Ocean Watch

Friday,  April 16, 2004

The wistful gaze of a kid in a baseball cap haunts me this week. I'm referring to the front-page picture of Simon Hultman, the Big Island resident who died recently from leptospirosis.
This healthy college student came home from Maryland for winter break, went back to school and died. Apparently, while on vacation, Simon hiked in Waipio Valley, a hot spot for leptospirosis, and picked up the germ.

It's tragic when someone dies from an infection, especially one that can be treated with antibiotics. But how well do they work? I wondered. And how do you know when to get them?

Dr. Vernon Ansdell, a tropical medicine specialist at Kaiser Permanente, told me that antibiotics don't cure leptospirosis completely, but when given early on, they decrease the length and severity of symptoms. This might save a life.

Knowing when to seek antibiotics, however, is a problem.

People can get leptospirosis from swimming in water contaminated with the urine of infected rats and other mammals. In a vicious cycle, the animals get it from drinking lepto-contaminated water.

Lepto bacteria survive in sea water for three days but are so dilute in the ocean, they pose little risk there.

This infection is hard to diagnose because it's so variable. You can have "lepto" and get over it with no symptoms at all; you can have it and think it's the flu; or you can have it and die.

The timing of leptospirosis also makes it tough to identify. Once the bacteria get inside (through eyes, ears, nose or cuts), symptoms begin (or not) in two to 20 days.

For those who get them, symptoms come in two phases. First, the bacteria multiply and invade the body. This can cause anything from feeling a bit off to being sick in bed, and lasts about a week. Most people recover and the symptoms disappear.

But not for long. For unknown reasons, the antibodies our bodies make to fight Leptospira sometimes turn on us and attack our own healthy cells. This causes more flulike symptoms for four to 30 days.

Dr. Ansdell says antibiotics help at this immune stage, too, but no one knows why.

With leptospirosis, most people think they have a flu bug, and telling the difference is hard. No quick lab tests exist to detect, either.

Most people with this infection don't even know they had it. Five to 10 percent of victims, however, suffer a dangerous second stage when those misguided antibodies attack kidneys, heart, liver and blood vessels.

Nationally, 5 percent of leptospirosis victims die.

From 1993 to 2002, doctors diagnosed 76 cases of leptospirosis on Oahu, 396 statewide. (No doubt, many more occurred and went undiagnosed.) Seven, or 1.8 percent, of those died.

That's the good news: Hawaii's fatality rate is lower than the rest of the country. The bad news is that Hawaii has the highest incidence of leptospirosis in the United States. Therefore, physicians here are alert to it, which might explain our below- average death rate.

The two big things to remember about leptospirosis:

  Don't dunk your head in Hawaii's fresh or brackish waters or go in with a cut or scrape.

  If you get sick after contact with a stream, pond, river mouth or mud hole, tell your doctor.

Simon Hultman's death put leptospirosis in the headlines. Hopefully, this awareness will prevent another tragedy.