Rodents, like rats and mice, can make pets and their owners sick from a bacterial infection called leptospirosis, or lepto for short. Urine from infected rodents can be found in puddles in the city and in rural areas. Finding out a pet has lepto as early in the disease as possible is crucial for recovery. Talk to your family veterinarian about vaccinating against this infection. Listen to this episode to find out what to watch for and how to protect your pet and yourself from this life-threatening disease.
Welcome Dr. Durocher-Babek!
[00:01:05] Dr. Lancellotti: Welcome, everyone, to today’s episode of Your Vet Wants You To Know. We’re going to be talking today about a disease called leptospirosis (lepto). Here in Los Angeles, we have been experiencing an outbreak of this disease, so I’ve had quite a number of clients ask me about it. As a dermatologist, I am not as knowledgeable about this particular disease as some family veterinarians or internal medicine specialists are. This is something that affects primarily the internal organs, and not so much the skin and the ears that I deal with. Today, I have with me an expert. Veterinary internal medicine specialist, Dr. Lawren Durocher-Babek, has come on to talk to us about lepto and what pet owners should be aware of when we’re dealing with this disease. Thank you very much for joining us today.
[00:01:53] Dr. Durocher-Babek: Thank you for having me.
[00:01:54] Dr. Lancellotti: Can you give our guests a little bit of a background about who you are, what your training is in, where you’re at right now, and what this particular topic means to you?
[00:02:04] Dr. Durocher-Babek: Well, I’m a small animal internal medicine specialist, and right now I live and I work in Hong Kong. I did all of my training in the (United) States and Canada. I went to vet school at University of Georgia, internship at Gwelf, residency at the Ohio State University, and then I practiced in some specialty referral practices in North Carolina and New Jersey. Then, we moved to Hong Kong in 2018 for a family adventure (and we certainly got what we asked for) and we love it here. The people are friendly, it’s a great culture, and there’s just about everything you could want to do. But the other thing that this place has is a subtropical climate, which means that infectious diseases are rampant. Leptospirosis is something that I’ve seen more of here than I’ve seen in any other part of my career. In fact, we had quite an outbreak of leptospirosis last summer, where we had multiple cases and a lot of dogs who needed dialysis. So, that was what really sparked my interest in leptospirosis, trying to figure out the best way to treat it, and the best way to prevent it.
[00:03:06] Dr. Lancellotti: It sounds like you’ve been all over the place. That is quite an adventure.
[00:03:11] Dr. Durocher-Babek: Yep. I would highly recommend it.
Diagnosing leptospirosis early
[00:03:13] Dr. Lancellotti: Can you tell us a little bit about one or two of the cases that you’ve dealt with, some pets that have been diagnosed with lepto, and what’s happened with them?
[00:03:23] Dr. Durocher-Babek: Sure. I can bring up two dogs that were really memorable to me, mostly because they came in around the same time, and they had very different disease trajectories. The first one was a very young, fit, mongrel dog (basically a mutt) who liked to go hiking with her owners all the time. In Hong Kong, we have a lot of hiking trails, streams, and rivers all throughout the city, and Nellie (this dog) started acting a little bit off after one of those hikes. About a week after she had gone on a huge hike, she was just really tired, she wasn’t eating quite as well, and they noticed a mild increase in her urination and her drinking. So, they immediately brought her in and got her checked out. And because we knew that leptospirosis had been rampant in the last week or so (in fact, one of Nellie’s friends had recently died from leptospirosis), we tested her for it right away. Because of that, we were able to start treating her for it, and she did really well. She had a couple of scary days there where we were scared that we were going to lose her or that she was going to need dialysis, but she pulled through with aggressive fluid therapy and antibiotics, and she’s completely back to normal. Her owners were super happy. We were very happy. She never looked back.
[00:04:43] Dr. Lancellotti: Knowing what to look for is important because it allowed you to make that diagnosis really quickly.
