From [HERE] and [HERE] A total of 74 Puerto Ricans are suspected to be suffering from leptospirosis since Hurricane Maria wreaked havoc across the island last month, and four deaths are being investigated as possible cases of the disease, according to the Associated Press.

Although dozens of people are may be suffering from the bacterial disease, officials have denied to call it an epidemic or a confirmed outbreak. 

The disease is the result of contact with water that has been contaminated by animal urine. Puerto Rico averages 60 reported cases of leptospirosis each year. The 74 suspected cases have transpired since Hurricane Maria hit the island.

More than a third of the island remains without running water; some of those affected by leptospirosis fell ill after drinking local stream water.

According to the CDC, symptoms of leptospirosis are wide and varied but can include high fever, jaundice, red eyes and body pain. The CDC also states that some infected people may have no symptoms at all, a worrisome thought for those in Puerto Rico that have resorted to drinking contaminated water.

The time between a person’s exposure to contaminated water and becoming sick can range from two days to four weeks, leaving plenty of time for more cases to be reported over the next month or more.

The CDC states that leptospirosis can last for a few days or several months depending on treatment, yet people in Puerto Rico are dying from the infection. 

"While most patients have mild or self-limiting infection, some patients will develop severe infection and present with bleeding or hemorrhage, kidney failure, meningitis and hepatitis," said Dr. M. Rizwan Sohail, a professor of medicine in the Division of Infectious Diseases at the Mayo Clinic. "The death rate in patients who develop severe infection is between 5 and 15 percent."

Doctors told HuffPost the U.S. territory is ripe for an outbreak of leptospirosis and other endemic diseases on the island if more aggressive preventive action isn’t taken soon.

Leptospirosis is spread through the urine of infected animals, including rats, pigs, dogs and horses. When a person comes into contact with water, mud or soil that has been contaminated by an infected animal’s urine, the bacteria can enter the body through open abrasions or mucous membranes in the eyes, nose and mouth, according to the U.S. Centers for Disease Control and Prevention. The current conditions in Puerto Rico are ripe for this type of infection.

Leptospirosis is rarely contagious between humans.

The disease often mimics many viral infections, making it hard to diagnose, Capó said. It is often underreported or misdiagnosed as dengue, a viral disease transmitted via mosquitoes. But unlike dengue, leptospirosis can be treated early on by using antibiotics. If left untreated, in some strains of the disease, patients may hemorrhage in the lungs or experience kidney failure and die.

Capó said the government isn’t responding quickly enough. Officials need to communicate the risks of the disease to both patients and doctors on the island.

“I would say the island is at risk of outbreaks of influenza, leptospirosis, dengue,” Capó said. “The potential for outbreak is imminent.”

‘The suspicion is so great that you don’t need to wait for lab results’

A doctor at Dr. Federico Trilla Hospital in Carolina who spoke to HuffPost says he knows of at least one death connected to leptospirosis and three current suspected cases being treated.

“There are cases, that despite not being confirmed, the suspicion is so great that you don’t need to wait for lab results,” said Dr. Cruz, whose name has been changed because he did not have permission to speak on record. “There was a patient, a 28-year-old man that in less than five days the disease killed him.” 

Dr. Cruz, who received details of the case from a fellow doctor at the hospital, told HuffPost that the patient had gone to three different hospitals before arriving at Dr. Federico Trilla hospital, around 13 miles east of San Juan. At each hospital he had been discharged with a virus diagnosis. No doctor had considered leptospirosis.

By the time the patient arrived at Dr. Cruz’s hospital he was experiencing organ failure. Compounding the problem: the hospital had no functioning intensive care unit due to a lack of electricity. Despite the administering of antibiotics, and an attempted transfer to a hospital with a working intensive care unit in San Juan, it was too late.

“In less than four hours of having been in our hospital with suspected leptospirosis, he died,” Dr. Cruz said.

‘Once it’s too late, I’ll be blunt, the patient will die’

Officials in the government say they are working to prevent outbreaks. Puerto Rican governor Ricardo Roselló told Huffpost the deaths that are suspected to be linked to leptospirosis are pending confirmation from the CDC.

When asked if the health system on the island currently had the infrastructure to deal with a possible outbreak of any disease, Roselló admitted that the hospital system is “very frail,” with only 20 hospitals running on the electric grid and the rest running only partially on generators.

As far as preventive measures for outbreaks, Roselló assured HuffPost that his government was doing an “aggressive” campaign with flyers.

But, Dr. Cruz says he hasn’t heard of any campaigns, and he feels the government should not be waiting for CDC confirmation of leptospirosis deaths before alerting communities of the risks.

“We have all of the elements for that bacteria to grow and spread, and with preventative antibiotics, we can save lives,” Dr, Cruz added. “Because once it’s too late, I’ll be blunt, the patient will die regardless of what we do. And it’s up to a 70 percent mortality rate if the infection reaches the lungs.” [MORE]