Post-Flood Leptospirosis

Flood disasters at the peak of the Cempaka tropical cyclone in the Special Region of Yogyakarta (DIY) and southern East Java on Tuesday, November 28, 2017 were very alarming. Follow-up danger after the flood recedes is a deadly * leptospirosis disease. * Leptospirosis is a disease caused by infection with the bacteria Leptospira sp. which can be transmitted from animals to humans (zoonoses). What do we need to be aware of?

Leptospirosis was first reported in 1886 by Dr. Adolf Weil with symptoms of * high fever accompanied by several neurological symptoms and enlargement of the liver and spleen. * Disease with the above symptoms by Goldsmith 1887 referred to as Weil's Disease. In 1915 Dr. Inada succeeded in proving that "Weil's Disease" * was caused by the Leptospira icterohemorrhagiae bacteria. *

In 2016, leptospirosis cases in Indonesia reached 343 people, 47 people died and CFR (Case Fatality Rate) 13.70%, while in DIY with 17 cases, 6 died, * the CFR in DIY was very high, namely 35.29%. * At the age of more than 50 years the death reaches 56%. In some publications the mortality rate is reported to be between 3-54% depending on the organ system that is infected.

* Leptospirosis is a disease that can be transmitted through water (water borne disease). * Urine (urine) from individuals affected by this disease is the main source of transmission, both in humans and in animals. * Heavy rain will help spread this disease, especially in flooded areas. * Leptospirosis events in humans are found in sewer cleaning workers, * because the sewers are contaminated with Leptospira bacteria. * Leptospirosis can also affect children, who live * in a dense urban environment with many house mice hanging around. *

The incubation period of Leptospirosis in humans is 2-26 days. Leptospirosis infection has very varied manifestations and * sometimes asymptomatic, resulting in frequent misdiagnosis, especially in subclinical infections characterized by mild to severe flu. * Nearly 40% of patients exposed to asymptomatic infections * but positive serological examination. * Approximately 90% sufferers will experience mild yellow eyes and skin, while 5% yellow is heavy which is known as Weil disease. * Leptospira disease journey consists of 2 phases, * namely the septicemic and immune phases. * In the phase transition period for 1-3 days the patient's condition might look better.

* Septicemic phase is known as the initial phase or leptospiremic phase because bacteria can be isolated from blood, cerebrospinal fluid and most body tissues. * At this stage, patients will experience flu-like symptoms for 4-7 days, characterized by fever, cold, and weakness muscle. Other symptoms are sore throat, cough, chest pain, vomiting of blood, headache, fear of light, mental disorders, inflammation of the lining of the brain (meningitis), and * enlargement of the spleen and liver. * Immune phase is often called * second phase or leptospirurik due to circulating antibodies can be detected by isolation of germs from urine, * and may not be obtained from blood or cerebrospinal fluid. This phase occurs at 0-30 days due to the body's defense response to infection. Symptoms depend on disturbed organs such as the lining of the brain, liver, eyes or kidneys.

If the brain membrane is attacked, depression, anxiety and headache will occur. On examination the liver is found yellow skin, enlarged liver (hepatomegaly), and signs of coagulopathy. Lung disorders include coughing, coughing up blood, and difficulty breathing. Hematological disorders in the form of inflammation and enlargement of the spleen (splenomegaly). Cardiac abnormalities are characterized by heart failure or pericarditis. Aseptic meningitis is the most important clinical manifestation in the immune phase.

* Weil syndrome is a form of severe Leptospirosis characterized by yellow skin or eyes, kidney dysfunction, liver necrosis, lung dysfunction, and diathesis bleeding. * This condition occurs at the end of the initial phase and increases in the second phase, but can worsen at any time. Pulmonary manifestations include coughing, difficulty breathing, chest pain, coughing up blood, and respiratory failure. Patients with heavy yellow are more susceptible to kidney failure, bleeding, and cardiovascular collapse. * Severe cases with liver and kidney disorders result in deaths of 20-40%. *

Diagnosis Leptospirosis is usually * done by serological examination. * Antibodies can be found in the blood on the 5-7th day after the presence of clinical symptoms. In addition to serological examination, to confirm Leptospirosis infection is * Microscopic agglutination test (MAT). * Culture or observation of Leptospira bacteria under a microscope with a dark background is generally insensitive. In addition, a diagnosis can also be made by observing Leptospira bacteria in infected organ specimens, using immunofloresen.

Leptospirosis can be treated with antibiotics doxycycline, ampisillin, amoxicillin, erythromycin * and newer antibiotics. However, treatment delay, misdiagnosis, or the occurrence of Weil Syndrome, * can increase mortality or CFR (Case Fatality Rate). *

The floods due to the Cempaka tropical cyclone in the Special Region of Yogyakarta (DIY) must be anticipated as well as possible. * Not only with the reconstruction of buildings after the flood, but also increased awareness of the dangers of leptospirosis. *

May be useful

Yogyakarta, November 29, 2017
*) Secretary of IDI Kota Yogyakarta Branch, pediatrician at Yogyakarta Panti Rapih Hospital and Siloam Hospital @LippoPlaza, S3 S3 Alumni, WA: 081227280161,

e-mail: fxwikan_indrarto@yahoo.com