Leptospirosis is a disease caused by the bacterium Leptospira that can be found in contaminated water or soil. It affects many different kinds of animals and people.

Without treatment, leptospirosis in people can lead to kidney damage, meningitis (inflammation of the membrane around the brain and spinal cord), liver failure, trouble breathing, and even death.

About 1 million cases in people occur around the world each year, with nearly 60,000 deaths. Leptospirosis has been reported throughout the United States.

Just like people, animals can become infected through contact with contaminated urine or other body fluids in water or soil. Signs and symptoms in infected animals can vary widely, and some animals don't show symptoms at all.

Leptospira are generally harmless spirochetes that are commonly found in the soil. However, some pathogenic species can cause an infection called leptospirosis in the kidneys and other organs (Figure 23.6). Leptospirosis can produce fever, headache, chills, vomiting, diarrhea, and rash with severe muscular pain. If the disease continues to progress, infection of the kidney, meninges, or liver may occur and may lead to organ failure or meningitis. When the kidney and liver become seriously infected, it is called Weil’s disease. Pulmonary hemorrhagic syndrome can also develop in the lungs, and jaundice may occur.

Leptospira spp. are found widely in animals such as dogs, horses, cattle, pigs, and rodents, and are excreted in their urine. Humans generally become infected by coming in contact with contaminated soil or water, often while swimming or during flooding; infection can also occur through contact with body fluids containing the bacteria. The bacteria may enter the body through mucous membranes, skin injuries, or by ingestion. The mechanism of pathogenicity is not well understood.

Leptospirosis is extremely rare in the United States, although it is endemic in Hawaii; 50% of all cases in the United States come from Hawaii. It is more common in tropical than in temperate climates, and individuals who work with animals or animal products are most at risk. The bacteria can also be cultivated in specialized media, with growth observed in broth in a few days to four weeks; however, diagnosis of leptospirosis is generally made using faster methods, such as detection of antibodies to Leptospira spp. in patient samples using serologic testing. Polymerase chain reaction (PCR), enzyme-linked immunosorbent assay (ELISA), slide agglutination, and indirect immunofluorescence tests may all be used for diagnosis. Treatment for leptospirosis involves broad-spectrum antibiotics such as penicillin and doxycycline. For more serious cases of leptospirosis, antibiotics may be given intravenously.

The bacteria that cause leptospirosis are spread through the urine (pee) of infected animals. The bacteria can survive in contaminated water or soil for weeks to months. Many different kinds of wild and domestic animals carry the bacteria, including:

• Livestock (cows, pigs, horses, sheep, goats, etc,)
• Dogs
• Cats
• Rodents (rats, mice, etc.)
• Marine mammals (sea lions, seals, etc.)
• Wild animals (zoo animals, wild pigs, etc.)

When these animals are infected, they may have no symptoms of the disease. Infected animals may continue to urinate the bacteria into the environment for several months or years.

It's rare for people to spread leptospirosis to other people.

People can become infected through:

• Contact with water or soil containing urine or body fluids from infected animals, especially after hurricanes, flooding, or heavy rainfall.
• Directly touching body fluids from an infected animal.
• Eating food or drinking water contaminated by the urine of an infected animal.

If you're involved in activities that put you in contact with water, soil or animals, you may be at increased risk for infection. These activities include:

• Water recreation like swimming, kayaking, canoeing, or rafting in rivers, swamps, or creeks
• Hiking or hunting
• Gardening, yardwork, outdoor cleaning and maintenance
• Jobs like working at a veterinary clinic, dairy farming, or butchering

If you are experiencing homelessness or living in a shelter or other facility that has a lot of people living closely together, you may also have a higher risk of getting leptospirosis.

Leptospirosis and Flooding‎

Everyone's risk for leptospirosis is higher after hurricanes, heavy rain, or flooding. Animal urine in the soil and other surfaces can get into floodwater or rainwater, contaminating them and other natural water sources like streams. People may be exposed to contaminated water or use it for drinking or bathing.

What is leptospirosis?

Leptospirosis is a disease caused by bacteria called leptospires. It occurs worldwide and can affect humans and animals, including dogs and cats. The disease can be serious in both humans and animals. Leptospires are maintained in the genital and urinary tract. Ninety percent (90%) of those infected with the bacteria have no symptoms. Symptoms of leptospirosis are sometimes non-specific and can easily be confused with the flu. Such symptoms include fever, chills, vomiting, diarrhea, abdominal pain, or skin rash. Leptospirosis can potentially result in life-threatening infections of the kidney, liver, brain, lung, and heart.

