Leptospirosis & its Homeopathic Approach

by

Dr. Pawan S. Chandak

Leptospirosis (also known as Weil's disease, canicola fever, canefield fever, nanukayami fever, 7-day fever and many more is a bacterial zoonotic disease caused by spirochaetes of the genus Leptospira that affects humans and a wide range of animals, including mammals, birds, amphibians, and reptiles. It was first described by Adolf Weil in 1886 when he reported an "acute infectious disease with enlargement of spleen, jaundice and nephritis".

Though being recognised among the world's most common zoonoses, leptospirosis is a relatively rare bacterial infection in humans. The infection is commonly transmitted to humans by allowing fresh water that has been contaminated by animal urine to come in contact with unhealed breaks in the skin, eyes or with the mucous membranes. Outside of tropical areas, leptospirosis cases have a relatively distinct seasonality with most of them occurring August-September/February-March.

 

Aetiology / Causes:

Scanning electron microscope of a number of Leptospira sp. bacteria atop a 0.1 m polycarbonate filter

Leptospirosis is caused by a spirochaete bacterium called Leptospira spp. that has at 5 different serovars of importance in the United States causing disease (icterohaemorrhagiae, canicola, pomona, grippotyphosa, and bratislava). There are other (less common) infectious strains.

 

Mode of Transmission:

Leptospirosis is transmitted by the urine of an infected animal, and is contagious as long as it is still moist. Although rats, mice and voles are important primary hosts, a wide range of other mammals including dogs, deer, rabbits, hedgehogs, cows, sheep, raccoons, possums, skunks, and even certain marine mammals are also able to carry and transmit the disease as secondary hosts. Dogs may lick the urine of an infected animal off the grass or soil, or drink from an infected puddle. There have been reports of "house dogs" contracting leptospirosis apparently from licking the urine of infected mice that entered the house. The type of habitats most likely to carry infective bacteria are muddy riverbanks, ditches, gulleys and muddy livestock rearing areas where there is regular passage of either wild or farm mammals. There is a direct correlation between the amount of rainfall and the incidence of leptospirosis, making it seasonal in temperate climates and year-round in tropical climates.

Leptospirosis is also transmitted by the semen of infected animals. Abattoir workers can contract the disease through contact with infected blood or body fluids.

Humans become infected through contact with water, food, or soil containing urine from these infected animals. This may happen by swallowing contaminated food or water or through skin contact. Leptospirosis is common among watersport enthusiasts in specific areas as prolonged immersion in water is known to promote the entry of the bacteria. Occupational risk factors include veterinarians, slaughter house workers, farmers, and sewer workers.

 

Clinical Features:

Symptoms

Leptospirosis is a biphasic disease that begins with flu-like symptoms (fever, chills, myalgias, intense headache). The first phase resolves and the patient is asymptomatic briefly before the second phase begins that is characterized by meningitis, liver damage (causing jaundice), and renal failure. Because of the wide range of symptoms the infection is often wrongly diagnosed. This leads to a lower registered number of cases than there really are.

Symptoms of leptospirosis include high fever, severe headache, chills, muscle aches, and vomiting, and may include jaundice, red eyes, abdominal pain, diarrhea, and/or a rash. The symptoms in humans appear after a 4-14 day incubation period.

 

Complications

Complications include meningitis, respiratory distress and renal interstitial tubular necrosis, which results in renal failure and often liver failure (the severe form of this disease is known as Weil's disease, though it is sometimes named Weil Syndrome. Cardiovascular problems are also possible.

 

Diagnostics

Kidney tissue, using a silver staining technique, revealing the presence of Leptospira bacteria

On infection the microorganism can be found in blood for the first 7 to 10 days (invoking serologically identifiable reactions) and then moving to the kidneys. After 7 to 10 days the microorganism can be found in fresh urine.

Hence, early diagnostic efforts include testing a serum or blood sample serologically with a panel of different strains.

It is also possible to culture the microorganism from blood, serum, fresh urine and possibly fresh kidney biopsy. Kidney function tests (Blood Urea Nitrogen and creatinine) as well as blood tests for liver functions are performed. The later reveal a moderate elevation of transaminases. Brief elevations of aspartate aminotransferase (AST), alanine aminotransferase (ALT), and gamma-glutamyltransferase (GGT) levels are relatively mild. These levels may be normal, even in children with jaundice.

Diagnosis of leptospirosis is confirmed with tests such as Enzyme-Linked Immunosorbent Assay (ELISA) and PCR. Serological testing, the MAT (microscopic agglutination test), is considered the gold standard in diagnosing leptospirosis.

 

Differential diagnosis list for leptospirosis is very large due to diverse symptomatics. For forms with middle to high severity, the list includes dengue fever and other hemorrhagic fevers, hepatitis of various etiologies, viral meningitis, malaria and typhoid fever. Light forms should be distinguished from influenza and other related viral diseases. Factors like certain dwelling areas, seasonality, contact with stagnant water (swimming, working on flooded meadows, etc) and/or rodents in the medical history support the leptospirosis hypothesis and serve as indications for specific tests (if available).

