Thailand On Alert For Leptospirosis

[george]

Provinces ordered to be on alert for leptospirosis

BANGKOK: -- The Public Health Ministry has order all provinces to be on alert for the emergence of leptospirosis after it found 587 people were infected and 15 died from the disease.

Dr Prat Boonyawongvirot, the ministry's permanent secretary, said Tuesday most infectious cases were found during the rainy season.

People with cuts or rashes on their legs who wade through floodwater are 15 times more at risk of contracting the disease.

-- The Nation 2008-07-01

[george]

Fact: Leptospirosis

Leptospirosis (also known as Weil's disease, canicola fever, canefield fever, nanukayami fever, 7-day fever and many more[1]) is a bacterial zoonotic disease caused by spirochaetes of the genus Leptospira that affects humans and a wide range of animals, including mammals, birds, amphibians, and reptiles. It was first described by Adolf Weil in 1886 when he reported an "acute infectious disease with enlargement of spleen, jaundice and nephritis". Leptospira was first observed in 1907 from a post mortem renal tissue slice.[2]

Though being recognised among the world's most common zoonoses, leptospirosis is a relatively rare bacterial infection in humans. The infection is commonly transmitted to humans by allowing fresh water that has been contaminated by animal urine to come in contact with unhealed breaks in the skin, eyes or with the mucous membranes. Outside of tropical areas, leptospirosis cases have a relatively distinct seasonality with most of them occurring August-September/February-March.

Leptospirosis is caused by a spirochaete bacterium called Leptospira spp. that has at 5 different serovars of importance in the United States causing disease (icterohaemorrhagiae, canicola, pomona, grippotyphosa, and bratislava).[3] There are other (less common) infectious strains. It should however be noted that genetically different leptospira organisms may be identical serologically and vice versa. Hence, an argument exists on the basis of strain identification. The traditional serologic system is seemingly more useful from diagnostic and epidemiologic standpoint at the moment (which may change with further development and spread of technologies like PCR).

Leptospirosis is transmitted by the urine of an infected animal, and is contagious as long as it is still moist. Although rats, mice and voles are important primary hosts, a wide range of other mammals including dogs, deer, rabbits, hedgehogs, cows, sheep, raccoons, possums, skunks, and even certain marine mammals are also able to carry and transmit the disease as secondary hosts. Dogs may lick the urine of an infected animal off the grass or soil, or drink from an infected puddle. There have been reports of "house dogs" contracting leptospirosis apparently from licking the urine of infected mice that entered the house. The type of habitats most likely to carry infective bacteria are muddy riverbanks, ditches, gulleys and muddy livestock rearing areas where there is regular passage of either wild or farm mammals. There is a direct correlation between the amount of rainfall and the incidence of leptospirosis, making it seasonal in temperate climates and year-round in tropical climates.

Leptospirosis is also transmitted by the semen of infected animals[4]. Abattoir workers can contract the disease through contact with infected blood or body fluids.

Humans become infected through contact with water, food, or soil containing urine from these infected animals. This may happen by swallowing contaminated food or water or through skin contact. The disease is not known to be spread from person to person and cases of bacterial dissemination in convalescence are extremely rare in humans. Leptospirosis is common among watersport enthusiasts in specific areas as prolonged immersion in water is known to promote the entry of the bacteria. Occupational risk factors include veterinarians, slaughter house workers, farmers, and sewer workers. An outbreak in an inner city environment has been linked to contact with rat urine.[3]

Symptoms

In animals, the incubation period (time of exposure to first symptoms) is anywhere from 2 to 20 days. In dogs, the liver and kidney are most commonly damaged by leptospirosis. Vasculitis can occur, causing edema and potentially disseminated intravascular coagulation (DIC). Myocarditis, pericarditis, meningitis, and uveitis are also possible sequelae. [3] One should strongly suspect leptospirosis and include it as part of a differential diagnosis if the sclerae of the dog's eyes appear jaundiced (even slightly yellow), though the absence of jaundice does not eliminate the possibility of leptospirosis, and its presence could indicate hepatitis or other liver pathology rather than leptospirosis. Vomiting, fever, failure to eat, reduced urine output, unusually dark or brown urine, and lethargy are also indications of the disease.

