Leptospirosis

Leptospirosis is a flu-like illness caused by the bacteria Leptospira. You can get infected through breaks in your skin, or through your eyes, nose or mouth.

Leptospirosis (pronounced “lep-toh-spy-ROH-sis”) is a zoonotic disease. This means it’s transmitted between animals and humans. You can get infected through:

• Direct contact with pee (urine) or reproductive fluids from infected animals
• Contact with contaminated water or soil
• Eating or drinking contaminated food or water

Phases

Leptospirosis has two phases: the leptospiremic (acute) phase and the immune (delayed) phase. You may have mild symptoms or no symptoms in the leptospiremic phase. Some people develop severe symptoms in the immune phase.

Leptospiremic phase

During the leptospiremic phase (also called the septicemic phase), bacteria are in your bloodstream and moving to your organs. You may get sudden, flu-like symptoms. They usually start within two to 14 days after a Leptospira infection. They last between three and 10 days. Blood tests will show signs of infection.

Immune phase

In the immune phase, Leptospira bacteria have moved from your blood to your organs. The bacteria are most concentrated in your kidneys, which make pee.

A small number of people will get very sick with Weil’s syndrome in this phase. Weil’s syndrome causes internal bleeding, kidney damage and severe yellowing of your skin and eyes (jaundice). Urine tests will show signs of the bacteria, and you’ll have antibodies to Leptospira in your blood.

Symptoms of leptospirosis

Some people start out with flu-like symptoms, and some have no symptoms at all. Initial symptoms of leptospirosis can include:

• High fever
• Red eyes (conjunctival injection)
• Headache
• Chills
• Muscle aches
• Abdominal pain
• Nausea and vomiting
• Diarrhea
• Yellow skin or eyes (jaundice)
• Rash

Severe leptospirosis (Weil’s syndrome) symptoms may start three to 10 days later. You may start feeling better before severe symptoms start. They include:

• Coughing up blood
• Chest pain
• Trouble breathing
• Severe yellowing of your skin or eyes
• Black, tarry poop (stool)
• Blood in your pee
• Decrease in the amount you pee
• Flat, red or dark spots on your skin that look like a rash (petechiae)

Causes

The bacteria Leptospira cause leptospirosis. Bacteria get into your body through your mouth, nose or eyes. They can also enter through breaks in your skin. They travel through your blood to your organs, collecting in your kidneys (the organ that “cleans” your blood). Bacteria from your kidneys leave your body in your pee, which can spread leptospirosis to other people or animals.

How does leptospirosis spread?

Leptospirosis is usually spread to humans from animal pee containing the bacteria Leptospira. Almost any mammal (like rats, dogs, horses, pigs or cows) can get leptospirosis. They may have few or no symptoms of illness.

Animals with leptospirosis can contaminate water or dirt (soil), which spreads the bacteria to other animals or humans. You can get leptospirosis from:

• Directly touching pee or other body fluids (like milk or blood) from an animal with leptospirosis
• Getting contaminated water or soil in your eyes, nose or mouth or in a break in your skin

A large number of people can get leptospirosis at once (an outbreak) after heavy rains and flooding. The floodwaters wash into rivers, lakes and canals, bringing bacteria with them.

Leptospirosis is rarely contagious from one person to another. But sometimes, outbreaks have happened in people living closely in a shared living space.

Risk factors

You can get leptospirosis no matter where you live, but it’s most common in tropical areas and warmer climates with lots of rainfall each year. You’re at an increased risk for leptospirosis if you live in or travel to these areas. They include:

• Oceania (Australia, New Zealand and the Pacific Islands)
• The Caribbean
• Parts of sub-Saharan Africa
• Parts of Latin America
• South and Southeast Asia

There have been outbreaks in the U.S. after flooding in Hawaii, Florida and Puerto Rico.

Recreational freshwater activities put you at an increased risk. This includes activities that put you in contact with animals or contaminated water or soil for a long time. Some activities that might put you at higher risk include:

• Boating
• Gardening
• Hiking
• Hunting
• Swimming
• White water rafting
• Working in a veterinary office, on a dairy farm, in a butcher shop or other work that involves animals

Complications

Left untreated, severe leptospirosis can lead to:

• Organ damage or failure, especially in your kidneys and liver
• Acute respiratory distress syndrome (ARDS)
• Respiratory failure
• Inflammation around your brain and spinal cord (meningitis)

How doctors diagnose leptospirosis

Healthcare providers diagnose leptospirosis with a physical exam, blood tests and urine (pee) tests. Your provider will ask you about your symptoms, your travel history and whether you could’ve been in contact with anything contaminated. If you’re very sick, you may have a chest X-ray or CT scan.

How is it treated?

Your healthcare provider might treat leptospirosis with a week of antibiotics. If you have severe leptospirosis, you’ll stay in the hospital to receive supportive care, like IV fluids.

When should I see my healthcare provider?

Contact a healthcare provider if you’ve been in water or soil that could have been contaminated and you have any symptoms of leptospirosis.

When should I go to the ER?

Go to the nearest ER if you have symptoms of severe leptospirosis, including:

• Coughing up blood
• Chest pain
• Trouble breathing
• Yellow skin or eyes
• Black, tarry poop
• Blood in your pee
• Peeing very little
• Rash-like red or dark spots on your skin

What can I expect if I have leptospirosis?

Most cases of leptospirosis are mild and don’t need treatment. Your healthcare provider will keep a close eye on your symptoms. Don’t hesitate to call 911 or go to the emergency room at the first sign of severe symptoms.

For mild symptoms, a healthcare provider can recommend over-the-counter treatments to help you feel better.

How long does it last?

Mild cases of leptospirosis last a few days to a few weeks. If you’re very sick, you can be in the hospital for a few weeks. It can take several months to fully recover from severe leptospirosis.

Can you survive leptospirosis?

Yes, most people survive leptospirosis. Most people have no symptoms or have very mild symptoms that go away on their own.

Only about 1% of people with leptospirosis get severely ill with Weil’s syndrome. Weil’s syndrome is often deadly if not treated or if you delay treatment. But if treated quickly, it’s very likely you’ll recover.

How can I prevent leptospirosis?

The best way to prevent leptospirosis is by not swimming or wading in water that might have animal pee in it. This includes floodwaters. Here are other ways you can reduce your risk:

• Take preventive medication. If you’re traveling and at high risk for leptospirosis, ask a provider about taking medication to keep from getting sick (prophylaxis).
• Avoid animals that could have leptospirosis.
• Wear protective clothing and shoes if you work with or around animals.
• Wear protective shoes and clothing if you have to be in contact with water or soil that might be contaminated with bacteria.
• Avoid water sports and swimming in lakes and rivers after floods.
• Drink only treated water. Don’t drink water from lakes, rivers and canals without boiling it first. Use bottled water for drinking and cooking if you don’t know if the water is treated.
• Wear gloves if you have to touch dead animals. Don’t touch them with your bare hands. Wash your hands thoroughly afterwards.
• Cover open cuts or wounds with waterproof dressing.