull her away from the wire feeder.
It was only after she cut her hands that she left the rescue to her son Ross, 24, who used gloves.
But Mrs Colburn, of Brighton, had already contracted Weil's disease, which is caused by bacteria found in rats' urine.
The disease can be treated if caught in time, but neither Mrs Colburn nor her family realised she had been infected.
It was not until four days later, on May 6, that she developed flu-like symptoms.

Two days after that, she was taken to the A&E department at the Royal Sussex County Hospital in Brighton.
But her condition deteriorated rapidly and she died of a heart attack within hours.
Consultant Dr Steven Barden said: 'When she was admitted she was suffering from severe jaundice and flu-like symptoms but was able to hold a conversation.
'When she told me she lived near a railway line and often came into contact with wild animals, I was reminded that my father lives near the same line and often comes into contact with rats. That's when I began to consider she was suffering from leptospirosis, also known as Weil's disease.'
Tests on post-mortem samples confirmed his suspicions.
In a second shattering blow to the family, Mr Colburn, also 56, became desperately ill with lung cancer and died two months later.

Peter Colburn died of cancer two months after his wife succumbed to Weil's disease
The deputy coroner for Brighton and Hove, Arthur Hooper, recorded a narrative verdict, saying: 'She was one of those rare cases that succumbed to the severe end of Weil's disease.'
After the hearing, Mrs Colburn's children said their mother had devoted part of her garden to wildlife, including foxes and badgers.

Her daughter Katrina, 27, said: 'My mum spent hours feeding wild animals and wouldn't have given it a second thought.'
Her sister Zoe, 30, said: 'We didn't even know dad had cancer. But when mum died the shock meant the disease really set in. It was like he was dying from a broken heart.'
Microbiologist Marc Cubbon said the leptospirosis bacteria infects small mammals and rodents. It gets onto their skin via their urine and people with open wounds can easily be infected.

:tiphat: http://www.dailymail.co.uk/news/art...s-days-scratched-trapped-rat-trying-free.html :yinyang:
A woman has died from a rare disease after she was scratched by a rat that she was trying to free from her garden bird feeder.


By Nick Britten
Last Updated: 9:59PM BST 12 Sep 2008


Carol Colburn, 56, ignored pleas from her husband to wear gloves and suffered scratches and cuts to her fingers as she struggled to free the rodent from the wire feeder. Four days later she developed flu-like symptoms, and within 48 hours she was dead.
An inquest heard she had contracted Weil's disease, a severe form of leptospirosis, which is caused by bacteria found in the urine of wild animals.
In most cases of leptospirosis, sufferers experience severe headaches and flu-like symptoms. Weil's disease, which affects around 10 per cent of lepto­spirosis victims, causes jaundice and liver damage, and can be fatal.
About 50 confirmed cases of Weil's disease are reported to the Public Health Authority each year but in 2006 just two people died from the condition.
In a statement given to the inquest, Mrs Colburn's husband, Peter, who has since died of lung cancer, said she had rushed outside after hearing the rat screaming. Ignoring requests from him and their son, Ross, to put gloves on, she grappled with the animal as she tried to free it.
She began feeling unwell and later became jaundiced and could not move.
Marc Cubbon, a microbiologist at the Royal Sussex Hospital in Brighton, told Brighton Coroners' Court that humans can become infected if they come into contact with the animal's urine, either in soil or in water, or if they come into contact with the animal's skin and they have an open wound.
He said it was also possible that humans might be able to inhale the disease.
He said that after a conversation with Mrs Colburn at 2pm on May 8, he had begun considering leptospirosis. By 5pm, she had died from a heart attack, before either of her daughters, Katrina, 27, and Zoe, 30, were able to get to hospital.
Katrina, 27, said: "My mum spent hours in the garden feeding wild animals and wouldn't have given it a second thought.
"It has come as such a shock and seems like such a shame that trying to rescue an animal should have such dire consequences."
Recording a narrative verdict, Arthur Hooper, the deputy coroner for Brighton and Hove, said: "The public should be made aware of the dangers of leaving food out, deliberately or unintentionally, that might attract animals like rats. If you must come into contact with rats please wear gloves." :tiphat: http://www.telegraph.co.uk/news/uknews/2827111/Woman-dies-after-being-scratched-by-rat.html