Leptospirosis in Puerto Rico after floods, rivers and streams

Leptospirosis is a disease caused by bacteria that pass from animals to people. According to the CDC, it spreads through the urine of infected animals, which can contaminate water or soil for weeks to months. Puerto Rico’s Department of Health explains that on the island it is carried mainly by rodents, dogs and pigs, and that you catch it through direct contact with their urine or with contaminated water, soil or food.

According to the CDC, the risk rises with contact with water or soil that contains animal urine, with drinking water or eating food contaminated by it, and with water recreation such as swimming or kayaking in rivers and creeks. The risk is highest after hurricanes and floods, and when you bathe in rivers, streams and swimming holes after heavy rain.

Leptospirosis is endemic in Puerto Rico, meaning cases are reported every year. According to a CDC report, about 10% to 15% of people who get sick develop severe, potentially fatal illness.

After Hurricane Fiona (September 2022) flooded much of the island, 156 cases were reported in 15 weeks: 3.6 times as many cases per week as before the storm. The share of patients who had contact with possibly contaminated water rose from 11% to 35%. That year the Department of Health required doctors to report each case within 24 hours. See also health after a hurricane.

According to the Department of Health, symptoms appear 2 to 30 days after exposure, most often between 5 and 14 days. Many can be mistaken for other illnesses, such as dengue or flu:

The CDC describes two possible phases: first fever and aches, then a short improvement, and in some people a severe second phase with kidney or liver failure or meningitis (inflammation of the membranes around the brain). Without treatment it can cause kidney damage, breathing problems and death.

Leptospirosis is treated with antibiotics, and the CDC says to give them as early as possible. Deciding that takes an exam and often same-day blood and urine tests. So if you have a fever after being in floodwater, a river or a stream, don’t wait for an appointment: go today to an urgent care center (CDT) or an emergency room and tell them where you were. Not sure where to go? Read ER vs urgent care in San Juan.

A video visit helps before symptoms appear, or after you have been treated in person. For example: you waded through floodwater and want to know what to watch for, a cut got wet and you want it checked, or you have been discharged and have questions about your recovery. We do not promise a “just in case” antibiotic: the doctor decides based on your situation.

You see Dr. Diana Nieves Castro, a Puerto Rico–licensed general practice physician with several years of emergency-department experience, in English or Spanish. We evaluate, diagnose and treat; if needed, we give you a lab order for a lab near you. If appropriate, the doctor prescribes and we send your prescription to your pharmacy. We do not prescribe controlled substances.

A doctor visit costs US$79, the same price for every age, with no membership; your card is charged when you request it, with a full refund if the visit can’t take place. Request a visit online 24/7 — we confirm your time by email or text. We send you a secure video link that works on your phone, tablet or computer. For patients under 21, a parent or legal guardian stays on camera with photo ID. You need to be physically in Puerto Rico. Book your visit.

According to the CDC and the Department of Health:

With any of these signs, go to an emergency room or call 911. Don’t book a video visit. See when to go to the ER.