Epidemiologists urge public to be cautious of leptospirosis and skin rashes following floods

Contaminated waters

Dr. Prabha Abeykoon

• Protective measures to be taken in clean-up efforts
• Medical advice needs to be sought urgently in case of suspected leptospirosis cases
• Thoroughly cooked vegetables and boiled water are encouraged
• Early medical advice in case of skin rashes and infections should be sought

By Randima Attygalle

In the aftermath of the unprecedented flooding which engulfed the island, epidemiologists warn the public to be cautious of possible outbreaks of leptospirosis, commonly known as ‘rat fever’ or ‘mee una’ and skin diseases. Communities directly exposed to stagnant waters resulting from flooding of their houses and neighbourhoods and rescue missions, community workers and aid providers are vulnerable to these diseases caused by contaminated waters. Experts caution that those involved in post-flood cleaning are particularly vulnerable to Leptospira bacteria, which thrive in the shallow, muddy water commonly left behind after heavy flooding.

Speaking to the Daily FT, Health Ministry Epidemiology Unit – Consultant Epidemiologist Dr. Prabha Abeykoon urged people suspected of either leptospirosis or skin infection, to seek immediate medical health. “Leptospirosis is often associated with rodents, and many different kinds of wild and domestic animals may also carry the bacteria,” she says.

The bacterium that causes leptospirosis is spread through the urine of infected animals, which can get into water or soil and can survive there for weeks or months. Humans can become infected with the bacterium either through contact with urine of an infected animal or with water or soil contaminated with the urine of infected animals. The bacteria can enter the body through skin, eyes, nose or mouth. Careless garbage disposal also encourages the breeding of rats.

Leptospirosis symptoms often appear suddenly and these include high fever, headache, and muscle aches, especially in the calves and back. Other common symptoms include chills, nausea, vomiting, diarrhoea, and red eyes. Some may develop more severe symptoms such as yellowing of the skin and eyes or what is known as jaundice. The manifestations of the disease as Dr. Abeykoon explains, have changed from these classical symptoms. “Today we also see a lot of respiratory issues, pulmonary haemorrhage (bleeding into the lungs), pancreatitis, and myocarditis. Some patients may also develop kidney failure.”

Some of these symptoms can also mimic a viral infection and even dengue and chikungunya, which are on the rise in the aftermath of heavy rains and flooding, making diagnosis of leptospirosis challenging at times, says the Epidemiologist. “Today kidney complications, lung involvement and cardiac complications are some specific features we give attention to in our investigations which often require intensive care. We also take account of the patient’s exposure to paddy fields and stagnant water in the diagnosis,” explains Dr. Abeykoon. 

Leptospirosis is treated with antibiotics, and the specific treatment depends on the severity of the disease in each case. Mild cases are treated with oral antibiotics while severe cases require hospitalisation and intravenous (IV) antibiotics. Health authorities also recommend that individuals engaged in cleanup work seek guidance from PHI in their respective MOH area to take recommended antibiotics if they fear infection as a result of being exposed to contaminated waters. “The drugs in the state sector are administered through PHIs in relevant MOH areas and in the private sector, they can be obtained on the prescription of a physician only,” Dr. Abeykoon notes. She also goes onto add that early antibiotic treatment is crucial for both mild and severe cases to reduce the severity and duration of the infection. 

The confirmation of leptospirosis in the first few days of the manifestation of symptoms is possible today with a PCR test. The National Reference Laboratory (NRL) for Leptospirosis at the Medical Research Institute (MRI) which serves as the central referral laboratory in the country performs certain specific leptospirosis tests. Samples are sent to the central laboratory from hospitals island-wide.

Health officials also advise residents to maintain good hygiene and take simple protective measures during cleanup efforts such as wearing gloves and boots when handling contaminated materials and keeping cuts and wounds securely covered, and drink only boiled and cooled water.