SIBU: Sarawak exhibits a declining trend of 50 per cent in the number of confirmed leptospirosis cases.
For the Epidemiology (Epid) Week 1–39 (Jan 1-Sept 30) this year, 64 confirmed cases were reported versus 128 registered in the same period last year, said state Health Department director Dr Jamilah Hashim.
However, Sarawak recorded three deaths from the 64 cases for Epid 1–39 this year, compared to only two deaths out of the 128 cases reported in the same period last year.
Asked if leptospirosis could be contracted through bodily contact with the excrement of infected animals such as rats, Dr Jamilah explained: “Infection is acquired from contact via open skin wound, mucosa/conjunctiva with water or soil contaminated with the urine of rodents, or animals that carry the bacteria.
“Ingestion of contaminated water may also cause infection. There is no documentation of human to human transmission.”
On the types of occupations deemed as being most vulnerable to leptospirosis, Dr Jamilah pointed out that the exposure would depend on the chance of contact between human and the infected animals, or a contaminated environment through occupational and/or recreational activities.
“Some groups are at a higher risk such as workers in agricultural sectors, sewerage workers, livestock handlers, military personnel, search-and-rescue workers in high-risk environment, disaster relief workers (during floods, for example), people involved with outdoor/recreational activities such as water recreation and jungle-tracking, travellers who are not previously exposed to the bacteria, as well as people with chronic diseases and open skin wounds,” she said in a media statement to The Borneo Post.
Dr Jamilah advised those in these high-risk groups to always wear protective clothing and have on-standby equipment that could interrupt disease transmission; thereby preventing infection or disease in the human host.
“Always practice healthy habits such as frequent hand-washing, and strive to avoid areas that have increased risk exposure.”
Asked if the public should avoid lakes, she said: “We advise people to avoid areas with increased risk of exposure. Those staying near riverbanks must drink only boiled water, not just to prevent leptospirosis but other infectious diseases as well.”
On symptoms, she said the usual presentation would be an acute febrile illness with headache, myalgia (particularly the calf muscle) and prostration associated with any of the symptoms/signs – conjunctiva suffusion, anuria or oliguria, jaundice, cough, haemoptysis and breathlessness, haemorrhages (from the intestines – lung bleeding is notorious in some areas), meningeal irritation, cardiac arrhythmia or failure, and skin rash.
Other common symptoms would include nausea, vomiting, abdominal pains, diarrhoea, and arthralgia (pain in joints and nerves).
“The clinical diagnosis is difficult where diseases with symptoms similar to those of leptospirosis occur frequently. In this regard, treatment must be initiated early with antibiotics,” stressed Dr Jamilah.
Severe cases are usually treated with high doses of IV Benzyl penicillin (30mg/kg up to 1.2g IV six-hourly for five to seven days).
Less severe cases are treated with oral antibiotics such as Doxycycline (2mg/kg up to 100mg 12-hourly for five to seven day), Tetracycline, Ampicillin or Amoxicillin.
The third-generation Cephalosporin, such as Ceftriaxone and Cefotaxime, and Quinolone antibiotics may also be effective.
Jarisch-Herxheimer reaction (reaction to the endotoxin-like products released following the death of harmful microorganisms within the body during antibiotic treatment) may occur after the start of antimicrobial therapy.
“The patient will be monitored and given supportive care as appropriate – for example, dialysis and mechanical ventilation,” said Dr Jamilah.