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Journalism of Courage
What is this strange illness called leptospirosis, currently raging in pockets of Maharashtra and Gujarat? The very first agent causing spirochaetal jaundice was described by Adolf Weil, a German physician in 1886, and named Leptospira iceterohaemorrhagiae. Leptospires are characterised by their slender appearance, numerous coils, hooked ends and active motility.
Some species of leptospires are harmless to man and animals, while others are potential pathogens. The parasitic leptospires are normally carried in the kidneys of rodents and other small mammals and are excreted in their urine. The microorganisms appear to cause no harm to their normal host but if they are transmitted accidentally to other animal species or to humans, they may give rise to mild, or even extremely severe, clinical infections.
The pathogenic leptospires enter though cuts on the body, abrasions of the skin or through the mucous membranes of the nose, mouth and eyes. They multiply in the blood and circulate to all parts of the body, affecting any organ. Consequently, the signs and symptoms that characterise the disease vary considerably in both form and intensity. A mild influenza like illness may develop, sometimes with meningitis and usually with some degree of renal involvement. At the other end of the spectrum, the disease may be severe and could even turn fatal, characterised by jaundice and haemorrhages in the eyes, skin and mucous membranes.
It is precisely because of this variability in the signs and symptoms of the infection that leptospirosis cannot be diagnosed on clinical grounds alone. But if the patient’s living and working conditions allow for likely exposure to infection from animal sources, or if the patient has been swimming in or has accidentally fallen into fresh waters in areas that harbour rodents and are liable to flooding, leptospirosis may be suspected.
Leptospires usually responds to treatment with antibiotics, provided the drugs are administered in large enough doses early in the infection. If, however, there is impairment of kidney function, it may be necessary to resort to renal dialysis to counteract the ureamia, which is the main cause of death.
Given these serious consequences, communities vulnerable to possible infection must take special care. Agricultural workers should protect their skin by wearing suitable gloves and boots when engaged in planting rice, cane, flax, digging ditches, cleaning out pig pens, cowsheds, and the like. Soldiers exposed to terrain contaminated by animal carriers and people who enjoy water sports should be warned of possible infection. In parts of the world where the risk of infection is high among certain groups of people, like sugarcane workers, vaccination against local leptospiral strains is being carried out successfully. The incidence of human infection can be reduced by the widespread vaccination of domestic animals and pets. Buildings that house animals should be rat-proofed and regularly washed down with sodium hypochlorite solution so that leptospires can be killed.
As in the case of every other disease, prevention is always better than cure.
The writer is attached to the department of microbiology, Kurukshetra University