In humans, leptospiral infection causes a wide range of symptoms, and some infected persons may have no symptoms at all. Leptospirosis is a biphasic disease that begins with flu-like symptoms (fever, chills, myalgias, intense headache). The first phase resolves and the patient is asymptomatic briefly before the second phase begins that is characterized by meningitis, liver damage (causing jaundice), and renal failure. Because of the wide range of symptoms the infection is often wrongly diagnosed. This leads to a lower registered number of cases than there really are. Symptoms of leptospirosis include high fever, severe headache, chills, muscle aches, and vomiting, and may include jaundice, red eyes, abdominal pain, diarrhea, and/or a rash. The symptoms in humans appear after a 4-14 day incubation period.

Complications

Complications include meningitis, respiratory distress and renal interstitial tubular necrosis, which results in renal failure and often liver failure (the severe form of this disease is known as Weil's disease, though it is sometimes named Weil Syndrome[1][5]). Cardiovascular problems are also possible. Approximately 5-50% of severe leptospirosis cases are fatal, however, such cases only constitute about 10% of all registered incidents.

Diagnostics

On infection the microorganism can be found in blood for the first 7 to 10 days (invoking serologically identifiable reactions) and then moving to the kidneys. After 7 to 10 days the microorganism can be found in fresh urine. Hence, early diagnostic efforts include testing a serum or blood sample serologically with a panel of different strains. It is also possible to culture the microorganism from blood, serum, fresh urine and possibly fresh kidney biopsy. Kidney function tests (Blood Urea Nitrogen and creatinine) as well as blood tests for liver functions are performed. The later reveal a moderate elevation of transaminases. Brief elevations of aspartate aminotransferase (AST), alanine aminotransferase (ALT), and gamma-glutamyltransferase (GGT) levels are relatively mild. These levels may be normal, even in children with jaundice. Diagnosis of leptospirosis is confirmed with tests such as Enzyme-Linked Immunosorbent Assay (ELISA) and PCR. Serological testing, the MAT (microscopic agglutination test), is considered the gold standard in diagnosing leptospirosis. As a large panel of different leptospira need to be subcultured frequently, which is both laborious and expensive, it is underused, mainly in developing countries.

Differential diagnosis list for leptospirosis is very large due to diverse symptomatics. For forms with middle to high severity, the list includes dengue fever and other hemorrhagic fevers, hepatitis of various etiologies, viral meningitis, malaria and typhoid fever. Light forms should be distinguished from influenza and other related viral diseases. Specific tests are a must for proper diagnosis of leptospirosis. Under circumstances of limited access (e.g., developing countries) to specific diagnostic means, close attention must be paid to anamnesis of the patient. Factors like certain dwelling areas, seasonality, contact with stagnant water (swimming, working on flooded meadows, etc) and/or rodents in the medical history support the leptospirosis hypothesis and serve as indications for specific tests (if available).

Leptospira can be cultured in Ellinghausen-McCullough-Johnson-Harris medium, which is incubated at 28 to 30ºC.[6] The median time to positivity is three weeks with a maximum of 3 months. This makes culture techniques useless for diagnostic purposes, but is commonly used in research.

Treatment

Leptospirosis treatment is a relatively complicated process comprising two main components - suppressing the causative agent and fighting possible complications. Aetiotropic drugs are antibiotics, such as doxycycline, penicillin, ampicillin, and amoxicillin (doxycycline can also be used as a prophylaxis). There are no human vaccines; animal vaccines are only for a few strains, and are only effective for a few months. Human therapeutic dosage of drugs is as follows: doxycycline 100 mg orally every 12 hours for 1 week or penicillin 1-1.5 MU every 4 hours for 1 week. Doxycycline 200-250 mg once a week is administered as a prophylaxis. In dogs, penicillin is most commonly used to end the leptospiremic phase (infection of the blood), and doxycycline is used to eliminate the carrier state.