[00:04:49] Dr. Durocher-Babek: It was crucial because her family veterinarian tested her for leptospirosis before he did anything else. That way she was able to be transferred to our practice within an hour, and get started on IV fluids and antibiotics. I think what really saved her was how quickly we jumped on her. The other case that I had (which happened around the same time- about two days later) was a dog who actually didn’t go hiking too often, but of course would be taken out on walks. It was never camping, swimming, or anything else like that, so when she started getting sick, nobody really thought about leptospirosis, at first. She was vomiting and having diarrhea, and the first thought was that maybe she got into something that she shouldn’t have and just had an upset stomach. A couple of days went by before somebody thought to test her blood work and check her for leptospirosis, and unfortunately she was positive, so she was transferred to us for continued care. Despite very aggressive therapy, including dialysis, she passed away. She actually bled into her lungs and we weren’t able to save her. I really think those few days made a crucial difference between her and Nellie, and it wasn’t that her family wasn’t looking for issues, it was more that we just weren’t clued in that she could potentially have leptospirosis, which explains why she wasn’t aggressively treated right off the bat.
[00:06:16] Dr. Lancellotti: That’s one of the reasons why I’m really glad that you came on this episode- so that we can give people the knowledge to be able to clue into something like this, to be able to provide them with that really fast-acting care when the animal does get sick.
What is leptospirosis? How can a pet get Lepto?
Dr. Lancellotti: We’ve had our public health department in Los Angeles issue these warnings, so can you give us a little bit of an overview of what leptospirosis is? What is this disease and how might an animal get exposed?
[00:06:46] Dr. Durocher-Babek: Leptospirosis is caused by a spiral-shaped bacteria called a spirochete, and it’s found in the urine of infected wildlife, including rats. So these wildlife urinate in a stream or a puddle, and then your dog drinks from the stream and gets infected. We see an increase in this disease when there’s been a lot of rain washing water down the mountains. We’ve seen it when the soil is really wet, so that the urine kind of stays in place. Then, once your dog ingests the leptospiral bacteria, it can spread in the blood stream throughout the whole body, affecting mostly the kidneys and the liver, but it can also affect the eyes, lungs, brain- everything in the body.
[00:07:33] Dr. Lancellotti: So it really just goes everywhere. We’re not talking about just one organ. We’re not talking about just the gastrointestinal tract. Once this animal ingests it, every part of their body is going to be affected.
[00:07:45] Dr. Durocher-Babek: Exactly. And that’s part of the problem too, because it’s not always classic signs. It’s not always kidney failure and liver failure, or not always just kidney failure and not liver failure- it can be a combination of all of these signs.
How can I tell if my pet has Lepto?
[00:08:01] Dr. Lancellotti: Are there any particular red flags that owners should watch for? Or is this a disease where it’s really tough to tell exactly what’s going?
[00:08:11] Dr. Durocher-Babek: It is tough to tell, because the red flags can look like anything. So some of these dogs will start with vomiting and diarrhea. Some of them will just be a little bit lethargic. Some of them might drink and pee a little bit more. So it’s not always something that you pick up on at home. You might find that your dog is acting sick, but you don’t immediately think, “Oh, he’s got leptospirosis.” A lot of these dogs do have fever, but unless you’re checking their body temperature at home, you might not actually know that. Some of the dogs can develop jaundice (yellowing of the whites of their eyes and skin), but we’d like to catch it before that happens. Because when that happens, it means the liver is very affected.
How do veterinarians test for Lepto?
[00:08:53] Dr. Lancellotti: So, if we’re going to be catching this disease, we’ve got to do some testing. What tests might a veterinarian recommend to a pet owner, and why are they going to be recommending those tests?
[00:09:02] Dr. Durocher-Babek: The first thing your vet is going to want to do is a thorough physical exam. They want to make sure that they’re not missing anything else going on. Once they do the thorough physical exam, they’re going to want to just do basic blood work – the blood tests that you get once a year (to check out your senior pets) that look at your white blood cells, red blood cells, platelets, kidneys, liver- all of the organs. Once you’ve started with that screening test, then they may also have what’s called a rapid snap test for leptospirosis. This is something that they can do in the clinic which shows you if you have lepto. It’s great because it’s fast, but it’s not 100% accurate. A lot of times, we’ll use it as a screening. If they’re positive, then we’ll do extra testing on top of it. Or if they’re negative, and we really think that they have leptospirosis, we’ll send out for more specialized blood tests, which can take a couple of days to come back.
