Flood-hit Kerala now battles 'rat fever': All you need to know about leptospirosis

As  flood-ravaged Kerala  struggles to get back on her feet after weeks of torrential rain, the state is now faced with a new public health challenge – leptospirosis. From rotting livestock to stagnant waters — there are multiple reasons for the outbreak of what has come to be known as “rat fever”. Leptospirosis, or rat fever, has already claimed  19 lives in Kerala since the deluge. The health ministry has declared an emergency protocol in Kozhikode and issued a  high alert in several regions of the state. But what is this new malady and how does it spread during floods? More importantly, what can you do to keep yourself safe if faced with a flood where you live? We speak to an infection specialist for some quick takeaways to remember if you live in a flood-prone area. What is leptospirosis? Leptospirosis, or rat fever, is a bacterial infection that people can contract from animals. “It affects the kidneys and liver severely, and is often accompanied by jaundice,” Dr Sachin Melinkeri, Infection Specialist at KEM Hospital, Pune, said. Jaundice  can be identified by the yellowing of the skin and white part of one’s eyes. This happens when the red blood cells are being destroyed at an unusual rate by an infection. Is rat fever fatal? Left untreated, leptospirosis is life-threatening. It can lead to permanent failure of the liver, permanent kidney damage, and meningitis (an inflammation of the membrane that covers the brain and spinal cord). Meningitis  can cause painful swelling at the back of the neck and head, and kill in hours. “It (leptospirosis) could lead to death if its isn’t diagnosed and treated correctly” Melinkeri said. “The trouble is that it often gets misdiagnosed as a viral infection like dengue due to similarities in early symptoms." Can people be asymptomatic or carriers? “It (leptospirosis) usually shows symptoms in a matter of 2-5 days from the time someone is infected. It is unlikely for an infected person to be asymptomatic for longer than 10 days at the most.” Melinkeri explains. How does it spread? It spreads through contact with urine or faeces from dogs, rats or farm animals that are already infected with leptospirosis. During floods, the reason that cases of leptospirosis rise is that contaminated water is all around. “Poor sanitation is the biggest reason for spread of the infection,” Melinkeri says. The bacteria can enter a healthy person through cuts and wounds that are exposed to contaminated water. [caption id=“attachment_5036541” align=“alignnone” width=“1280”] This image shows residents wading through flood waters in Kerala. Flood water is contaminated with numerous pathogens, and is the prime means of transmission of the Leptospira bacterium that causes leptospirosis, also known as rat fever. It enters wounds on the skin from faeces and urine of infected dogs, rats and farm animals. Image courtesy: Reuters.[/caption] What are symptoms to watch for? Melinkeri explains that the first symptoms to look for are “high fever, chills, headache and muscle pain.” It is these symptoms that lead to it being commonly misdiagnosed as dengue fever, which caused by a virus, he adds. “Dengue and malaria are much more prevalent than a leptospirosis infection in an area affected by floods.” How is it diagnosed? “Doctors are generally wary of diagnosing leptospirosis without an ‘infection panel’ test,” says Melinkeri. An infection panel is a test of urine and blood to look for an immune response our body may have generated to the bacteria. The tests look for antibodies (proteins produced by our body during an immune response) to the Leptospira bacteria in a ‘Microscopic Agglutination Test (MAT)’ – the most widely-used way method to confirm a leptospirosis infection. How can leptospirosis be prevented? “There’s no easy answer here,” says Melinkeri, who believes that proper sanitation and treatment processes in a city are the only effective way to keep chances of a leptospirosis outbreak to a minimum. “Avoiding walking in flood water that could have been contaminated by animals… is the most sensible thing to do to prevent a leptospirosis infection,” Melinkeri advises. What should I do if I can’t avoid it? There are some preventive measures you can take in an emergency if you have reason to suspect you have contracted a leptospirosis infection. “ Doxycycline is definitely the most widely available one, which at 100 mg has been a standard prescription for bacterial infections since the 1990s.” If there is cause to suspect a leptospirosis infection, the Municipal Corporation of Greater Mumbai  (MCGM) recommends a 100 mg dose of doxycycline three hours before wading into water, or a single 200 mg dose once daily for 3 days after walking through potentially contaminated waters as an immediate preventive measure. [caption id=“attachment_5112071” align=“alignnone” width=“589”] A public notice issued by CGM to deal with Red fever. Image courtesy: MCGM[/caption] When asked if there are alternatives to this medicine, Melinkeri  said, “Doxycycline has been shown to cause deformities in young children as well as pregnant women, for who  **erythromycin**  is a far safer preventive medication at the same dosage”.