Leptospirosis or ‘Rat Fever’ in Sri Lanka

Dr B. J. C. Perera
MBBS(Cey), DCH(Cey), DCH(Eng), MD(Paed),
MRCP(UK), FRCP(Edin), FRCP(Lond), FRCPCH(UK),
FSLCPaed, FCCP, Hony. FRCPCH(UK), Hony. FCGP(SL)
(Specialist Consultant Paediatrician and Honorary Senior Fellow,
Postgraduate Institute of Medicine, University of Colombo, Sri Lanka)

Sri Lanka is grappling with a surge in leptospirosis cases at present. It is a bacterial disease often transmitted through contaminated water and soil. Following the recent devastating floods, the number of infections has skyrocketed, with over 10,000 cases reported so far, with a significant number of fatalities. In 2023, there were around 9,000 cases with over 200 deaths. In medical terminology, Leptospirosis is classified as a zoonotic disease, meaning that it can be transmitted between animals and humans.

Leptospirosis is caused by a bacterium called Leptospira icterohaemorrhagiae, commonly found in the urine of infected animals, particularly rodents. The disease is also known as “Rat Fever” as rats carry this organism and excrete it in their urine. When floodwaters contaminate the environment, these bacteria can spread widely. The organism is also found in agricultural plots such as paddy fields. People can contract the disease by wading through floodwaters, consuming contaminated food or water, or handling infected animals. Children are particularly vulnerable to catching the disease as they love to play in water-logged paddy fields and flood waters.

The organism enters the body of humans through breaks in the skin, and mucous membranes, or through the gastrointestinal tract. There has been an alarming spike that came in the aftermath of severe flooding in recent months, which has created ideal conditions for the spread of this potentially fatal disease. Floodwaters often mix with waste, animal urine, and other contaminants, creating an environment ripe for the proliferation of Leptospira bacteria. People’s unavoidable exposure to these waters, especially in rural and suburban areas, has significantly increased infection rates. Additionally, inadequate drainage systems, poor sanitation in flood-affected areas, and delayed medical interventions have amplified the crisis. The heavy toll on Sri Lanka’s healthcare system due to other ongoing challenges has also strained resources for managing the outbreak.

The symptoms of leptospirosis can range from a mild flu-like illness to a severe, life-threatening condition. In its early stages, it may present with fever, headache, chills, rigors or shaking episodes, vomiting, muscle aches which could be quite severe, and redness of the whites of the eyes due to bleeding. Some moderate to severely affected patients start to pass reddish urine due to bleeding from the genitourinary tract. The organism is labelled as icterohaemorrhagiae because the name implies two of the most devastating complications of the disease; ictero meaning jaundice signifying liver involvement, and haemorrhage implying a bleeding tendency. The initial mild phase of the illness often resolves on its own or with minimal treatment. Yet for all that, some patients progress to a more severe life-threatening form of the disease characterised by major bleeding tendencies, kidney failure, liver damage, brain involvement, respiratory distress, and end up in death. However, the real problem is that at the onset of the disease, it is impossible to predict the subsequent course the disease will take. It could be mild or it could sometimes end up in death, as seen at the two extreme ends. Therefore, once a firm or likely diagnosis of leptospirosis is made, the full course of treatment must be given, irrespective of even the initial mild nature.

If detected early, leptospirosis can be very effectively treated with appropriate antibiotics. The secret is to refrain from disregarding symptoms and taking meaningful steps to seek medical care early. This should be very clearly conveyed to the general public. In the more severely affected patients and those who present late and have complications of the disease, even intensive care management in a tertiary care hospital may be necessary. Severe liver and kidney failure need specific treatment to ensure recovery. Severe kidney failure may even need renal replacement therapy such as dialysis.

The best way to prevent leptospirosis is to avoid exposure to contaminated water and soil. This can be done by wearing protective gear such as waterproof high boots, gloves and long-sleeved clothing, particularly when working in flood-affected areas, avoiding wading through or swimming in floodwaters, drinking boiled or treated water, maintaining personal hygiene by washing hands thoroughly with soap and water after any activity that may have exposed one to contaminated water or soil, vaccinating pets against leptospirosis and controlling the rodent populations.

The government and public health authorities play a crucial role in preventing and controlling leptospirosis outbreaks. The measures to be taken include closely monitoring the number of cases and identifying areas at high risk, early detection and treatment of affected patients by providing timely diagnosis and treatment, educating the public about the risks of leptospirosis and the preventive measures that should be taken, and improving sanitation and hygiene as well as developing and implementing a comprehensive leptospirosis control programme.

The leptospirosis outbreak in Sri Lanka serves as a stark reminder of the importance of preparedness and prevention. By understanding the risks, taking necessary precautions, and supporting public health efforts, we can effectively mitigate the impact of this deadly disease. While individual actions are vital, controlling a public health crisis of this magnitude requires coordinated efforts by health authorities, local governments, and communities. Public Awareness Campaigns are vital and authorities should disseminate information through media about the risks, symptoms, and preventive measures for leptospirosis. Improving sanitation, addressing waste management and improving drainage systems can reduce contamination in flood-prone areas. This crisis also highlights the need for long-term investments in infrastructure, sanitation, and healthcare to build resilience against future outbreaks.

For now, raising awareness and taking immediate action are the most powerful tools to save lives. If you suspect you may have been exposed to leptospirosis or are experiencing any of the symptoms, seek medical attention immediately. Early diagnosis and treatment can significantly improve the chances of recovery. By working together, we can protect ourselves and our communities from the dangers of leptospirosis.

This article is for informational purposes only and should not be considered as binding medical advice. The general public must consult appropriate medical personnel without any delay, as and when required.