An Investigation of Leptospirosis death Maung srung district Roy-Et Province 23rd May 2012

Abstract

The Surveillance Rapid and Response Team, based within theRoi-et province and working with health
authorities in all majortowns, looksatassociatedrisksandpossiblecausesofmortalityattributedtoLeptospirosisto suggest possible solutions that help prevent transmission of the disease, in turn lowering mortality. This casestudy looks at the combined investigation of the Special Rapid Response Team (SRRT) and the local health authority into a death that resulted from Leptospirosis in the village of Tambol Nongphuer, Amphur Maung Srung. To understand the cause of infection the SRRT went through a step by step process of gathering information about the patient to determine the origin of the disease. Interviews were conducted with medical staff who had treated the patient and with the spouse to explore his habit and behaviour, the environment of the
patient was examined. Lymph fluid was collected from the patient, one of the cows that he was looking after and came into constant contact with, and a rat, found in a water tank that delivered water to their abode. This data was then sent to Khon Kean for analysis.The patient was male, married and self-employed. On the 18th May 2012 patient felt unwell and was believed to be hypothermic, he purchased medicine over the counter to relieve symptoms. Two days after
frst symptoms patient attended an appointment at the local hospital presenting with pyrexia, chest pain, body weakness and body fatigue. A tourniquet and a Leptospirosis test showed negative results with a blood test showing lowered platelet count, an acute febrile illness, possibly associated with Dengue virus, was suspected. A follow up appointment was then arranged over the next three days.After an episode of coughing up blood and a large quantity of phlegm on the 23rd May 2012, the patient was then taken back to hospital. Tests revealed a more substantial drop in platelet count and a raised BUN and creatinine level, patient was now suffering with renal impairment. Pneumonia was suspected and the patient was admitted. X-ray showed bi-basal infltration in lungs, and the patient was treated with Ceftriaxone (Cef-3), Rulid, Glyceryl Guaiacolate (GG) and Paracetamol. Pyrexia was still increasing and patient began to
suffer from rigors, then patient was transferred to the city hospital where the physicians suspected Leptospirosis and an acute kidney injury, creatinine levels continued to rise and his liver began to fail. Patient died the same day. Cause of death was suspected to be aggressive Leptospirosis, causing acidic blood and respiratory failure. Tests for Leptospirosis, Scrub Typhus, Melioidosis, Hepatitis C, B and HIV, results were all negative apart from a positive Hepatitis B result. Relatives were interviewed to explore the history of the patient. It had transpired that the patient was not from the local area and had been living within the province and had arrived relatively recently. The patient acquired all water from a single tank supplying his residence, this water tank showed to
have several indications that it had a signifcant rat infestation. Samples from this tank and two others within the vicinity tested positive for Leptospirosis. It was believed that the Hepatitis already contracted by the patient exacerbated the Leptospirosis. The local health authority, allied with the department for agriculture and other groups in the region, were on the forefront of a campaign designed to reduce incidence of Leptospirosis. The three main objectives
were: to reduce number of rats in area, to stop cattle drinking from the same sources of water as humans, and avoid usage of water sources suspected of containing Leptospirosis. Chloride has been added to water to neutralise any infection (now 5 ppm), residents are also advised not to drink water unless it is boiled frst and avoid suspected water coming into contact with broken skin. The public awareness of Leptospirosis has been raised to inform residents about possible dangers, signs and symptoms and what to do if you suspect you or someone else has the disease. Residents have also been advised that any tanks or containers of water should be kept covered. Any water source that has evidence of rats inhabiting the area should be avoided.