A significant change in the clinical picture of leptospirosis in the State now, with pulmonary haemorrhagic syndrome emerging as the primary cause for death, has had the Health Department renew the warning about the disease in the post-flood period.
Current measures by the department were adequate, given the fact that even when lakhs were exposed to floodwaters, the number of cases being reported was very low, A.P. Sugunan, senior scientist at the Indian Council of Medical Research’s Regional Research Centre, Andaman and Nicobar, said here on Friday.
This means that the department’s advisory that those exposed to floodwaters should take Doxycycline drug as prophylaxis (preventive treatment) was an effective strategy against the disease.
15 deaths since Aug 24
There had been 15 leptospirosis deaths in the State since August 24 and in none of the cases, except one, the patients had taken Doxycyline However, the change in the clinical picture of leptospirosis, with pulmonary involvement within the first two days itself before any hepatic or renal symptoms manifest, was something that every clinician should take note of, Dr. Sugunan said.
“Any person who has been exposed to floodwaters should take 200 mg of Doxycycline every week, from the last exposure to floodwaters. This should be continued for six consecutive weeks,” he said.
Protocol modified
In the current situation, the department has modified its protocol for leptospirosis slightly. Any person presenting with fever and myalgia (pain in muscles) should be given presumptive treatment with Doxycycline. If the patient displays any indication of pulmonary distress, he should be immediately referred to a tertiary care centre and administered Crystalline Penicillin (CP) injection as soon as possible.
Early penicillin therapy was important to prevent the patient progressing to pulmonary haemorrhage and subsequent death, Dr. Sugunan said.
Penicillin availability
Availability of penicillin in the private sector is again an issue, it is pointed out. However, government hospitals have adequate supplies of CP.
The revised protocol has been circulated amongst doctors and in all professional associations such as the IMA and the IAP
“A spike in leptospirosis cases was to be expected in the post-flood situation and the Health Department had issued adequate early warnings. Leptospirosis is easily preventable and curable when detected and treated early. But non-compliance by people with the health advisories is emerging as a major headache for us,” Additional Director of Health Services (Public Health) K.J. Reena said.
Early detection
The Health Department is also trying to make available newer molecular diagnosis tests such as PCR tests for early detection of leptospirosis. However, clinical testing had very little significance in the case of leptospirosis, doctors said.
“If there is a history of exposure to floodwaters and clinical symptoms (myalgia or muscle pain primarily, even fever might be very mild), the presumptive diagnosis should be leptospirosis. In most of the deaths reported, the patient had suddenly developed respiratory symptoms and complications. In fact, we suspect that a lot of leptospirosis deaths may have been mistakenly reported as ARDS (acute respiratory distress syndrome),” a senior official said.
It was sad that poor compliance with health advisories was leading to loss of lives, she added.
