Immediate action following exposure
The first thing to say is that infection is far from certain, even when the exposure was from a high-risk source. Unless you are already feeling unwell, you have plenty of time to seek help. Even people in the early stages of illness respond extremely well to antibiotics.
1 – Early recognition of exposure
2 – Early use of antibiotics
3 – Early blood testing
- The most important factor in saving lives is to recognise the risks, so if you are accidentally exposed to something you believe to be contaminated you can seek help without delay. The incubation period is at least 3 days so you have time to visit your doctor if you know it’s necessary!
- Antibiotics are very effective if given early in the infection, but less so in later days and weeks – so getting antibiotics as soon as possible is also important.
- Finally, your doctor needs to confirm if you actually have been infected or not – and for that they will need to take a blood sample, sometimes two. As the illness is so general in symptoms, without a test there is no way to tell what bacteria or viruses you may have picked up.
If the exposure happened recently and you do not feel ill:-
For unlikely events where the chances of infection are low (such as splashes on unbroken skin), we advise you to simply wait and watch for any illness. We know this sounds stupid, but antibiotics given in the first few days of illness are very effective, and unless there is a reasonable chance they are needed, the side effects and potential for resistance outweigh the benefits.
If the risk exposure was high (immersion in contaminated water, splashes on broken skin, drinking contaminated water, etc.) then you should contact your local doctor and request a single dose of antibiotics – called a prophylactic dose, details below – which will usually prevent any illness from developing. Your doctor may also decide to take a blood sample, but they will often need to wait about 24 hours from the exposure event in order to get measurable levels of the bacteria in your blood.
If you have started to feel unwell:-
Of course the most important advice is to go and see your doctor if you start to feel unwell. Early symptoms resemble a cold or flu, with a fever, headaches and often a red pinpoint skin rash – the detailed symptoms are described in the link below. Remember also that water contaminated with leptospires is possibly contaminated with other harmful bacteria and chemicals, and your illness may be caused by any one of them – without a blood test even a specialist doctor will find it hard to tell just from the symptoms.
In every case where someone has a ‘risk exposure’ and then shows compatible illness within the incubation period (4 to 21 days), a blood test for leptospirosis should be ordered and a program of antibiotics started – waiting for the test results is not a good idea, as in many cases it can take over two weeks for the results to come back. Note that in more severe infections the patient will seem to recover slightly after the first few days, but then rapidly become seriously ill. Mild cases will often self-limit and the patient recover without medical help, but it can be difficult to predict how each case will develop so the same testing and medication are advised for all cases in the first few days of illness.
When you visit your doctor, explain what you were doing and what you think you have been exposed to. If you say “Doctor, I went swimming and now I have a fever and a headache” you will most likely be given painkillers and sent home with a suspected case of the flu, or sinusitis. If you say “Doctor, I went swimming in dirty water. I’ve heard of people getting a nasty illness from rats and I’m worried I’ve got it” then you’ll prompt your doctor into ordering the right blood tests without putting their nose out of joint. Many doctors have never seen a case of leptospirosis and may not associate it with your symptoms. However, they also may not like you arriving and quoting medical terms at them like you’re a consultant bacteriologist. If you’re not getting anywhere, then you can resort to helping them towards a diagnosis a bit more forcibly.
Important notes for children
Young children are often exposed to leptospira during play, and while they are no more or less likely to be infected than an adult, parents can often miss the early symptoms, passing it off as a common flu or cold. Antibiotic treatment is also different in children, so parents are advised to seek medical advice if they are unsure as to the chances of infection or causes of an illness. More details are given in the topic links below.