Supportive therapy measures (esp. in severe cases) include detoxication and normalization of the hydro-electrolytic balance. Glucose and salt solution infusions may be administered; dialysis is used in serious cases. Elevations of serum potassium are common and if the potassium level gets too high special measures must be taken. Serum phosphorus levels may likewise increase to unacceptable levels due to renal failure. Treatment for hyperphosphatemia consists of treating the underlying disease, dialysis where appropriate, or oral administration of calcium carbonate, but not without first checking the serum calcium levels (these two levels are related). Corticosteroids administration in gradually reduced doses (e.g., prednisolone starting from 30-60 mg) during 7-10 days is recommended by some specialists in cases of severe haemorrhagic effects.

Research

Leptospirosis: a zoonotic disease of global importance. Lancet Infect Dis. 2003 Dec;3(12):757-71 Bharti AR, Nally JE, Ricaldi JN, Matthias MA, Diaz MM, Lovett MA, Levett PN, Gilman RH, Willig MR, Gotuzzo E, Vinetz JM; Peru-United States Leptospirosis Consortium.

In the past decade, leptospirosis has emerged as a globally important infectious disease. It occurs in urban environments of industrialised and developing countries, as well as in rural regions worldwide. Mortality remains significant, related both to delays in diagnosis due to lack of infrastructure and adequate clinical suspicion, and to other poorly understood reasons that may include inherent pathogenicity of some leptospiral strains or genetically determined host immunopathological responses. Pulmonary haemorrhage is recognised increasingly as a major, often lethal, manifestation of leptospirosis, the pathogenesis of which remains unclear. The completion of the genome sequence of Leptospira interrogans serovar lai, and other continuing leptospiral genome sequencing projects, promise to guide future work on the disease. Mainstays of treatment are still tetracyclines and beta-lactam/cephalosporins. No vaccine is available. Prevention is largely dependent on sanitation measures that may be difficult to implement, especially in developing countries.

In a study of 38 dogs diagnosed and properly treated for leptospirosis published in the February 2000 issue of the Journal of the American Veterinary Association, the survival rate for the dialysis patients was slightly higher than the ones not put on dialysis, but both were in the 85% range (plus or minus). Of the dogs in this study that did not die, most recovered adequate kidney function, although one had chronic renal problems.

Source: Wikipedia

[Foggy Bottom]

Nahhh - you got it wrong George

Leptospirosis is dizzy Irish dwarves

[geovalin]

The original post is ridiculously short.

In which provinces are located the infested and dead people?

As rats and dogs are agents of the spread, Bangkok should be a favorable ground for the illness.

[dkstoney]

That's pretty depressing stuff, George.

[animatic]

Well better fore warned and forearmed.

Depressing or not its treatable..

Considering how animals are moved around this country,

their pee goes with them, and could be ANYWHERE now...

I friend got something sounding similar;

last month over in Uban Ratch...

Bathing in a hot spring with an unhealed cut on his leg.

2 days later raging fevers and he took about the same

meds listed above. He's fine now.

[96tehtarp]

Provinces ordered to be on alert for leptospirosis

BANGKOK: -- The Public Health Ministry has order all provinces to be on alert for the emergence of leptospirosis after it found 587 people were infected and 15 died from the disease.

Dr Prat Boonyawongvirot, the ministry's permanent secretary, said Tuesday most infectious cases were found during the rainy season.

People with cuts or rashes on their legs who wade through floodwater are 15 times more at risk of contracting the disease.

-- The Nation 2008-07-01

โรคเล็ปโตสไปโรซิส (Leptospirosis)

How does one pronounce this is Thai?

[dseawarrior]

Provinces ordered to be on alert for leptospirosis

BANGKOK: -- The Public Health Ministry has order all provinces to be on alert for the emergence of leptospirosis after it found 587 people were infected and 15 died from the disease.

