Pest control
It took us eight hours to get here.” This was from a colleague who had come from the north to attend a conference.
While one can imagine how stifling and confining it might have felt to be cocooned in the vehicle for that length of time, an experience that is not novel to many, her recount managed to trigger another wave of thoughts that were more concerning: the effects of climate change, diseases, poverty, and of individuals left with no alternative but to wade through flooded waters. Aside from dengue, there has been a regrettable rise in numbers for leptospirosis compared to the same period from last year, according to the statistics from the Department of Health.
Leptospirosis is a widespread zoonotic disease that can be contracted from exposure to urine from infected mammals. Dogs, cattle, sheep, horses, and swine, to name a few, could be reservoirs, but the most notorious culprit would be the rodent or the rat, which can shed the bacterium intermittently or continuously, thereby easily contaminating the environment.
Portals of entry could be through mucous membranes of the eyes, nose, mouth, or other body parts, and/or through abraded skin. Imagine the mix of sewage, infected soil, and water that is inevitable when flooding occurs. Though this may be the common mode of transmission, occupational exposures (farmers, veterinarians), engaging in recreational activities such as kayaking, swimming in freshwater, and traveling to endemic areas may also place one at risk, as well as drinking contaminated water.
The disease has a broad range of possibilities, self-limiting and mild in most instances, it can be asymptomatic or severe, even potentially fatal. Clinical manifestations may be very nonspecific such as an abrupt onset of fever, headache, nausea, vomiting, nonproductive cough, diarrhea, body pain that is mostly concentrated on the calf and back muscles, conjunctival suffusion, and jaundice. Grouped into two categories, anicteric and icteric leptospirosis, the latter is more severe and commonly known as Weil’s disease wherein the patient exhibits fever, jaundice, and renal failure. Complications are not concentrated in the kidneys but are multisystemic, manifesting as pulmonary hemorrhage, myocarditis, heart failure, and rhabdomyolysis, and may even affect liver function as well.
Given our local epidemiology, obtaining a history of exposure, and exhibiting the aforementioned signs and symptoms, leptospirosis will remain to be one of the main considerations in a physician’s mind. In general, management is basically supportive and dependent on how the patient’s condition presents or progresses, which may involve, amongst others, renal, respiratory support, transfusion of blood products, and institution of antimicrobial therapy.
Prevention. Currently, there are no human vaccines available but there are a host of measures that might be relegated to being “common sense” but are worth mentioning. Uppermost is to avoid exposure at all costs to possible sources of infection. Keep surroundings clean and be conscious about keeping food and water from rodents who may just decide to invade your space. In the event that you have to wade through pools of water that may be potentially contaminated, plan ahead by bringing appropriate clothing and footwear. For those engaged in animal husbandry and for fur parents, adequate care includes having your animals and pets vaccinated.
Oftentimes the subject of chemoprophylaxis comes up. What if I didn’t have a choice and got exposed? What if I will have continued exposure? Local clinical practice guidelines have mentioned the use of specific antibiotics that may be considered in both scenarios. Studies in children are limited and recommendations have been based mostly on adult studies. Intake is to be under the advice of a physician and it is important to understand that receipt does not guarantee 100 percent protection against leptospirosis and one needs to still monitor for signs and symptoms.
While no one can be kept in a plastic bubble, the fact remains that we all can be at risk, with certain populations being more vulnerable. To eradicate leptospirosis is an impossibility but a semblance of control can be achieved if prioritized. At least on this score, pest control is available for rats of the four-legged variety.