There are two types of blood tests. We can test for the actual bacteria, called a PCR test. In that, we collect some urine and some blood, and we send that out for analysis. And they’re actually looking for the presence of the bacteria. That is the best test that we have that’s quick, but if your dog is later in the stages or has been treated with antibiotics, it might not test positive. So, the other thing we can do is test for antibodies against leptospirosis. There are going to be some dogs that have antibodies against leptospirosis, just walking around, because they’ve been exposed to it. What you have to do is give two different tests. You have to have an antibody test at the time of diagnosis, and then you’re going to test again about 2-4 weeks later, to see if those antibodies have actually risen. The theory is- if you’re actively infected with leptospirosis, you’re going to produce more antibodies. Or if you’re at the top of your infection and coming down, you’re going to produce less antibodies. So we’re looking for a change in the antibody level. The reason why we tend to like PCR a little bit more than the antibody test is that the antibody test takes a long time to come back. So even if I haven’t gotten a diagnosis of leptospirosis, oftentimes, I start treating for it while I’m waiting for my test results.
[00:11:26] Dr. Lancellotti: Yeah. because as you mentioned with your two cases, Nellie and Copper, you don’t want to lose critical time when we’re treating these animals. We want to make sure that we’re getting them supportive care and treating them appropriately, so that they have the best chance of recovery.
[00:11:41] Dr. Durocher-Babek: Exactly.
[00:11:42] Dr. Lancellotti: So with the testing, it sounds like there’s some blood work that we can do to look at the overall health of the animal, make sure their kidneys and livers are okay and see what’s going on with their platelets. But then there’s more specific testing looking at either for the lepto bacteria, or to look for antibodies that the animal is making to lepto, and how those antibodies are going to change in response to where they’re at in the disease process.
[00:12:11] Dr. Durocher-Babek: That’s exactly right.
How is leptospirosis treated in pets?
[00:12:13] Dr. Lancellotti: So once the veterinarian has confirmed an infection, what treatments might they recommend?
[00:12:20] Dr. Durocher-Babek: Usually, we recommend hospitalization and we’re going to start antibiotics and fluids. Lepto bacteria actually responds really well to antibiotics, but we need a long course to completely clear of the infection, because what can happen with some of these dogs is they can become carriers- where they feel better, but they’re still shedding bacteria into their urine.
Can leptospirosis affect pet owners and people?
[00:12:42] Dr. Lancellotti: Why is that really important? If the pet does become infected with lepto, and the infection isn’t completely cleared, why do we get concerned with that situation?
[00:12:52] Dr. Durocher-Babek: The biggest reason is because lepto is considered a zoonotic disease- meaning that it can be spread from animals to humans. If your dog has leptospirosis, you are at risk of getting leptospirosis. They shed the bacteria in their urine, so if you’re petting your dog or cleaning up after their urine and not wearing gloves, there’s a chance that you could get sick as well.
[00:13:15] Dr. Lancellotti: Yeah. And that’s certainly something that we would need to be aware of. As veterinarians, we’re not only taking care of the pets, but we have a responsibility for public health as well. We want to keep these people safe and healthy when we’re trying to help their pet recover from this disease. You had mentioned other situations where humans might be infected with leptospirosis. Tell me a little bit about that.
[00:13:39] Dr. Durocher-Babek: One of the big times that we get outbreaks in leptospirosis is when triathletes will have an open-water swim. If they’re swimming in a not very clean river, then a lot of those triathletes will actually become positive for leptospirosis and get really sick.
[00:13:55] Dr. Lancellotti: Is this something that a lot of human physicians are on the lookout for?
[00:14:02] Dr. Durocher-Babek: Actually, no. I had a dog a couple of years ago who was infected with leptospirosis, and I let the owner know about that. I told him what I tell everybody who is around a leptospirosis positive dog- if you start feeling sick, go to see your human physician (MD) and make sure that you tell them that you’ve been exposed to leptospirosis, this owner started feeling sick and he went to his doctor and he told him, “My dog possibly has leptospirosis,” and the medical doctor didn’t actually know anything about it. The medical doctor ended up calling me to ask how to treat the human patient and also how to test for it. Meanwhile, I’m thinking, this is definitely not the species I’m supposed to be treating, and realizing that this is not something that is commonly seen in human medicine. So you might get a doctor who has seen it before, especially in places like Hong Kong or maybe in California now, but you do have to really be an advocate for your own care. And if you start having flu-like symptoms and your dog is sick with leptospirosis, you want to make sure that they’re testing you for leptospirosis and they get you started on antibiotics.
