As if the inner cities of America are not troubled enough, now they have a newly recognized problem to deal with: leptospirosis. A report in Annals of Internal Medicine today showed that living in an inner city is a risk factor for the disease.
Leptospirosis is a disease with symptoms ranging from mild aches and pains to jaundice, meningitis, kidney failure, and in rare cases death. Caused by the bacterium Leptospira interrogans , which infects a range of animals, the disease is known and diagnosed mainly in tropical regions. An outbreak of leptospirosis in Nicaragua last fall sickened thousands of people, killing 20.
Cases in the United States are rare, although the disease is probably underestimated because its symptoms are often attributed to d other causes. Such was the case when a "very sick woman" showed at Johns Hopkins Medical Center in November 1993, says infectious disease specialist Joseph Vinetz Johns Hopkins. Its symptoms - severe jaundice and meningitis - baffled doctors. Then Vinetz recalls, "I literally woke up in the middle of the night and thought she had leptospirosis"
Vinetz team learned that the patient had walked barefoot in the streets of the center-. Baltimore city, where she had seen rats, and had cut his foot 10 days earlier. subsequent investigations revealed two other Baltimore patients with leptospirosis who had also been in infested alleys of rats
What particularly surprised Vinetz was none of the patients had been in the country. - most previous cases of leptospirosis in the United States have been associated with exposure to animals infected with activities such as camping or agriculture. Vinetz alleged that his patients had been infected by rats, and his suspicions were apparently confirmed when his team found L. interrogans in 19 of 21 rats caught in the alleys where patients were.
"leptospirosis in urban areas are not a new problem," said Richard Spiegel, epidemiologist at the Centers for Disease Control and Prevention. However, he said, "it is probably significantly underdiagnosed." Besides the confusion resulting in disease symptoms, there is no single laboratory test to confirm a diagnosis, but the disease is not going away, said Vinetz. ". Many inland cities are in a worse and worse "
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