What is adventure racing?

Adventure racing is a multi-discipline team or individual sporting event. Participants often travel to a remote wilderness location with the goal to compete against each other and challenge themselves out of their comfort zone. Races often feature unexpected tasks and difficulty levels and can last a few hours to several days, depending on the race. As the name implies, adventure racing entails adventurous, sporting activities in unfamiliar surroundings. Activities often include paddling (kayaking, canoeing, rafting), swimming, hiking through dense forest, cross country running and/or skiing, mountain biking, or climbing.

Am I at risk?

People who enjoy outdoor activities where freshwater or wet soil are encountered may be at risk for leptospirosis. This includes swimming, kayaking, rafting and canoeing in freshwater, hiking and camping. Learn how to help prevent infection and stay safe outdoors.

Adventure race participants should be aware of the potential risk of exposure to leptospires in unfamiliar environments where water may be contaminated with urine from infected animals, or the bacteria may be found in damp soil, vegetation and mud. Leptospires can survive in water or soil for weeks to months. Infection can occur when the organisms enter the body through cuts or abrasion in the skin, mucous membranes (nose, mouth, eyes) or consumption of wet food. Heavy rainfall or flooding can increase the likelihood of river and lake contamination. Adventure racers may be at increased risk for infection when they engage in sport activities (submersion, swimming, kayaking, canoeing, or rafting) in rivers, swamps or creeks. In the past, adventure racers have developed leptospirosis after white-water rafting trip in Costa Rica, participating in a triathlon in Wisconsin and Illinois, participating in an “Eco-Challenge” expedition race in Borneo, Malaysia, and adventure racing in a swamp in Florida.

How can I protect myself against leptospirosis while racing?

• Research the location to which you’ll be traveling.
• Be aware of possible infectious disease risks that you may encounter.
• Avoid contact with environments potentially contaminated with animal urine.
• Avoid swallowing water from lakes, rivers or swamps while swimming.
• Avoid participation in adventure racing activities if you have any cuts or abrasion of the skin.
• Wear protective clothing and shoes.

Is there a treatment for leptospirosis?

Be sure to contact your health care provider if you exhibit any symptoms suggestive of leptospirosis following participation in adventure race activities. The time between exposure and development of symptoms (also called the incubation period) for leptospirosis is 2 days to 4 weeks. Doxycycline, penicillin, or similar treatments are useful in treating leptospirosis.

Leptospirosis is a bacterial disease that occurs worldwide and can cause serious illnesses such as kidney or liver failure, meningitis, difficulty breathing, and bleeding. Cases of leptospirosis can increase after hurricanes or floods when people may have to wade through contaminated water or use it for drinking or bathing.

How do people get leptospirosis?

People can get leptospirosis when they have contact with water or soil containing urine or other body fluids from infected animals, if they directly touch the urine from an infected animal or if they consume food or water contaminated by urine. The bacteria can survive for months in urine-contaminated water and soil. A variety of animals can spread leptospirosis, including rodents, dogs, livestock, and wildlife. During a hurricane or heavy rain, animal urine in the soil or on other surfaces can run into floodwater, contaminating it. Streams and other natural water sources can also be contaminated.

What are the symptoms of leptospirosis?

Symptoms usually start from 5 to 14 days after contact with the bacteria that causes leptospirosis. However, symptoms can begin anywhere from 2 to 30 days after contact. Early symptoms can include:

• Fever
• Headache
• Muscle aches
• Red eyes
• Vomiting
• Diarrhea
• Abdominal pain
• Jaundice (yellowing of the skin and eyes)
• Skin rash
• Cough

Who is at risk?

Leptospirosis most often affects people who work outdoors or with animals, or those who take part in recreational activities involving water or soil, like swimming, boating, and gardening. After floods or heavy rains, anyone who has been in contact with floodwater, contaminated freshwater (rivers and streams) or soil could be at risk for infection.