[00:15:16] Dr. Lancellotti: I love that you worked with the human physician. I think that’s just such a beautiful representation of ‘one health’ and veterinarians coming together with the human side of things and working for the good of the pet and the pet owner. That’s fantastic.
[00:15:31] Dr. Durocher-Babek: Yeah. It really impressed me that this MD reached out to me and asked me, because a lot of times they don’t. This was a perfect example of ‘one health’ and working together to make the whole family healthy, rather than just the pet.
How can I protect myself if my pet had Lepto?
[00:15:44] Dr. Lancellotti: I love it. What’s something else that pet owners can do, as far as protecting themselves, when they’re taking care of an animal who’s been diagnosed with lepto and they’ve come home from the hospital?
[00:15:56] Dr. Durocher-Babek: Most times, if they’ve been released from the hospital, that means that the bacteria has been cleared from their urine and their bloodstream. We try to keep them in the hospital for as long as we can- usually, about 3-5 days. But you do want to make sure that you’re still safe afterwards, by wearing gloves when you’re picking up their urine or their feces and making sure to wash your hands well after petting your dog. If your dog has peed on themselves, a good bath is always a good idea. And then, try to clean up the environment a bit. Leptospirosis is easily killed in the environment with just your regular disinfectants, like bleach. So, if your pet usually sleeps on a certain bedding or will pee when they’re sleeping, make sure that you wash all their bedding with warm, soapy water. Just running them through the washing machine should be enough, but you can always add bleach to it as well. Make sure that you’ve cleaned up all their toys, just following good hygiene practices. And the other thing to remember, too, is if you have other dogs in your household, they’ve potentially been exposed. So you want to get them screened as well. So bringing them to your family practitioner, getting screening blood tests is always a good idea. There are some people who will actually advocate for the other dogs in the household, all being treated as well, even if they don’t test positive for leptospirosis.
[00:17:21] Dr. Lancellotti: Sort of as a prophylactic measure for them?
[00:17:24] Dr. Durocher-Babek: Yes. Exactly.
Should my pet be vaccinated for leptospirosis?
[00:17:26] Dr. Lancellotti: So, since we know that there’s currently an outbreak happening in our region here in Los Angeles, I want to talk about some of the preventative measures that pet owners here can take to protect their pets from even becoming infected in the first place. I know that there is a leptospirosis vaccine available and some other environmental management steps that pet owners can take. Can you talk a little bit about the vaccine and some things that pet owners can do to protect their animals?
[00:17:56] Dr. Durocher-Babek: The vaccine is great, but it’s not perfect. It’s like any other vaccine- there are going to be some problems associated with it. For example, there are hundreds of strains of leptospirosis out there. The vaccine only covers for about 4 of them. So we’re not going to be able to cover all of these strains that are out there. However, studies have shown that the leptospirosis vaccine does decrease the severity of the disease, even if your dog is not infected with the same strain. So I highly recommend the vaccination for those pets who are going outside, but I also recommend the vaccine for any pet, really. Unless they are sitting in their apartment, never leaving the room, never in access to any wildlife or anything outdoors, I think that the vaccination makes sense. The other thing that you can do, if you bring your dog hiking and camping, is try to prevent them from drinking the water. That’s a lot easier said than done, so I usually recommend just vaccinating them and keeping a really close eye on them. Constant vigilance, as any Harry Potter fan will know, is really important for these guys. If you notice your dog is acting sick, bring them in sooner rather than later, and try to keep them from drinking any of the puddles or streams. If there’s been a large rainfall, then maybe hold off on hiking for a couple of days. But this happens in urban environments because rats carry it, and rats are more common in cities. Rats like to pee in puddles and dogs like to drink from the puddles. So, no dog is completely protected against this.
[00:19:39] Dr. Lancellotti: So, the vaccine would be a great option for people who are living in areas where they know lepto is prevalent, and it just gives them that layer of protection.
[00:19:48] Dr. Durocher-Babek: Exactly. A long time ago, there used to be a higher incidence of vaccine reactions to the leptospirosis vaccine. That’s gotten better. You can still have a reaction to the vaccine, just like you can have a reaction to any vaccine- but we know that about leptospirosis, so we do watch them very closely after they’ve gotten a lepto vaccine. And I would say that the incidence of allergic reaction to the vaccine is pretty low, nowadays.
