By  Dra. María Alt. Santana Acosta

Physician and Bioanalyst- Hematologist / Microbiologist – Teacher From Universidad Central del Este -San Pedro de Macorís, Dominican Republic.

Leptospirosis, also called Weil’s disease or Canine Fever, is a zoonotic bacterial disease caused by leptospires, bacteria encompassed in spirochetes. The reservoir for this disease is made up of wild and domestic animals, mainly rodents, but each serovar has some preferred reservoirs such as: Rats for L. Icterohaemorrhagiae, pigs for L. Pomona, cattle for L. Hardjo, dogs for L. canicula

Many other mammals are capable of maintaining brief carrier states. There are other serovars that infect reptiles and amphibians and are generally considered not to affect humans, although suspicious cases have been observed in Barbados and Trinidad.

The distribution of leptospirosis is worldwide, with the exception of the polar regions. It is the most extensive zoonosis in the world and occurs in developed and developing countries, both in rural and urban areas, although it is more widespread in countries with a tropical climate, due to the greater survival of the microorganism in hot and humid environments. Likewise, the disease presents a certain seasonality, presenting more cases in summer and autumn in temperate countries and during rainy seasons in warm countries.

It is difficult to estimate the prevalence of the disease, due to the lack of data in general. The best-known high-risk areas include Brazil, China, the Caribbean, India, the Pacific Islands, Malaysia, the Seychelles, Sri Lanka, Thailand, and Vietnam. Worldwide, about 100,000 human cases and about 1,000 deaths a year occur

In January 2019 the Australian government today declared an outbreak of leptospirosis, a disease that is transmitted through water contaminated by animal urine, following the deaths of four people this month.

While in the Dominican Republic the Weekly Epidemiological Bulletin 01 From 12/30/2018 to 01/05/2019 Four (4) suspected cases of leptospirosis were reported this week, three (3) alive and one deceased. The live cases correspond to two men and a woman, 49, 57 and 58 years of age, residing in the municipalities of Santo Domingo Oeste, Higuey and San Juan. The death of this week corresponds to a 73-year-old woman, a housewife occupation, who was taken to a regional reference health center 5 days after starting the clinical picture, died half an hour after arriving in emergencies.

Over the past four weeks, 23 cases have been reported, including two (2) disease-related deaths (case fatality = 8.7%). During this period the highest frequency of cases resides in the O Metropolitan region.

Leptospires pathogenic for humans belong to the L. interrogans species, of which at least 23 serogroups have been identified, which in turn are divided into more than 200 serovars. The most identified serovars are: L. icterohaemorrhagiae, L. Canícola, L. Autumnalis, L. Hebdomidis, L. Australis, L. Pomona, and L. Herdjo.

In areas where leptospirosis is endemic, most infections are asymptomatic or very mild. When it manifests, it can be mild, in 90% of cases, with characteristics of a flu-like illness, with headache, fever and myalgia.

Severe cases (Weil syndrome) are characterized by hepatic impairment with jaundice, impaired renal function, confusion, and bleeding diathesis, due to damage to the capillary endothelium that causes generalized vasculitis.

The severity depends on the infecting serovar and on factors of the infected host, and can reach a lethality of up to 20% in severe cases.

The suspected diagnosis is made by the clinic and epidemiological conditions, but it is a difficult diagnosis, which hinders the fight against the disease. The diagnosis is confirmed by detection of specific antibodies and by the isolation of leptospires in blood in the first 7 days, in the CSF from the 4th to the 10th day and / or in urine from the 10th day.

Transmission occurs mainly through direct contact with blood, urine, or tissues of infected animals, which penetrate the host’s skin if it is slagged or through mucosa. Transmission by contact with material contaminated by urine from affected animals is also possible. The microorganism survives for a long time in the water, which makes it an important vehicle of transmission when swimming in contaminated water, as well as by contact with wet soil or contaminated vegetation (especially sugar cane has been implicated). Infection by ingestion of contaminated food and, rarely, by inhalation of aerosolized droplets of contaminated liquids has been reported.

The risk of transmission increases after periods of heavy rain, because water saturates the environment and leptospires in the soil pass directly into surface waters.

The incubation period is approximately 10 days, with limits between 4 and 19 days. The period of transmissibility from the reservoir to man or, rarely, from person to person, lasts while leptospires are excreted in urine, which generally lasts a month in sick humans and a long time in animals.

The preventive measures we can take: inform the population about the mode of transmission of the disease. Use of footwear and gloves to avoid direct contact with standing water or mud. Do not drink directly from cans, serve it in a glass and then drink it

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