Like many residents and volunteers, I spent a Saturday morning shoveling mud to help clear a community member's driveway after the flooding. By Monday, I felt really sick with fever, chills and body aches. The next day, I could barely get out of bed.
I'd heard about leptospirosis, a disease spread by bacteria in animal urine often found in mud and water after flooding.
I finally went to the emergency room Wednesday evening and thought it would be a quick test to rule out leptospirosis.
But, it turns out, the test is not that simple.
“Leptospira bacteria are slow growers, and so culturing Leptospira in a bacterial culture can take up to six weeks,” explained Dr. Nathan Tan, the deputy state epidemiologist with the Department of Health. “And so for final results to be returned, it can take a while.”
Since test results can take from a week to six weeks, doctors typically go ahead to treat for leptospirosis if they think their patient has it.
Tan calls treatment “straightforward:” a round of antibiotics. But leptospirosis can be serious.
“These are infections that should be treated early to get the best outcome. In most cases, the infection will be mild, but in 5% to 10% of the cases, severe outcome can happen. And in those severe cases, 5% to 15% can result in death,” he said.
Sometimes, making a diagnosis without test results can mean testing to rule out other illnesses, or some educated guesswork.
“When somebody presents with flu-like illness, the clinician needs to make a determination of what's the most likely infection,” Dr. Tan said.
Dr. Randi Taniguchi-Fu, who practices internal medicine at Molokai General Hospital, confirmed as a doctor, if you are suspicious of leptospirosis, it’s common practice to start the patient on empiric antibiotics, meaning it is not confirmed yet but you treat it while the test is pending.
“Since the floods, our ER physicians and outpatient physicians have been diligent in keeping leptospirosis on our differential,” she said, via email. “I have seen the test ordered for a few of my patients in hospital. One I thought for sure would come back positive because he had high fever, chills, severe body aches [and other symptoms] and most importantly his house was flooded.”
She said the patient started antibiotics and improved, but his leptospirosis test ended up coming back negative.
Leptospirosis symptoms can include fever, body aches, headache, nausea, yellowed skin and eyes, fatigue, rash and more.
In my case, I tested negative for flu and COVID at the ER, and my regular blood work came back with no red flags. The doctor didn’t think it was leptospirosis, so we decided against antibiotics. But given my mud exposure and symptoms, I did request a leptospirosis test.
Nearly two weeks later, I finally got the results a couple of days ago — it was negative. My symptoms had lasted about a week.
But even if you test negative, Tan said that might not necessarily mean you’re in the clear.
“Those antibodies that can be formed in response to infection, may not be present early on, and so a repeat test after a couple of weeks to see if there is a detection of antibodies later on, can help improve the ability to confirm leptospirosis infections,” he said.
Tests are processed here in Hawaiʻi by the state laboratory, and Tan said we’re one of the few states with that capacity.
So, why does it take so long to get results?
“Every effort is made to provide timely results, however, just by the nature of the bacteria, the nature of the tests that are available, there are limitations in both the sensitivity and the time it takes to get a final result,” he said.
Tan explained the bacteria does not spread between people and requires direct contact with contaminated mud or water.
“I would say for those who have been impacted by the recent storms and flooding, it's important to, when possible, avoid contact with flood water, mud and damp materials, keep cuts covered to keep out contaminated water, and wear protective clothing. And then again, to seek medical care early if symptoms develop.”
So far this year, there have been 10 leptospirosis cases statewide. The state Department of Health said none of those were confirmed to be connected with the recent flooding.
“It is not uncommon each year that we have cases of leptospirosis,” said Tan. “Prior to the pandemic, for example, in 2019, there were 33 cases of leptospirosis. Last year, there were 17.”
Leptospira bacteria can survive for weeks to months in fresh water and damp soil. The DOH advises residents in flooded areas to continue taking precautions until mud has dried completely.