[00:20:16] Dr. Lancellotti: Great. So maybe if your pet has had a history of having a vaccine reaction, talking to your family veterinarian before getting the vaccine (about what to look out for afterwards) would be a good way to keep them safe and protected against any further reactions in the future.
[00:20:32] Dr. Durocher-Babek: Absolutely. I highly recommend that everybody talks to their family practitioner about all of the vaccines, because every vaccine should be different, right? Every dog is different, so every dog has a slightly different vaccine protocol. You want to make sure that you talk to your family vet about risks, reactions, when to vaccinate, how often to vaccinate, and how many vaccines to be given all at once.
[00:20:58] Dr. Lancellotti: Perfect. Yeah. We always want to balance the risk versus the benefit. That’s something that we talk about in almost every single episode of this show. There are risks associated with the vaccine, but the benefit is certainly there. Having a conversation with your family veterinarian who knows your pet will be helpful in guiding the recommendations for that individual animal.
[00:21:19] Dr. Durocher-Babek: Absolutely. And it’s important to talk to your vet about what your concerns are, too. Make sure that you’ve talked to them about what you’ve read on Google or what you’ve heard from other people, so that they have a chance to talk about whether that’s something you really should be concerned about or not.
What should pet owners know about leptospirosis?
[00:21:33] Dr. Lancellotti: In terms of leptospirosis, what are the big takeaway points that you would like pet owners to remember?
[00:21:39] Dr. Durocher-Babek: I think the really important thing to remember here is that early intervention makes a big difference. The fact that we know that lepto is prevalent right now helps us, because it means that we test for it earlier, rather than later. The fact that Nellie’s owners knew that leptospirosis was prevalent, immediately asked for the testing, and immediately brought her in, really saved her life. The other pet’s owners were really vigilant, but they just didn’t know that leptospirosis was prevalent in the area, and I think that those few days really made a difference for her.
[00:22:15] Dr. Lancellotti: Great. So every pet owner that’s listening is now more knowledgeable and can be more vigilant about what’s going on with their pet, knowing that this is something that they should be aware of if their animal falls ill, saving them those precious days of treatment.
Internal medicine resources from Dr. Durocher-Babek
Dr. Lancellotti: I wanted to give you the opportunity to talk about your website a little bit. I really like your website. You’ve got some great resources on there and some great handouts, as far as different common diseases. Can you tell the listeners a little bit about your website and some things that you’d like to highlight?
[00:22:48] Dr. Durocher-Babek: Absolutely. I started developing this website a couple of years ago because I realized that there’s not a lot of great information available for pet owners out there. You either get stuff that’s all the way out in the bell curve, on one end or the other, in terms of veterinary health. Pet owners just want to know how to treat them. We want to learn. And that’s our job as veterinarians. We’re supposed to be educating people, so if we get pet owners who don’t understand what’s going on, that’s something we need to work on. The website was a way to centralize all that information for all of my patients and clients and their families- but also for everybody. I wanted to use it as a good resource for the typical diseases that I’m going to see as an internal medicine specialist. As I joked earlier, I don’t do anything that’s external- no eyes, ears or skin. Everything that I look at is internal, so I’m hoping it’s a good resource for the typical things I see- like kidney disease, inflammatory bowel disease, Leptospirosis, tick fever, etc- just a way for people to have a couple of minutes to think about things before they look it up. When we’re in with our vets, as pet owners, you don’t hear everything that’s being said because you’re just so worried. It’s the same thing that happens to us when we go to our physicians. We don’t take in all of the information. So this way, with having the information out there, you can do it in a calmer manner or in the middle of the night. That’s what I’m really trying to do with this website.
[00:24:30] Dr. Lancellotti: Yeah, this really is such a great resource for pet owners. If you have questions about some internal medicine diseases and things that internists treat on a regular basis, there is just a wealth of information here, in a really easy-to-understand format. think that’s a great tool for pet owners to check out and get some more reputable and reliable evidence-based information, as far as what’s going on with their pet. Thank you very much for putting all of that together.
[00:25:09] Dr. Durocher-Babek: Thank you.
