Leptospirosis & HIV

A question was raised to me the other night by a fellow pozzie:

This was our conversation. I hope you don't mind posting our conversation as I know this would be a good learning experience to others.

Pozziepinoy: What's the problem??

23h

Fellow Poz: i need the opinion of Dr Ditangco... lumusob kasi ako sa baha. gusto ko ng meds to prevent leptospirosis (I waded in the flood. I need meds to prevent leptospirosis)

23h

Fellow Poz: but at the same time walang effect sa arv ko  (but at the same time no side effects from my ARV)

23h

Pozziepinoy: wala ka bang sugat? ano ARV's mo? I'll ask her. May OI's ka ba? (do you have open wounds? What are your ARV's? I'll ask her. Do you have OI's?)

23h

Pozziepinoy: sorry I have to ask kasi tiyak itatanong yan sa akin. Ano din CD4 mo? (sorry I have to ask those since she will ask me too)

22h

Fellow Poz: wala naman akong sugat that I know (I don't have any wounds that I know) and my CD4 is 500.

22h

Fellow Poz: im taking lopinavir/ritonovir and lamivudine/zidovudine. I don't have OI's

I then texted Dr. Ditangco and this was her reply:"He can go and consult if he wants prophylaxis. There is no problem with his ARV's. Tell him no self medication please."
Metro Manila and most of the provinces in Luzon had been submerged by the continuous monsoon rains. The incidence of Leptospirosis will be on the rise again due to the flooding as the infection can be transmitted by animals to humans by wading in the flood waters especially if the person has open wounds. 
What is leptospirosis?

Leptospirosis is an infectious disease caused by a type of bacteria called a spirochete. Leptospirosis can be transmitted by many animals such as rats, skunks, opossums, raccoons, foxes, and other vermin. It is transmitted though contact with infected soil or water. The soil or water is contaminated with the waste products of an infected animal. People contract the disease by either ingesting contaminated food or water or by broken skin and mucous membrane (eyes, nose, sinuses, mouth) contact with the contaminated water or soil.

Leptospirosis occurs worldwide, but it is most commonly acquired in the tropics.

What are leptospirosis symptoms and signs?

Leptospirosis symptoms begin from two to 25 days after initial direct exposure to the urine or tissue of an infected animal. This can even occur via contaminated soil or water. Veterinarians, pet shop owners, sewage workers, and farm employees are at particularly high risk. People participating in outdoor sporting activities like canoeing, rafting, hiking, and camping can also come into contact with contaminated water or soil.

The illness typically progresses through two phases:

• The first phase of nonspecific flu-like symptoms includes headaches, muscle aches, eye pain with bright lights, followed by chills and fever. Watering and redness of the eyes occurs and symptoms seem to improve by the fifth to ninth day.
• The second phase begins after a few days of feeling well. The initial symptoms recur with fever and aching with stiffness of the neck. Some patients develop serious inflammation of the nerves to the eyes, brain, spinal column (meningitis), or other nerves. Right upper area abdominal pain may occur. Less common symptoms relate to disease of the liver, lungs, kidneys, and heart.

Leptospirosis associated with liver and kidney disease is called Weil's syndrome and is characterized by yellowing of the eyes (jaundice). Patients with Weil's syndrome can also develop kidney disease and have more serious involvement of the organs affected.

Antibiotic Therapy

Dosage of Antibiotics for Leptospirosis

Dosage of Antibiotics in Adults with Renal Impairment

Note: Please consult your doctor especially your HIV specialist before taking any antibiotics against leptospirosis.

Credits and References:http://en.wikipedia.org/wiki/Leptospirosishttp://www.medicinenet.com/leptospirosis/article.htmhttp://www.psmid.org.ph/contents/Leptospirosis_GUIDELINES_(contents).pdf