Dr Prat Boonyawongvirot, the ministry's permanent secretary, said Tuesday most infectious cases were found during the rainy season.

People with cuts or rashes on their legs who wade through floodwater are 15 times more at risk of contracting the disease.

-- The Nation 2008-07-01

โรคเล็ปโตสไปโรซิส (Leptospirosis)

How does one pronounce this is Thai?

Hi, Thanks for the interesting question...

OK... I will give this one a shot for pronunciation:

Roughly breaking it down, using an long "o" (oa) sound like "oak" sound in English:

โรค = "Roak" (rhymes with "oak" sound in English, meaning _disease_ in Thai)

เล็ปโตสไปโรซิส = "lebp dtoa s(b)poa roa seet" basically a direct loan word (taat saap) from English with Thai pronunciation...

So, string it all together and you get...

โรคเล็ปโตสไปโรซิส = "Roak lebp dtoa s(b)poa roa seet"

Easy, eh?

Enjoy,

dseawarrior

BTW, check out the Thai Visa Thai language forum... Lots of resources there...

[topdjdel]

Having had this disease caught from sewer working and surviving let me you it is not pleasant and being on a drip in hospital due to lack of white blood cells and tested for everything else is bloody scary oh and the fact the disease does not leave your system so if like me when in Thailand when its hot hot hot the headaches are unbearable.

So any advice on this killer disease raised (its been put here for a reason) please take note of it and do not become a number.

del

[Tomissan]

โรคเล็ปโตสไปโรซิส (Leptospirosis)

How does one pronounce this is Thai?

Otherwise, commonly known as: Rok yeeoh noo, Rat piss disease

[flying]

Having had this disease caught from sewer working and surviving let me you it is not pleasant and being on a drip in hospital due to lack of white blood cells and tested for everything else is bloody scary oh and the fact the disease does not leave your system so if like me when in Thailand when its hot hot hot the headaches are unbearable.

So any advice on this killer disease raised (its been put here for a reason) please take note of it and do not become a number.

del

I remember over ten years ago it made its way through this part of Hawaii

The main problem was it was being misdiagnosed as a normal flu. Similar symtoms at start up.

I remember a lady here in her early 30's died of it.

She contracted it working in a graden. Her hand had a cut & she got it wet in some puddles. After exibiting symptoms they sent her home thinking it was a flu.

Another lady also got it but did not die she was treated properly.

She contracted it while carrying a stalk of fresh cut bananas. She also had a cut on her arm.

You know the Feds did all kind of testing back then on it here. Anyone with any symptoms even strep throat etc. got tested,

Now we never hear of it anymore. How is that possible I wonder?

[Maverell]

Hey people - dont worry - you have more chance of death being run down on the streets of Bangkok by a bus or taxi. Followed by catching HIV from a bar girl !! If you live elsewhere I have no idea

[Chewie1104]

I don't know if this is what I caught in April, but I was hospitalized for 8 days with similar symptoms. Both my legs had some kind of bacteria, were swollen and it was in my bloodstream. They didn't know what it was and I was on intravenous antibiotics for 8 days. It was some very stung stuff called vancomician.

I had some blisters on my feet and small cuts on my legs. We visited the Elephant Nature Park in Chaing Mai where we bathed the elephants in the local river. It was a great experience and I wanted to ignore the connection of the park and what happened to me. I have videos of the Elephant Dung floating in the river next to one of the elephants I was bathing. I'm sure there was urine in the water too.

The next morning I was cold and not feeling very good. By the afternoon I had a temp of almost 104 and the next day the hotel doctor said I needed to get to a hospital for further care. I flew to Bangkok that afternoon and staff at Bumrungrad met us at the airport.

Be warned about this. It can be some bad stuff if this is what I caught.

