MANILA declared leptospirosis an “epidemic condition” on Monday, Sept. 7, after the disease’s attack rate nearly tripled in a week and city government district hospitals reached full capacity.
The Manila Health Department recorded an attack rate of 3.48% this week, up from 1.27% last week, prompting the declaration amid rising infections.
The development comes weeks after severe flooding hit Manila, including UST, where thousands of Thomasians were stranded inside campus buildings on Aug. 17 after heavy rains brought by the southwest monsoon.
Assoc. Prof. Maria Rhona Bergantin of the Faculty of Medicine and Surgery warned that the danger does not end when floodwaters recede, as leptospirosis symptoms can take weeks to appear and may initially resemble other illnesses.
Bergantin, an internal medicine and infectious diseases specialist, said people exposed to floodwaters should seek medical advice, particularly if they develop symptoms.
Leptospirosis is a zoonotic disease caused by Leptospira interrogans, a bacterium commonly transmitted to humans through contact with water contaminated by the urine of infected animals, particularly rodents.
The bacteria can survive in water for extended periods and enter the body through open cuts or micro-abrasions.
“The bacteria, the Leptospira interrogans, [are typically] transmitted to humans via [contact] with urine-contaminated water,” Bergantin told the Varsitarian.
While leptospirosis cases usually spike following torrential rains, Bergantin said infections may also occur among people whose occupations expose them to contaminated water or rat excrement.
“Mayroon kami nakikitang mga patients na mga plumbers, o kaya ‘yung mga nasa sa marketplaces where they have their legs soaked in water din,” she said.
(We see patients who are plumbers or those working in marketplaces where their legs are also soaked in water.)
Symptoms easily missed
Leptospirosis may initially resemble other illnesses, with symptoms including fever, severe muscle pain in the calf area and, in some cases, abdominal pain.
“You might even confuse it with dengue kasi lalagnatin lang, akala trangkaso, masakit ‘yung mga muscle, masakit ‘yung mga joint, and then, ‘yun pala, leptospirosis na,” Bergantin said.
(You might even confuse it with dengue because it may present only with fever. You might think it is the flu because of muscle and joint pain, only to find out that it is already leptospirosis.)
Bergantin said some patients may not develop fever at all, while about 10% may experience gastrointestinal symptoms.
“Baka mamaya, they might pass it off just as something that they ate, something that’s [not] well-prepared. Pero ganoon siya, sobra siyang non-specific,” she said. “Ang pinaka-importanteng tool will always be an exposure to risk factors for [the] possibility of leptospirosis.”
(Patients might pass it off as due to something they ate or something that was not well-prepared. But that is how the disease is: its symptoms are very non-specific. The most important indicator will always be exposure to risk factors for the possibility of leptospirosis.)
Symptoms may take weeks to emerge
A person exposed to contaminated water may not immediately show signs of infection because of the disease’s incubation period, or the interval between infection and the onset of symptoms.
Bergantin said the incubation period for leptospirosis could range from about one to three weeks, during which the bacteria multiply in the body before symptoms begin to manifest.
“In such a way, there are certain patients na kahit matagal na ‘yung exposure, saka lang sila nagma-manifest,” she said.
(In some patients, symptoms manifest only long after the exposure.)
She said the severity of the disease could depend on a patient’s immune response and how soon medical care is sought.
“One of the things that probably can also influence is the fact that there are certain patients who would consult a bit late. If the medicine is not given earlier on, definitely the organism has time to increase in numbers,” Bergantin said.
Prevention and treatment
Treatment depends on the severity of the infection, Bergantin said. Patients with mild cases may be given antibiotics, while those with severe manifestations may require hospitalization and additional interventions.
“Basically, we have to give antibiotics to these patients. Most especially if nandun na ‘yung symptoms niya,” she said. “‘Yung iba nag-undergo ng dialysis, ‘yung iba nag-undergo din ng respiratory support.”
(Basically, we have to give antibiotics to these patients, especially if symptoms are already present. Some undergo dialysis, while others require respiratory support.)
For people exposed to floodwater, Bergantin advised immediately washing exposed areas upon reaching home and consulting a health professional about post-exposure prophylaxis, which may vary depending on the level of exposure.
“Pagdating sa bahay, maghugas, maligo na agad. Hugasan ang paa or areas kung saan na-expose na nga. Soap and water, and then eventually alcohol. Huwag nang hintayin na magkaroon ng symptoms bago mag-control,” she said.
(Once you get home, wash and take a bath immediately. Wash your feet or other areas exposed to floodwater with soap and water, and then eventually alcohol. Do not wait for symptoms to appear before taking action.)
“You have to take prophylaxis. It’s very important for any individual to consult kasi depende ‘yung prophylaxis doon sa category ng pagkaka-expose doon sa patient,” Bergantin said.
(You have to take prophylaxis. It is very important for any individual to consult because the prophylaxis depends on the patient’s category of exposure.)
Bergantin stressed that prophylaxis does not guarantee protection against infection.
“The public should also know that even if a person takes in prophylaxis, it’s not 100% effective. Hindi parang naka-inom ako ng doxycycline, ibig sabihin, okay na ako, hindi na ako pwedeng magkaroon ng leptospirosis,” she said.
(The public should also know that even if a person takes prophylaxis, it is not 100% effective. Taking doxycycline does not mean you are already safe and can no longer develop leptospirosis.)
She advised the public to avoid unnecessary contact with floodwater and use protective boots or foot coverings when exposure cannot be avoided. Households should also be kept clean to discourage rodents.
Leptospirosis is not the only health concern associated with flooding, Bergantin said. Prolonged exposure to wet conditions may contribute to fungal infections, while contaminated water supplies may cause gastrointestinal illnesses such as diarrhea. Joshua Emmanuel E. Camacho
