The deadly problem of leptospirosis

On June 24, 2018, a 47-year-old male patient was seen at the emergency room of the National Kidney and Transplant Institute (NKTI). His lungs were failing, blood was flooding his airway, and every breath was a struggle. His kidneys were beginning to shut down, producing no urine. His liver was swollen, giving him a yellowish tinge. His pancreas was producing large amounts of enzymes, threatening to digest his abdominal organs.

The patient had severe leptospirosis. From his clinical appearance, death was but a few hours away. Immediately, Ecmo (extracorporeal membrane oxygenation) was instituted.

Basically, Ecmo is a device similar to a dialysis machine used for kidney failure. The patient’s blood vessels are connected to this machine (which is outside the body, thus the term extracorporeal), which then supplies oxygen to the blood, taking over the functions of the failing lung. Ecmo is sometimes called dialysis of the lungs, for lack of a better technical term.

After six days on the machine, and an additional 12 days on the ventilator or breathing apparatus, and a very complicated, stormy and expensive clinical course, the patient walked out of the hospital alive. He has since returned to a normal life, tending to his store in Taguig. After his case, 12 other patients have undergone this procedure.

Theoretically, it may be possible to support a person’s failing heart and lungs indefinitely. In Taipei, a friend (a heart surgeon) related to me the case of a patient whose damaged heart was removed and placed on Ecmo life support until a donor heart became available for transplantation 18 days later. He was dubbed the “heartless” patient.

The NKTI acquired three of these machines last year; in fact, the “bopis” hospitals (the government-run Philippine Heart Center, Lung Center of the Philippines and the NKTI) have these expensive lifesaving machines. “Bopis” refers to the spicy Filipino dish usually made up of chopped pig innards like the heart and lungs.

The rains have begun, and it’s leptospirosis season once again. While rain is welcomed by farmers, torrential and continuous rainfall causes flooding. In a crowded metropolis such as Manila, leptospirosis, caused by the corkscrew-shaped bacteria usually from the urine of rats coming in contact with open skin wounds, poses a danger to people wading in floodwaters.

Last year, patients contaminated with leptospirosis swamped the NKTI’s emergency room, most of them needing hemodialysis to reverse kidney failure. Even the hospital’s basketball court was converted into a makeshift ward to accommodate the overflow of patients. The influx began in 2009, when Tropical Storm “Ondoy” flooded large swaths of the metropolis, resulting in a leptospirosis outbreak.

Flooding in Manila and its environs is exacerbated by a combination of uncollected garbage that clog esteros, the lack of trees to absorb rainfall, low-lying areas like Navotas, and the changing climate. Throw in a large rodent population and you have the threat of leptospirosis.

To address this serious public health problem, we should start copying the flood control system of the Netherlands. This is an instance of a public health problem seeking a public works or infrastructure solution.

In 1854, the English physician John Snow demonstrated that an epidemic of cholera was traced to contaminated drinking water from a public water pump in Soho, London. Snow did not believe in the prevailing concept then of cholera and bubonic plague being transmitted by “bad air.” His work laid down the foundation of modern epidemiology, leading to improvements in water and waste systems, and the basic tenet we know today — that a clean environment helps ensure health and wellness.

In her 1994 book, “The Coming Plague,” Pulitzer Prize-winning journalist Laurie Garrett stated the obvious: factors such as internecine wars and the resulting refugee migration, deforestation, antibiotic misuse, etc., have fostered the spread of Ebola, HIV, Lassa, SARS in southern China, swine flu in Mexico, dengue in Southeast Asia and the hantavirus in South Korea. And to think that in the 1980s, scientists throughout the wealthy world were focused on cancer and heart disease in the mistaken notion that antibiotics and vaccines had ended infectious diseases. In reality, microbes have been on this planet long before human beings; we are the intruders—but that’s another story.

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Dr. Jose Luis J. Danguilan, a thoracic surgeon, is the former executive director of the Lung Center of the Philippines.