[wrecker]

Wow, there are probably not so many farangs working in the fields of working with animals. It is highly likely that the decease is brought into the country by refugees rom Burma. In that case it might be a painful but stark reminder that Thailand cannot simply please dictators, but that human rights abuses next door affect the health of rural Thai people.

Most people have little to fear from the disease given their profession. (or should I say the lack of profession?)

[naklang]

I don't know if this is what I caught in April, but I was hospitalized for 8 days with similar symptoms. Both my legs had some kind of bacteria, were swollen and it was in my bloodstream. They didn't know what it was and I was on intravenous antibiotics for 8 days. It was some very stung stuff called vancomician.

I had some blisters on my feet and small cuts on my legs. We visited the Elephant Nature Park in Chaing Mai where we bathed the elephants in the local river. It was a great experience and I wanted to ignore the connection of the park and what happened to me. I have videos of the Elephant Dung floating in the river next to one of the elephants I was bathing. I'm sure there was urine in the water too.

The next morning I was cold and not feeling very good. By the afternoon I had a temp of almost 104 and the next day the hotel doctor said I needed to get to a hospital for further care. I flew to Bangkok that afternoon and staff at Bumrungrad met us at the airport.

Be warned about this. It can be some bad stuff if this is what I caught.

You were very lucky. If they had you on a Vancomycin drip, it was a serious blood infection. All travel clinics warn to stay out of fresh water in SE-Asia even without open wounds. To get in with them?...............crazy!. Not worth it.

[GungaDin]

Wow, there are probably not so many farangs working in the fields of working with animals. It is highly likely that the decease is brought into the country by refugees rom Burma. In that case it might be a painful but stark reminder that Thailand cannot simply please dictators, but that human rights abuses next door affect the health of rural Thai people.

Most people have little to fear from the disease given their profession. (or should I say the lack of profession?)

Sorry, but that's rubbish!

Take a stroll down any soi with foodstalls or restaurants in Thailand and you will see rats, day and night.

Soi 22 is a good example.

"Rats Piss Disease" can be caught in any flooded soi.

A good pair of knee length 'Wellies" is a good investment, better still, a pair of waders.

Thanks for the Wiki info.

[Trevor]

Rat-piss disease, malaria, dengue, bargirl clap ... all you need is ...

http://www.mmsmiracle.com/

Kills all known germs. Oral Domestos, but perfectly safe. I take it myself. Active ingredient is chlorine dioxide gas. Buy now before they ban it!

[john11k]

Not very funny Gaz changmai, !!! considering it is a searious topic, J

[uha]

I would very much like to have the information about this disease in Thai language to show this to the family - does anyone know where I can find it?

[lothda]

Rat-piss disease, malaria, dengue, bargirl clap ... all you need is ...

http://www.mmsmiracle.com/

Kills all known germs. Oral Domestos, but perfectly safe. I take it myself. Active ingredient is chlorine dioxide gas. Buy now before they ban it!

There's a reason to ban it - it's rubbish, like all "miracle cure" scams. The website doesn't even manage to spell the chemical formula correctly. Do not, under any circumstances, use this.

[Scott]

I am a bit of a hypochondriac, so I tend to pay attention to these kind of threads. This disease, even though it's uncommon, does concern me. When it rains, I--and a lot of other people--put on our shorts and flip-flops and wade through the water. My feet usually have cuts and scratches, most likely because of mosquito bites and itching them, so it's worth noting that this disease could be a problem for a lot of people.

I doubt you have to have flip flops on, just nice wet feet would probably do the trick.

[Free-spirit]

If you do catch a serious bacterial or viral based disease like this you are best to take regular amounts of Colloidal Silver. It is the only product that I am aware of that has the ability to disable bacteria, fungus and virus by disabling their respiratory cell membrane - in effect it works by suffocating harmful microbes - without causing any harmful side-effects to the person drinking it. This is in stark contrast to pharmaceutical anti-biotics which try to kill bacteria by poisoning it, and often end up poisoning the patient instead!

