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The Honolulu Advertiser
Posted on: Wednesday, February 11, 2004

Hawai'i sees many Leptospirosis cases

By Robbie Dingeman
Advertiser Health Writer

Hawai'i recorded nearly 500 cases of leptospirosis in the past decade and six of those people died of the bacterial disease, an illness suspected in the death of a Big Island college student last month.

Simon Hultman went hiking and swimming in Waipi'o Valley, a known source of leptospirosis. He died last month.
The disease is transmitted from animals to humans usually when people contact the bacteria through fresh water or mud that has been contaminated by the infected animals — commonly rats or mice — who urinate in the water or soil.

Dr. Paul Effler, Hawai'i's state epidemiologist, said people need to be aware of the danger of the bacteria in freshwater ponds, streams and catchment water and be careful to report unexplained fevers or illnesses that develop after such exposure to their doctors.

Simon Hultman, 22, of Pahoa, became ill within a week of spending the holidays in Hawai'i. He had returned to college in Maryland where he was a senior in international studies. While he was home, he went hiking and swimming in various places, including Waipi'o Valley, a known source of leptospirosis.

A state Health Department report on leptospirosis exposure from 1993 to 2002 indicates 28 cases developed after contact with the Waipi'o River, more than any single source in the survey.

Leptospirosis in Hawai'i

• Where: Has been found in Waipi'o River and Valley on the Big Island, Maunawili Stream/Falls, Kapena Falls/Nu'uanu Stream and Kahana Stream on O'ahu; and on Kaua'i, Waimea River, Wailua River and the Hanalei River.

• Cases: Hawai'i averages 44 cases a year with a high of 72 in 1997. In the Waipi'o River, 28 cases were recorded from 1993 to 2002, more than any other source in the survey. College student Simon Hultman had been hiking there during the holidays, and died within a week of returning to the Mainland.

Other locations associated with multiple cases of the disease include: on O'ahu, Maunawili Stream/Falls, Kapena Falls/Nu'uanu Stream and Kahana Stream; and on Kaua'i, Waimea River, Wailua River and the Hanalei River.

Lisa Abbott, a family nurse practitioner, came down with leptospirosis in 1993 after hiking and camping on Kaua'i and recovered. She traces her exposure to showering in catchment water that wasn't screened to keep rats out of the fresh water source.

Abbott said she got sick about a week after her trip. "I got a very high fever and terrible body aches. I'd never had a fever like that before," she said.

She called a doctor friend who took her to the emergency room. Abbott said she was hospitalized for a week and spent another week at home recovering. "It was very painful," she said.

But even with her health background, she said, she didn't figure out the link between her freshwater exposure and her sickness. After she recovered, she joined a leptospirosis education committee for several years to try to increase public awareness of the disease.

She hopes people think twice before swimming underwater in freshwater streams or jumping into ponds, especially where there are warning signs posted about leptospirosis, like at Kapena Falls and Maunawili Falls. "Even though the water looks very inviting," Abbott said, "you are taking a risk of possibly becoming ill."

Dr. Landis Lum, a family practice physician with Kaiser Permanente's Kailua clinic, said he sees about one case of leptospirosis a year. Hikers and swimmers most commonly contract the disease through cuts and scrapes.

People are known to have reported the disease after swimming, jumping or diving into water, he said, where it is believed the bacteria enters the body through water forced up through the nose.

An avid hiker himself, Lum urges people to be cautious about their freshwater exposure but not let it stop them from enjoying Hawai'i's outdoor experience. He said it's important to know about the risk because the fever and aches can be mistaken for the flu or a virus.

Simon Hultman's mother, Diane Hultman has said that health officials have said they are testing for dengue fever and leptospirosis as possible causes of her son's death.

The U.S. Centers for Disease Control and Prevention estimates that half of the nation's annual 100 to 200 recorded cases of leptospirosis occur in Hawai'i. The CDC laboratory is analyzing test results in the Hultman case.

Effler said the disease is more common in the tropics. He said that people can be treated effectively for the disease with antibiotics if the diagnosis is made early enough.

The number of diagnosed cases in Hawai'i has averaged about 44 annually with a high of 72 in 1997 when the Health Department was actively calling clinics to ask if they had suspected cases of the disease, Effler said. He said the disease also has been linked to taro farming and others who spent a lot of time in the water.

Lum said he also has seen in it in people who surf near a river mouth. He said people should watch for fever, headaches, backaches, muscle aches after they have been in fresh water.

Lum just went swimming this weekend at Waimano pools off a trail above Pearl City. "If you have a cut or scrape, you should not swim in the water," Lum said. "If you get a flulike illness afterward, immediately go and see your doctor."

He said the disease can take two to 30 days to show up. And that's why awareness is important. "You could forget you went hiking."

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