Accident Database

Report ID# 731

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Accident Description

 NY Times: Deadly Infection Re-emerges as People Get Adventurous>

After you read this, you may think twice about foreign river adventures. And going into Lake Springfield in Illinois would be an equally bad idea. My parents wouldn't let me swim there during my entire childhood.>

Marti L.Bridges Conservation Director Idaho Rivers United>

Deadly Infection Re-emerges as People Get Adventurous>>>

By ALICIA AULT After falling out of her raft on a whitewater expedition this spring in the Costa Rican rain forest, Dr. Nicole MacLaren was so grateful she was alive that it did not occur to her that her near-drowning might lead to something else - a potentially fatal bacterial infection called leptospirosis. But four days after returning to Park City, Utah, Dr. MacLaren, 37, developed the first signs of infection: a fever that soared to 103.5 degrees and drenching sweats that alternated with chills so severe they felt almost like a seizure.>>>

Dr. MacLaren, a veterinary ophthalmologist, had a splitting headache, and her eyes and muscles ached. In the emergency room, her kidney and liver were found to be inflamed. The effect on the kidney and the discovery that she also had meningitis suggested that she had leptospirosis, but her joint aches made dengue fever, a mosquito-borne illness that causes severe joint pain, a suspect as well. Malaria had been ruled out by a blood test. All three illnesses are found in the Costa Rican rain forests.>>>

She was treated with intravenous antibiotics on the assumption that she had an infection, and leptospirosis was confirmed in her three-day hospital stay."It was terrifying, because as a vet, I?d dealt with so many cases that had died," said Dr. MacLaren, referring to leptospirosis she had treated in dogs. The corkscrew-shaped Leptospira interrogans has been on earth as long as its host mammals - mostly dogs, pigs, cattle and rats. The bacterium, which has 250 pathogenic strains, causes leptospirosis, the most common disease transmitted from animals to humans. There are not good numbers on leptospirosis incidence, but health officials and some researchers say that as people venture more boldly into remote wilderness, there is likely to be an increase.>>>

"We suspect that as people pursue these kinds of activities more and more, as we venture into areas where essentially human populations have not spent time before, this may continue to increase." said Dr. Jim Sejvar of the meningitis and special pathogens branch at the Centers for Disease Control and Prevention. The illness is not easily recognized by doctors, even though it has long been seen as a scourge in developing nations. Under the right conditions high heat and humidity - the bacteria, which are shed in animal urine, can live on the ground for weeks or months. Torrential rains carry the leptospires from riverbanks, grass, jungle floors or dirty streets and alleys into places where people are playing or living. People get sick by swallowing contaminated water or by getting it in their eyes or in open cuts. Fever and nausea or vomiting occur two days to a month after the bacteria have colonized the entire body. Antibiotic treatment is usually needed, and in many people - it is not clear why - the leptospires run amok, leading to kidney and liver failure, meningitis and, sometimes, death.>>>

The Centers for Disease Control and Prevention recently confirmed a leptospirosis outbreak in 30 American athletes in the Eco-Challenge Expedition Race who likely became ill by swimming and canoeing in the flooded Segama River, which runs through a dense rain forest in Malaysian Borneo. The jungle is inhabited by rats, civet cats, bearded pigs, monkeys and orangutan. No racers died, but at least 12 were hospitalized, and the C.D.C. urged them all to be treated. A similar outbreak occurred in the United States in 1998, when 110 of 775 triathletes contracted leptospirosis after swimming in Lake Springfield in Illinois. Dr. Joe Vinetz, a leptospirosis expert, who is a professor at the University of Texas Medical Branch in Galveston, said he believed the disease was re-emerging because of greater participation in adventurous activities and the growing interaction between rats and people in urban areas. Cleaning up after rats and dogs is difficult, which means more urban residents are coming into contact with leptospira-laden urine, Dr. Vinetz said. He also said people in developing countries were becoming more vulnerable as poor areas - and their often ubiquitous rats - sprawled.>>>

Dr. Vinetz surprised other researchers in 1996 by proving that three inner-city Baltimore residents with unexplained flulike illnesses had leptospirosis, contracted by walking barefoot through alleys. Of the 21 rats from those alleys that Dr. Vinetz tested, 19 carried leptospires. Forty percent of the cattle at a Texas slaughterhouse Dr. Vinetz surveyed recently were carrying the bacteria. That is tenfold higher than previous tests of cattle in the United States, Dr. Vinetz said.. The C.D.C. and the World Health Organization agree that leptospirosis has historically been underreported.>>>

So it is hard to know whether leptospirosis is on the rise, or if cases like the Eco-Challenge outbreak and Dr. MacLaren?s infection will cause increased awareness and thus, more reports. American doctors are not required to report suspected cases, and they often will not try to confirm them, since only two laboratories in the United States are equipped for testing - the C.D.C.?s in Atlanta and the World Health Organization?s Collaborating Center for Tropical Diseases, at the University of Texas in Galveston. Not surprisingly, only 100 to 200 cases are tallied each year, about half in Hawaii, which has conditions favorable for leptospirosis. ?There are likely cases throughout the U.S. that go undiagnosed,? Dr. Sejvar said. Dr. Vernon Ansdell, an internist who specializes in tropical and travel medicine at Kaiser Permanente in Honolulu, agreed. ?I think it?s certainly being underdiagnosed, even in a place like Hawaii where we have a fair index for suspicion,? he said.>>>

Many cases of unexplained meningitis may be due to leptospirosis, said Dr. David Haake, a professor at the University of California at Los Angeles. Since these people are treated and cured with antibiotics, a definitive diagnosis is not usually made. International data were first collected by a survey of World Health Organization members in 1996. Results were published three years later. In that time, almost a half million cases were reported in China alone. Brazil had almost 30,000 cases, estimating 250 deaths a year. Mortality rates for those who become infected can be as high as 25 percent, especially in developing nations. If so, leptospirosis kills more people than the Ebola virus, Dr. Vinetz said.>>>

Hal Karp, a 36-year-old freelance writer and editor in Dallas, did not have to travel to get leptospirosis. He contracted it from his dog, Buddy. Mr. Karp deduced that Buddy was infected from grass or water contaminated with urine from cattle at a rodeo across the street from his kennel. As Buddy got sicker, Mr. Karp spent more time with him, coming into contact with the dog?s urine. Not realizing he had been exposed, he ignored a fever and headaches that began shortly after Buddy was euthanized. Mr. Karp started antibiotics on the advice of an infectious disease specialist who confirmed his leptospirosis.>>>

Mr. Karp?s pregnant wife took preventive antibiotics, since leptospirosis can cause miscarriage. She delivered a healthy baby and did not become ill. Studies have shown that doxycycline works as a preventive. Some Eco-Challenge racers took the drug as an anti-malarial, and did not get leptospirosis. Dr. MacLaren said she wished she had been warned to take doxycycline before her trip. Five months later, she is still weak, and has only recently gone back to her veterinary practice part time. She is still grappling with what happened. ?As a tourist, you don't expect to get something that could kill you.?>>>

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