I have found a good source of colloidal silver in Thailand here: www.colloidalsilverasia.com

FS

Edited July 2, 2008 by Free-spirit

[meelousee]

Hey people - dont worry - you have more chance of death being run down on the streets of Bangkok by a bus or taxi. Followed by catching HIV from a bar girl !! If you live elsewhere I have no idea

Don’t Worry? Are you nuts? Folks worry allot (but be on the safe side)here is why:

Riding a motorcycle on a wet street you are breathing in particles of wet dust from the road. Walking down a street with motorcycles, busses, Taxis and Samlors kicking up a fine mist you BREATH IT!

The roads contain, cat piss, dog piss, elephant piss, rat piss, and drunken derelicts do the same along with fecees of all. This washes into drains, the drains they ferment and then over flow, flood the road with a lethal mix of toxins I can not even spell. During the rainy season, I ride only in closed vehicles, and if I walk on a street other than my Soi I cover my nose and mouth with a pah yen from 7-11 or one from home.

Folks do worry and protect yourself, those runny noses and sinus infections many people get during this time of year is from what I will call Road Toxins some of them will kill you.

Edited July 2, 2008 by meelousee

[john b good]

The original post is ridiculously short.

In which provinces are located the infested and dead people?

As rats and dogs are agents of the spread, Bangkok should be a favorable ground for the illness.

Can only post the info that is available at the time.

Do you want George to massage the story to fill a couple of pages

Edited July 2, 2008 by john b good

[geriatrickid]

Ok before everyone panics, let's consider some things that were not stated;

1. In Thailand, the vector is primarily rodents, in particular rats. However, if the government says, hey, know what, we got a problem with rats, it's not going to paint a very nice picture for the outside world. Better to trot out the textbook explanation with rat as a vector buried somewhere inside the narrative.

2. My understanding of the reports is that the cases are clustered in urban areas. For those of you that have seen Bangkok and other areas , you know the sewage mixes with the rain. Again, not something anyone in an official position wants to say is hey, we have inadequate public sanitation and when there is a heavy rainfall, and you walk in the puddles, chances are you going to be wading through that pee you flushed earlier in the day.

3. Of the fatalities and the seriously ill, obear in mind that a large number of the deceased are either subjects that already had depressed immune systems, were elderly or were otherwise comprimised. If you have access to sanitation facilities and wash off immediately after contact with runoff, you cut educe your chances of contracting a beastie significantly. Oh wait, I forgot, alot of the poor people in the flooded areas do not have access to proper sanitation. Go figger.

Yes, there is a risk and yes it is admirable that a warning was sounded. Unfortunately, the warning is useless, if people still have to wade through filthy runoff and nothing is done about the rats. Personally, I'm more woried about Dengue . According to WHO there are approx. 45,000 dengue cases every year in Thailand.

The situation can be contained but that would require a bit of urban planing and common sense. Until that happens, avoid the puddles and sewage ponds.

[tuky]

Is the same thing you can catch from drinking out of a can without cleaning the rim first?

I have heard said that rats p1ss can contaminate the top?

[soundman]

Is the same thing you can catch from drinking out of a can without cleaning the rim first?

I have heard said that rats p1ss can contaminate the top?

Personally I never drink out of the can tuky without thouroughly wiping the rim first. You never know who used it before you!

[Payboy]

without thouroughly wiping the rim first

difficult to practise in public, no....

Edited July 2, 2008 by Payboy

[MJK]

Hi!

A friend of ours from Skandinavia visited us in Chiang Mai on March, got headache and feaver here and was diagnosed of leptospirosis back home. She had to take antibiotics for 6 weeks, but she's ok now.

[96tehtarp]

โรคเล็ปโตสไปโรซิส = "Roak lebp dtoa s(b)poa roa seet"

Easy, eh?

Enjoy,

dseawarrior

BTW, check out the Thai Visa Thai language forum... Lots of resources there...

nope... not at all easy. Thank you for your translation. I will look at the language forum.

Thanks again.