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The Honolulu Advertiser
Posted on: Saturday, April 10, 2004

Leptospirosis killed student

By Robbie Dingeman
Advertiser Health Writer

Federal health officials have concluded that leptospirosis, a bacterial disease present in Hawai'i's streams and ponds, is what killed a college student from the Big Island in January, the state's top disease doctor said yesterday.

Simon Hultman, 22, of Pahoa, died Jan. 26, shortly after returning to school in Maryland after spending the holidays with family on the Big Island, where he went hiking and swimming. His family had been awaiting test results from the U.S. Centers for Disease Control and Prevention.

Hultman's sister, Sharon Beauchan, yesterday said the family was told by state health officials that he had been exposed to leptospirosis and a form of dengue fever.

Facts about leptospirosis

• Leptospirosis is a bacterial disease that causes flulike symptoms and, in rare cases, death.

• About 500 cases, including seven deaths, have been reported in Hawai'i in the past decade.

• People in Hawai'i commonly get it when wading or swimming in streams, ponds and other freshwater sources that have been contaminated by animal urine or droppings.

• Symptoms include fever, nausea, chills, headache, vomiting, diarrhea and body aches. More serious symptoms include jaundice, kidney failure and heart failure.

• Stay out of fresh water and muddy areas if you have open cuts. Don't put your head underwater or drink stream water. See a doctor if symptoms arise.

Source: State Dept. of Health

State epidemiologist Dr. Paul Effler yesterday said autopsy results do show some exposure to dengue fever but that he and CDC officials believe the evidence clearly points to leptospirosis as the cause of death.

Hultman's death is the seventh attributed to leptospirosis in Hawai'i in the past decade. About 500 people have reported contracting the disease in that period. State health records show that at least 25 people died of leptospirosis in Hawai'i from 1907 to 1985.

Hultman was a senior studying international relations at Washington College in Chestertown, Md. He returned to school Jan. 14 and on Jan. 19 went to the emergency room at Chester River Hospital Center, complaining of fever and other flulike symptoms. He died a week later at the University of Maryland Medical Center in Baltimore.

Leptospirosis is a bacterial disease that can cause fevers, and in rare cases, death. It is usually transmitted through contact with the urine of infected animals. In Hawai'i, the most common route of transmission is when people wade or swim in fresh water contaminated by animal urine.

While he was home in December, Hultman hiked and swam in various places, including Waipi'o Valley, a known source of leptospirosis.

Beauchan said she and her family will meet next week with state health officials to get details of what the test results mean. "Their feelings are that he died from leptospirosis," she said.

Hultman's family hopes that Simon's death will make people think about the risk of the disease and the symptoms — fever, chills, headache, body ache and even stiff neck, jaundice — and ask their doctors about potential exposure.

"It's out there," Beauchan said. "You just think more of it when it strikes close to home."

Beauchan said she doesn't know what her talented brother knew about the disease, but she knows that Maryland doctors did treat him for leptospirosis.

Beauchan said the family will hear more about Hultman's illness from Effler and other specialists on Friday, which would have been her brother's 23rd birthday.

Effler said state health officials have remained vigilant on seeking out any other cases of illnesses accompanied by fever on the Big Island since Hultman's death. "We're not finding other denguelike illness," he said, supporting the conclusion that leptospirosis killed Hultman.

Effler echoed the Hultman family's hope that people will become more aware of the symptoms of leptospirosis as they enjoy hiking and swimming in Hawai'i. "There is a small but real risk in exposure to fresh water."

Dr. Landis Lum, a family practice physician with Kaiser Permanente's Kailua clinic, said he sees about one leptospirosis case a year. He said most people get sick after hiking or swimming with cuts and scrapes.

An avid hiker, Lum urges cautious exploration. "I'm going to go swimming again. I'm not going to dive under the water. And I'm not going to go in with cuts and scrapes," he said.

Studies indicate that swimming, diving and jumping into the water can force the bacteria up one's nose. Since the disease can often be treated with antibiotics, Lum said early detection offers the best defense against the illness.

Lum said the disease can fool people because symptoms show up anywhere from two to 30 days after exposure. People may forget about having been in fresh water days or weeks earlier when they try to track down what's making them sick.

Still, the chance of people getting leptospirosis remain low and the death rate among those who do get it is about 1 percent, Lum said.

And while he wants people to be safe, he urges against being frightened. "You need to enjoy and appreciate our 'aina," he said.

Reach Robbie Dingeman at rdingeman@honoluluadvertiser.com or 535-2429.