[00:25:11] Dr. Lancellotti: A lot of family veterinarians are comfortable managing pets with leptospirosis and helping you with the diagnosis and treatment, but the link to find a veterinary internal medicine specialist near you will be posted on the Your Vet Wants You To Know website. And you can also view the references for today’s show in the show notes on the website.
Scratching the Itch
Dr. Lancellotti: I like to end each episode with a segment called Scratching The Itch. It’s a short segment that highlights something- either a human interest story, a product, or a website- just something that provides relief or makes you feel good. Hence, scratching the itch. Do you happen to have a ‘scratching that itch’ for our listeners today?
[00:25:48] Dr. Durocher-Babek: Well, it’s a little bit different than a website or a product. For my ‘scratching the itch,’ what I want to make sure that everybody thinks about is not to be afraid of change. I think we all get stuck really easily and we think that big changes in our lives are insurmountable and just too scary. Three years ago, I moved my whole family (two kids – a two-year-old and a four-year-old – and my husband) all the way around the world to Hong Kong. We knew one person who was going to be my boss and that was about it.
[00:26:29] Dr. Lancellotti: That’s really scary.
[00:26:31] Dr. Durocher-Babek: It was very scary. And there were moments when we thought that we were crazy to do it.
[00:26:36] Dr. Lancellotti: Especially with the two kids! You know? I’ve got a four-and-a-half-year-old and a 15 month-old at home and I can’t imagine moving around the world. Talk about insurmountable. I mean, it truly feels like that.
[00:26:51] Dr. Durocher-Babek: And it did feel like that, at times. We thought we were crazy multiple times. Up until the day we actually were on the flight and we landed, we kept saying to ourselves, in the middle of the night, “Are we crazy? Should we do this?” But we did it. And I have to tell you, it’s just been amazing. It’s a wonderful experience to get away from what you’re typically used to. If you had told me, five years ago, that I would end up living in Hong Kong, I would have told you that you were crazy! I never felt compelled to live in a big city. I never felt compelled to live in Asia. I never felt compelled to really travel that far. I thought that if I was going to be living overseas, I’d be living in England, in a cozy little cottage in the Cotswolds with a bunch of books and cats and tea. And somehow I ended up in Hong Kong. And we landed right before the protests and a T-10 typhoon, which is like the highest typhoon you can have. Then, COVID happened. But every day, we just look around and we think about how lucky we are to be here, have this experience, and to teach our kids that the world doesn’t just revolve around one city- like New York City. The world is a great big place. Our kids have friends from South Africa, Ireland, China, Hong Kong, Taiwan, and they’re learning how to speak Mandarin, which is amazing to me.
[00:28:16] Dr. Lancellotti: That’s wonderful.
[00:28:17] Dr. Durocher-Babek: If we hadn’t made this change, we would have always wondered, ‘what if?’ So, what I like to tell people is, “Make the change if you want to. What’s the worst that’s going to happen?” It’s never as bad as you think it’s going to be. It’s never the catastrophe that we’d like to make it into our heads. And if it doesn’t work out, you can always go back.
[00:28:38] Dr. Lancellotti: I have to tell you, that’s a wonderful ‘scratching the itch.’ That really just put a big smile on my face. What an exciting adventure for your whole family. Really, really cool. Thank you for sharing that.
[00:28:48] Dr. Durocher-Babek: And if any vets who are listening out there want to talk about Hong Kong, or any people have any questions, they can always ask.
[00:28:55] Dr. Lancellotti: Excellent. You seem to be a huge wealth of information. So, I really appreciate you coming on today and sharing that information with everybody who’s listening.
[00:29:12] Dr. Durocher-Babek: Well, thank you so much for having me. This has been really enjoyable.
[00:29:16] Dr. Lancellotti: That’s great. And for everyone that’s listening, I look forward to your next visit with Your Vet Wants You To Know.
References:
- Sykes JE, et al. 2010 ACVIM Small Animal Consensus Statement on Leptospirosis: Diagnosis, Epidemiology, Treatment, and Prevention. JVIM 2011: 25:1-13
- Sykes JE, Reagan KL. Leptospirosis in dogs: Diagnosis, Treatment, and Management. Today’s Vet Pract. September-October 2019;9(5):88-93