Some activities that increase your risk of leptospirosis include

• Drinking from potentially contaminated water sources, including floodwater, streams, rivers, or unsafe tap water.
• Bathing or wading in floodwater or contaminated fresh water, especially when putting your head under water or if you have an open wound or scratch.
• Eating food that has been exposed to contaminated water or potentially urinated on by rodents.

How can I avoid leptospirosis?

The most important way you can prevent leptospirosis is to avoid touching or drinking water that may be contaminated. If that is not possible, follow these steps to reduce your risk of leptospirosis:

• Treat water to make it safe to drink by boiling or using an appropriate chemical treatment, especially if it has been collected from a source that could be exposed to urine from animals or contaminated by floodwater runoff.
• Cover cuts or abrasions with waterproof bandages or other coverings that seal out water.
• Do not wade, swim, bathe, submerse your head in, or swallow floodwater or any fresh water source that may contain animal urine or be contaminated by floodwater runoff.
• Wear waterproof protective clothing, shoes or boots near floodwater or other water or soil that may be contaminated with animal urine.
• Prevent rodent infestation by keeping food, water and trash in closed containers, and trapping any rodents you see.
• Avoid eating food that rodents may have had access to.
• If you suspect your pet or livestock have leptospirosis, contact a veterinarian. Symptoms of leptospirosis in dogs may include fever, fatigue, lack of appetite and increased or decreased urination. Symptoms of leptospirosis in livestock may include abortion, decreased milk production and weak offspring.

How is leptospirosis treated?

If you have symptoms of leptospirosis, contact a doctor right away. If your doctor thinks you have leptospirosis, they will likely give you antibiotics. Treatment is most effective when started as soon as possible.

The bacteria that cause leptospirosis are spread through the urine of infected animals, which can get into water or soil and can survive there for weeks to months. Many different kinds of wild and domestic animals carry the bacterium.

These can include, but are not limited to:

• Cattle
• Pigs
• Horses
• Dogs
• Rodents
• Wild animals

When these animals are infected, they may have no symptoms of the disease.

Infected animals may continue to excrete the bacteria into the environment continuously or every once in a while for a few months up to several years.

Humans can become infected through:

• Contact with urine (or other body fluids, except saliva) from infected animals.
• Contact with water, soil, or food contaminated with the urine of infected animals.

The bacteria can enter the body through skin or mucous membranes (eyes, nose, or mouth), especially if the skin is broken from a cut or scratch. Drinking contaminated water can also cause infection. Outbreaks of leptospirosis are usually caused by exposure to contaminated water, such as floodwaters. Person to person transmission is rare.

In humans, Leptospirosis can cause a wide range of symptoms, including:

• High fever
• Headache
• Chills
• Muscle aches
• Vomiting
• Jaundice (yellow skin and eyes)
• Red eyes
• Abdominal pain
• Diarrhea
• Rash

Many of these symptoms can be mistaken for other diseases. In addition, some infected persons may have no symptoms at all.

The time between a person’s exposure to a contaminated source and becoming sick is 2 days to 4 weeks. Illness usually begins abruptly with fever and other symptoms. Leptospirosis may occur in two phases:

• After the first phase (with fever, chills, headache, muscle aches, vomiting, or diarrhea) the patient may recover for a time but become ill again.
• If a second phase occurs, it is more severe; the person may have kidney or liver failure or meningitis.

The illness lasts from a few days to 3 weeks or longer. Without treatment, recovery may take several months.

Leptospirosis is treated with antibiotics, such as doxycycline or penicillin, which should be given early in the course of the disease.

Intravenous antibiotics may be required for persons with more severe symptoms. Persons with symptoms suggestive of leptospirosis should contact a health care provider.

The risk of acquiring leptospirosis can be greatly reduced by not swimming or wading in water that might be contaminated with animal urine, or eliminating contact with potentially infected animals.

Protective clothing or footwear should be worn by those exposed to contaminated water or soil because of their job or recreational activities.

What is leptospirosis?

Leptospirosis is a disease caused by bacteria. Infected animals spread the bacteria through their urine (pee). When infected animals pee, the bacteria get into the water or soil and can live there for weeks to months.

You can be infected if you touch fresh water, soil, or other objects contaminated with infected animal urine. The most common way you can get infected is urine or contaminated water getting in your eyes, nose, mouth, or broken skin (such as a cut or scratch). You can also get infected by eating contaminated food or drinking contaminated water.

