In many cases, leptospirosis takes the course of a benign febrile illness. However, more severe forms of the disease can prove life-threatening.
What is leptospirosis?
Leptospirosis is an infectious disease caused by bacteria. Depending on the pathogen that caused leptospirosis in the affected person, different forms of the disease can be distinguished; to mention here are, for example, Weil’s disease or field fever. Typical symptoms of the first phase of leptospirosis (which usually occurs in two phases) are similar to those of influenza: patients suffer from muscle pain, headache and high fever. Other possible symptoms include a skin rash or conjunctivitis. In a second phase of the disease, in addition to renewed fever, inflammation of the kidneys, liver and/or heart muscle can occur. The bacterial infectious disease is widespread worldwide; within Germany, approximately 40 people are affected by a new case each year.
Causes
Leptospirosis is caused by infection with the bacterium Leptospira interrogans (a helical bacterium belonging to the genus Leptospira). Transmission of the bacterium to humans usually occurs via body fluids (such as saliva, blood, or urine) of infected rodents; in rarer cases, transmission of leptospirosis by mammals is also possible. The fluids infected with the bacterium Leptospira interrogans get into soil or water, for example. In the case of human contact with the corresponding substances, the bacterium causing leptospirosis can enter the organism of an affected person, for example, via mucous membranes or skin injuries. Infected secretion droplets can also be ingested via the respiratory air, which subsequently lead to possible leptospirosis. Because of the route of transmission, workers in fields or sewers and water sports enthusiasts are particularly at risk for contracting leptospirosis.
Symptoms, complaints, and signs
Leptospirosis can manifest itself through a wide variety of symptoms. Some people experience only a mild malaise after infection with the causative bacteria. In other cases, severe and, in extreme cases, even life-threatening complications may develop that require prompt treatment. The acute phase of the disease lasts about a week. As a result of the bacteria being carried into the bloodstream, a fever develops in the first instance, which can last for three to eight days. This is sometimes accompanied by muscle pain, headache and joint pain. A painful stiffening of the neck is typical. Furthermore, conjunctivitis may develop, which is manifested by a noticeable swelling and redness of the conjunctiva. The heartbeat is reduced and the blood pressure is low. In addition, a skin rash may occur. In the immune phase, signs of internal organ involvement may appear. Depending on which organ is affected, jaundice, cough, shortness of breath or inflammation of the kidneys may occur. In a severe course, meningitis or myocarditis occur after a few days. The severe symptoms appear in the second week of illness and quickly cause a life-threatening condition.
Diagnosis and course
During the first phase of illness, the causative agents of leptospirosis or antibodies formed can be detected, for example, with the aid of a blood sample. Because the bacterium Leptospira interrogans can often no longer be identified in the second phase of the disease, a diagnosis here is usually based solely on antibodies present in the organism of an affected person. After a possible incubation period (the period between infection and the first symptoms of leptospirosis) of up to 30 days, the onset of the disease is usually sudden; the first phase of the disease lasts about 3 – 7 days and is then followed by a short period with few symptoms. The second phase of the disease, which now follows, can finally last up to 30 days. Mild forms of leptospirosis usually take a benign course. The comparatively mild forms of the disease include, for example, field fever. The course of Weil’s disease is often more severe; here the disease can even lead to the death of a patient.
Complications
In leptospirosis, the affected person usually suffers from the usual complaints and symptoms of flu or a cold. It comes thereby to a strong chill and furthermore also to a high fever. In most cases, patients also suffer from headaches and aching limbs. The ability of the affected person to cope with stress decreases significantly and the quality of life is reduced. It is also not uncommon for leptospirosis to cause conjunctivitis, which in the worst case can lead to complete blindness. There may also be severe pain in the shins or calves. In the worst case, leptospirosis can lead to the death of the affected person if the internal organs are also damaged. The treatment of this disease is carried out with the help of antibiotics and usually does not show any particular complications. In most cases, this also results in a positive course of the disease and no further complaints. Other drugs that can reduce fever are also used in the treatment. With successful treatment, there is no reduction in the patient’s life expectancy.
When should you see a doctor?
If unusually high fever, chills, headache, aching limbs, and other symptoms that seem to occur without cause are noticed, the primary care physician should be consulted. There may be underlying leptospirosis or another serious illness that requires evaluation. If gastrointestinal complaints occur, as well as cough or sore throat, medical advice is also required. Signs of jaundice indicate Weil’s disease. Liver dysfunction, pain in the right upper abdomen and blood clotting disorders also point to an icteric course, which must be clarified by a physician in any case. Affected persons should consult a physician if the above-mentioned signs of illness persist for more than a few days. If the symptoms suddenly become more severe, there should be no more hesitation in consulting a doctor. The right contact person is the liver specialist. In addition, other internists and alternative physicians may be consulted, always depending on the type, severity and cause of the symptoms. Patients with pre-existing conditions should talk to the responsible physician if they have unusual symptoms.
