1. LEPTOSPIROSIS IN MALAYSIA
by Agnes Ling & Estella Chua

2. The Various Names
Swineherd's disease, swamp fever, or mud fever, Weil's disease, Weil's syndrome, canicola fever, canefield fever, nanukayami fever, 7-day fever, Rat Catcher's Yellows, Fort Bragg fever, and Pretibial fever
In Malaysia: Penyakit Kencing Tikus (Rat Urine Disease)

3. Introduction Most common zoonotic disease worldwide
Most prevalent in trophics, subtrophics
Caused by pathogenic spiral bacteria that belong to the genus: Leptospira, 
family:Leptospiraceae
order: Spirochaetales
the organism enters the body when mucous membranes or abraded skin come in contact with contaminated environmental sources.

4. Leptospires
Images above generated in 3DS Max and are based on direct measurements and sectional profiles of Leptospira Interrogans.

5. Etiology
In 1883,first recognized as an occupational disease of sewer workers
In 1886, Weil described the clinical manifestations in 4 men who had severe jaundice, fever, and hemorrhage with renal involvement.
in 1916, Inada et al identified the causal agent in Japan

6. Epidemiology
The most important reservoirs are rodents( rats) also dogs, livestock, wild animals, and cats. 
Urinary shedding of organisms from infected animals
A person can only be affected by direct exposure to the bacteria physically entering the bloodstream.
Likelihood in freshwater, damp alkaline soil, vegetation, and mud with temperatures higher than 22°C.
It is NOT contagious that is, it will not be passed from human to human.
1. Either through drinking or through broken skin such as lesion or through the eyes
Although rats and mice are primary hosts (incidentally, they are also carrier of many other diseases), a wide range of other mammals including dogs, deer, rabbits, cows, sheep and certain marine mammals are able to carry and transmit the disease as secondary hosts.
Note that the risk in saltwater is virtually zero.

7. Risk factors
Partial or total immersion in mud and water plays a role in facilitating infection in sewer workers and rice field workers.
Milkers may be splattered in the face, causing subsequent infection via the conjunctivae.
Infection of military troops occurs as a result of direct exposure to infected urine or indirect contact with contaminated soil and water.

8. Cases

9. Two people have died of leptospirosis in Kedah -- an employee of the Penang Health Department who had gone on a picnic to Lata Bayu and the a 17-year-old boy who had a dip in Puncak Janing
The recent spate began in July when eight people, who were among a search and rescue group looking for a drowning victim in a recreational area in eastern Pahang state,

14. Cases of Leptospirosis in Malaysia
Year
Number of Cases
2004
263
2005
378
2006
527
2007
929
2008
1263
2009
1418
Source: Report of Morbidity and Mortility for Health of Ministry Hospitals

15. Development of disease
Pathogen enters –multiplies in blood and tissue (usually lasts about 7 days)– affect liver and kidney.
(Anicteric leptospirosis) Systemic with aseptic meningitis
(Icteric leptospirosis) Overwhelming disease (Weil’s disease)
Vascular collapse
Thrombocytopenia
Hemorrhage
Hepatic and renal dysfunction

17. Clinical Progression
Recreational activities that present some risk include traveling to tropical areas, canoeing, hiking, kayaking, fishing in contaminated water or in endemic areas.
An outbreak of an acute febrile illness occurred among athletes competing in the Eco-Challenge-Sabah 2000 in Malaysia; 44% of those who reported ill. Among the factors are kayaking and swimming in and swallowing water from the Segama River.
Widespread flooding- flooding in Philippines 2009 caused 2000 cases n more than 100 death

18. Treatment Antimicrobial therapy(severe)
Dialysis(renal failure);renal function is restored in most.
Those with Weil syndrome may need transfusions of whole blood, platelets, or both.
Supportive therapy and careful management of renal, hepatic, hematologic, and CNS complications

19. Sources