Some people with leptospirosis will not have any symptoms. When symptoms occur, they can include fever, headache, chills, muscle aches, vomiting, jaundice (yellow eyes and skin), red eyes, stomach pain, diarrhea, and sometimes a rash. Without proper treatment with antibiotics, people with leptospirosis may develop serious problems with their kidneys, liver, or lining of the brain and spinal cord (meningitis). In some cases, leptospirosis can cause death.

Who is at risk?

Leptospirosis is found in countries around the world. It is most common in temperate or tropical climate regions that include South and Southeast Asia, Oceania, the Caribbean, parts of sub-Saharan Africa, and parts of Latin America.

Travelers are more likely to get leptospirosis if they

• Visit flooded or recently flooded areas
• Swim, wade, kayak, or raft in potentially contaminated fresh water like lakes and rivers
• Visit urban areas with poor sanitation
• Touch animals or their body fluids. Animals that can be infected are mammals, including rodents, cows, sheep/goats, pigs, horses, dogs, and wildlife.

What can travelers do to prevent leptospirosis?

There is no vaccine approved for use in the United States to prevent leptospirosis in people.

Travelers can take the following steps to protect themselves:

• Avoid touching fresh water or soil that may be contaminated with animal urine
• Avoid touching objects that may be contaminated with animal urine, such as animal bedding
• Don't wade, swim, or put your head in floodwaters or water from lakes, rivers, or swamps. Especially avoid freshwater contact after flooding or heavy rain.
• If it is not possible to avoid wading in floodwaters or other fresh water, wear protective clothing like footwear and cover cuts and wounds with waterproof bandages or dressing.
• Make water safe to drink by boiling or using an appropriate chemical treatment

For some travelers, taking medicine before you travel to prevent leptospirosis might be an option. Talk to your health care provider before you travel and tell them about all your planned activities.

There is no vaccine approved in the United States to prevent leptospirosis.

If you traveled and feel sick, particularly if you have a fever, talk to a healthcare provider, and tell them about your travel. Avoid contact with other people while you are sick.

Leptospirosis is an infectious disease caused by bacteria. It can lead to potentially fatal infections of the kidney, liver, brain, lung or heart.

How do people get leptospirosis?

There are two common ways to develop leptospirosis:

• Drinking or contact with water (such as by swimming, rafting or kayaking) or soil that has been contaminated by urine or body fluids of infected animals
• Exposure to the urine or body fluids of infected animals

What are the symptoms of leptospirosis?

Symptoms of leptospirosis can develop anywhere from 2 days to 4 weeks after being exposed to the bacteria.

Common symptoms of leptospirosis include:

• Fever
• Chills
• Headache
• Muscle Aches
• Vomiting
• Diarrhea
• Abdominal Pain
• Jaundice (yellowing of the skin and eyes)
• Skin Rash
• Red Eyes

Which animals can spread leptospirosis to people?

Many animals can spread leptospirosis, including pets (such as dogs), farm animals, or wildlife.

The animals that commonly develop or spread leptospirosis include:

• Rodents
• Raccoons
• Opossums
• Cattle
• Swine
• Dogs
• Horses
• Buffaloes
• Sheep
• Goats

Am I at risk?

There is always a risk of infection for people who have contact with infected animals or soil/water where the bacteria are present.

People who work outdoors or with animals may be at increased risk for infection, such as:

• Farmers
• Mine Workers
• Sewer Workers
• Slaughterhouse Workers
• Veterinarians/Animal Caretakers
• Fishermen and people who work with fish
• Dairy Farmers
• Military Personnel

Those involved in outdoor freshwater activities may also face an increased risk.

Activities may include:

• Swimming
• Rafting
• Kayaking

How is leptospirosis treated?

If you have symptoms of leptospirosis, contact a doctor who can test for the disease.

If an infection is confirmed, it will likely be treated with antibiotics (medicine that can cure the disease). Treatment is most effective when started as soon as possible.

How can leptospirosis be prevented?

There are several steps you can take to help prevent getting leptospirosis. These include:

• See a veterinarian to get vaccines for your pets that can protect against this disease
• Avoid contact with animal urine or body fluids, especially if there are any cuts or abrasion of the skin
• Do not swim in, walk in, or swallow water that may contain animal urine
• Wear protective clothing or footwear near soil or water that may be contaminated with animal urine