Treatment and therapy
The type of medical treatment for leptospirosis depends on the phase of illness and individual symptoms, among other factors. During the first 5 days of an existing leptospirosis, the disease is usually fought with the help of antibiotics; which antibiotic agents are used in individual cases depends approximately on the assessment of the attending physician and the constitution of a patient. If leptospirosis lasts longer than 5 days, antibiotic treatment is usually no longer effective. This is due to the fact that symptoms of the second phase of leptospirosis are usually no longer due to the action of the causative bacterium; rather, the corresponding symptoms are a consequence of the body’s own immune response to the bacterium Leptospira interrogans. Sensible therapeutic measures in the second phase of leptospirosis therefore usually focus on combating individual symptoms: While high fever, for example, can be controlled with antipyretic drugs, other possible treatment measures are directed, for example, toward adequate hydration and the repair of any damage that may have occurred to organs.
Outlook and prognosis
The prognosis of leptospirosis is tied to the time of diagnosis and the course of the disease. If left untreated, a life-threatening condition develops. The pathogens can spread unhindered in the organism and cause weakening of the body. This leads to destruction of the internal organs and ultimately to a failure of the organism’s functional activity. If a visit to the doctor is initiated immediately with the onset of the first symptoms, therapeutic measures can be taken without delay. The administration of medication leads to a regression of the symptoms. The causative pathogen is prevented from spreading by the ingredients of the preparations and suddenly dies. If no damage to the organs has occurred, the prognosis is favorable and the patient can be discharged from therapy after a few weeks as recovered.If treatment takes place at an advanced stage of the disease, the course of the disease worsens considerably. The activity of the internal organs is attacked and irreparable damage can occur in severe cases. A fatal course of the disease is possible despite all efforts. In some patients, only organ transplantation can ultimately help prolong life. This treatment measure is associated with numerous complications and challenges. In addition, a stable immune system is mandatory for transplantation, otherwise the donor organ will be rejected.
Prevention
Leptospirosis can be prevented, for example, by avoiding stays in bodies of water that have not been declared safe bathing places by public authorities. Occupational leptospirosis can be prevented by wearing appropriate protective clothing. To avoid possible infection from pets, vaccination of appropriate animals is possible if the risk is present.
Aftercare
Aftercare is very important for a bacterial infection such as leptospirosis. For one thing, it is important to prevent the infection from flaring up again and then perhaps leading to complications. One example is heart involvement after an influenza infection. On the other hand, it is also a matter of regenerating the body, which has been weakened by a bacterial infection, and in this way making it resilient again for the demands of everyday life. The bacterial infection can affect different areas such as respiratory tract and gastrointestinal tract. Therefore, the measures for aftercare are also always somewhat different. However, strengthening the immune system is an important factor in almost all cases as part of aftercare. Defending against renewed bacterial infections and strengthening the general condition is possible with a whole bundle of measures. These include a healthy diet with adequate drinking, plenty of sleep and sufficient exercise. When it comes to activities and sports, however, it is important that the patient no longer has a fever. It is not uncommon for antibiotics to be prescribed against a bacterial infection, which can have side effects such as gastrointestinal problems or fungal infections. Here, aftercare also means rebuilding the intestinal or vaginal flora in the case of such infections. Nicotine and alcohol weaken the immune system. It is good if the patient abstains from them during regeneration and aftercare.
Affected persons should also see a doctor regularly to check the setting of the medication as well as possible side effects and, in case of intolerance, obtain a change.
What you can do yourself
If leptospirosis has been diagnosed, antibiotic therapy is required. Patients are advised to take it easy and stay in bed. Especially in the first days after treatment, the immune system must be protected from major stress, because a cold can lead to a superinfection, which would have serious consequences for the body. If the course is mild, the patient may return to light work and sports after one week. In a severe course, treatment in the clinic is required. Since leptospirosis does not necessarily stop at an outpatient stay, appropriate precautions must be taken for a longer hospital stay. Again, after treatment, rest is the order of the day. The administration of cefotaxime, doxycycline and other antibiotics puts a considerable strain on the body and therefore requires good follow-up care by the patient and physician. After leptospirosis has resolved, further follow-up examinations in the physician’s office are indicated. In addition, the cause of the disease should be determined and the triggers avoided in the future. Pet owners who suspect an infection in their pet should consult a veterinarian and have the symptoms clarified before an outbreak of the disease or even transmission to humans occurs.