Leptospira can be cultured in Ellinghausen-McCullough-Johnson-Harris medium, which is incubated at 28 to 30C. The median time to positivity is three weeks with a maximum of 3 months.

 

Treatment

Supportive therapy measures (esp. in severe cases) include detoxication and normalization of the hydro-electrolytic balance. Glucose and salt solution infusions may be administered; dialysis is used in serious cases. Elevations of serum potassium are common and if the potassium level gets too high special measures must be taken. Serum phosphorus levels may likewise increase to unacceptable levels due to renal failure. Treatment for hyperphosphatemia consists of treating the underlying disease, dialysis where appropriate, or oral administration of calcium carbonate, but not without first checking the serum calcium levels (these two levels are related).

 

Homeopathic Treatment

Repertorial Approach:

Aconite: Sudden onset of fever, with chilliness, throbbing pulses and great restlessness from anxiety. It is a remedy of cold, dry weather, bitter winds.

Gelsemium: There is heaviness and tiredness of body and limbs. Head heavy; eyelids heavy, limbs heavy. Useful for cold & fevers of mild winters.

Chills in back. Dr. Tylor says "Chills and heat chase one another." There bursting type of headachae from neck, over head to eyes and forehead; relieved by copious urination. Thirstless remedy.

 

Eupatorium Perfoliatum: There is intense aching in limbs and back as if bones were broken. Patient dare not move for pain. There is aching in all bones with soreness of flesh. There is bursting type of headachae as if patient dare not move for pain. There is shivering chills in back. Chill begins at 7 to 9 am. Eyeballs sore. There may be vomiting of bile. Useful for 'Break-bone fever' i.e. Dengue.

 

Pyrogenum: It is useful for the fever of violent pulsations and intense restlessness. Pulse are very rapid, ratio between pulse and temperature disturbed. High temperature with slow pulse or the reverse.

Chilliness so intense that no fire can warm. Creeping chills in back, with thumping heart. Bursting headachae, with intense restlessness. Patient has hard bed sensation, feels beaten, bruised.

 > better by beginning to move, has to keep on moving, rocking, wriggling for momentary relief.

Copious urination of clear water with fever.

 

Kali phos: It is useful for General weakness and gloom.

 

Arsenic Album: Chilliness, restlessness, anxiety, fear of death, prostration. Burning relived by heat. Patient is oversensitive, fastidious. Red- hot - needle like pains. Sensation of ice water running through veins or boiling water going through veins. Patient has thirst for sips of cold water at frequent interval.

< midnight.

 

Pulsatilla: Useful for Influenza with flitting chilliness: Chills in spots. Cold creeps in back. Chilliness < warm room. Profuse morning sweat. Heat as if hot water thrown over him. One sided chilliness - heat - sweat. External warmth is intolerable. < close room. Palpitation and anxiety, must throw off clothes. Better out of doors. Better for slow motion. Dry cough < at night, goes on sitting up, returns on lying down down again. Patient is thirstless, no hunger, Tearful, peevish.

 

Sulphur: Useful for Fever which partially recovers and then relapses. Frequent flushing of heat. Uneasiness in blood. Patient is very sensitive to open air, to darughts < washing and bath. Patient feels oppresssion, burning, stitchers and congestion in chest. Patient feels heat of crown of head with cold feet. There is burning of soles at night, must be put out of bed. Patient feels hungry - starving at 11 a.m. Patient feels drowsy by day, restless at night. Starts from frightful dreams.

 

Baptisia: Useful for rapid onset of fever. Patient sinks rapidly into a stupid typhoid state. There is dull, red face, drugged, besotted apperarence. High temperature: red, dusky & comatose appearence. Patient drops asleep while answering. It is useful medicine for Fever with Gastrointestinal complaints: sudden attacks of violent diarrhoea and vomiting. Great prostration. In worst cases mouth and throat are foul, and discharges very offensive. Patient feels that he is scattered into parts and can't get himself together.

 

Bryonia: Useful for Influenza with white tongue, thirst for much cold fluid. Symptoms worse from every movement, every noise, attacked with dry heat. Patient wants to lie quite still and be let alone. Also useful for Pleurisy, Pleuro-pnemonia. Headachae and pain all better by pressure and worse by movement. The anxiety, dream and delirium of Bryonia are of buissness, in delirium he wants to go home. Pain in head < coughing. Patient is irritable.

 

Rhus Tox: Patient feels stiff, lame and bruised on first motion . by continued motion till he becomes weak and must rest then restlessness and uneasiness drive him to move again.

Ailments from cold, damp weather, from cold damp when perspiring. Anxiety, fear < at night. Restlessness, intense fever, thirst, great prostration. Patient weeps without knowing why.

Indicated for Typhoid form of fever. Severe aching in bones.

 

Nux Vomica: Useful for Fever with Chilliness on the slightest movement. Chilliness < after drinking, on slightest exposure to the open air. He cannot get warm. Great coldness not removed by heat of stove, or by bed coverings. Attacks as of fever, shivering and drwaing inn limbs. Hahnemann says, "Serious ailments from catching cold are often removed by it. "

 

 

 

 

Dr. Pawan S. Chandak