Released: May 11, 2012

What Is the Current Situation?

Flooding has caused an outbreak of leptospirosis in Peru, especially in the Loreto region. This is the worst flooding seen in this area for over 20 years. Peru has reported more than 300 cases and 3 deaths associated with leptospirosis thus far in 2012. Health authorities have alerted people to take precautions against the infection.

What Is Leptospirosis?

Leptospirosis is a disease that is spread by animal urine. People become infected with the disease when they come in contact with body fluids of infected animals or in contact with water, soil, or food contaminated with infected urine. Leptospirosis is a hazard for many people who work outdoors or with animals. The disease has also been associated with swimming, wading, kayaking, and rafting in contaminated lakes and rivers. Symptoms include high fever, headache, chills, muscle aches, vomiting, jaundice (yellow eyes and skin), red eyes, abdominal pain, diarrhea, and rash. Some people do not experience symptoms. This disease can cause kidney or liver failure and/or meningitis (swelling of the tissue covering the brain). Without treatment, recovery can take several months.

Leptospirosis occurs throughout the world, especially in regions with flooding. Leptospirosis occurs more often in tropical areas. Urban areas lacking sanitation may also have a higher risk of leptospirosis.

How Can Travelers Protect Themselves?

No vaccine is available to prevent leptospirosis. Travelers to areas with flooding can take the following steps to prevent the disease:

• Avoid swallowing flood waters or water from lakes, rivers, and swamps. Wear protective clothing, especially footwear, if you are wading in flood waters or other areas that might be contaminated.
• Avoid wading in flooded areas, especially if you have any cuts or abrasions.
• Avoid contact with environments contaminated with animal urine.
• Talk to your health care provider about taking medicine to help prevent leptospirosis. Be sure to tell your health care provider about all your planned activities.

Clinician Information:

Adult travelers who travel to the Loreto region of Peru are at increased risk for leptospirosis and should be advised to consider chemoprophylaxis with doxycycline (200 mg orally, weekly), begun 1–2 days before and continuing through the period of exposure. Indications for prophylactic doxycycline use for children < 8 years of age have not been established. Travelers at increased risk for leptospirosis and in need of malaria chemoprophylaxis should consider using doxycycline for both indications.

Diagnosis of leptospirosis is usually based on serology. Antibodies may be detected in the blood within 5–7 days of symptom onset. Culture and demonstration of the organism under darkfield microscopy are both relatively insensitive. No PCR assay has been validated with clinical specimens. Confirmation of leptospirosis requires seroconversion between acute- and convalescent-phase serum specimens, as demonstrated by the microscopic agglutination test (MAT), culture of the organism from clinical specimens, or demonstration of Leptospira in a clinical specimen by immunofluorescence.

Missed or delayed diagnosis of leptospirosis is common because of its nonspecific clinical presentation and a low index of suspicion among clinicians seeing returned travelers. Antimicrobial therapy should be initiated early in the course of the disease if leptospirosis is suspected. Intravenous penicillin is a drug of choice for patients with severe leptospirosis. As with other spirochete infections, a Jarisch-Herxheimer reaction (an acute febrile reaction that can range from rash to anaphylaxis) can develop after initiation of penicillin therapy. Various methods have been described to prevent or control Jarisch-Herxheimer reactions, and management should follow the appropriate standards for patient care. Doxycycline is effective in decreasing the severity and duration of leptospirosis and the occurrence of leptospiruria. Parenteral third-generation cephalosporins and azithromycin may also be used for treatment. Because of the risk for potential complications, including cardiac arrhythmia, renal failure, pulmonary involvement and respiratory distress, or myocarditis, patients with leptospirosis may require hospitalization, supportive therapy, and close monitoring.

Ten illnesses reported

SACRAMENTO, May 10, 2012 – Raw milk, raw skim milk (non-fat), raw cream and raw butter produced by Organic Pastures Dairy of Fresno County is the subject of a statewide recall and quarantine order announced by California State Veterinarian Dr. Annette Whiteford. The quarantine order came following the confirmed detection of campylobacter bacteria in raw cream. Consumers are strongly urged to dispose of any Organic Pastures products of these types remaining in their refrigerators, and retailers are to pull those products immediately from their shelves.From January through April 30, 2012, the California Department of Public Health (CDPH) reports that at least 10 people with campylobacter infection were identified throughout California and reported consuming Organic Pastures raw milk prior to illness onset. Their median age is 11.5 years, with six under 18. The age range is nine months to 38 years. They are residents of Fresno, Los Angeles, San Diego, San Luis Obispo and Santa Clara counties. None of the patients have been hospitalized, and there have been no deaths.

According to CDPH, symptoms of campylobacteriosis include diarrhea, abdominal cramps, and fever. Most people with campylobacteriosis recover completely. Illness usually occurs 2 to 5 days after exposure to campylobacter and lasts about a week. The illness is usually mild and some people with campylobacteriosis have no symptoms at all. However, in some persons with compromised immune systems, it can cause a serious, life-threatening infection. A small percentage of people may have joint pain and swelling after infection. In addition, a rare disease called Guillain-Barre syndrome that causes weakness and paralysis can occur several weeks after the initial illness.

-30-