UAE doctors warn of ‘rat fever’ risks during travel after Indian expat dies of leptospirosis in Kerala

Dubai: The family of an Indian expat in Dubai, who died last week during a vacation in Kerala, has confirmed that final laboratory results show he had contracted leptospirosis, commonly known as rat fever, highlighting risks of infection during rainy-season travel and from rat-infested surroundings.

Teejo George, 48, a senior sales supervisor with a Dubai-based engineering consultancy, died at a hospital in Kannur on August 8, two days after being admitted with diarrhoea and body pain that doctors initially attributed to suspected rat fever.

His family has since told Gulf News that further lab test results confirmed the diagnosis was leptospirosis, a bacterial disease spread through water, soil or food contaminated by the urine of infected animals, particularly rodents.

The tragedy has struck close to his community in the UAE, where he lived and worked for nearly three decades, and highlighted the risks expats face while travelling to flood-prone areas during the rainy season and at rat-infested houses and surroundings anywhere in the world.

What is rat fever?

Speaking to Gulf News, Dr Bashirat L. Giwa, infectious disease consultant at Burjeel Medical City, Abu Dhabi, said "rat fever" is a loose term. "'Rat fever' usually means rat-bite fever, a rare, serious bacterial illness passed by rodents.

It can also refer to leptospirosis, a different bacterial disease spread through water or soil contaminated by rat urine," she said, adding that both cause fever and body aches but differ in cause and risk.

Incubation and symptoms

"The incubation period for leptospirosis is typically 5 to 14 days after exposure to the bacteria, though symptoms can begin anywhere between 2 and 30 days," Dr Bashirat said.

Dr Deepak Damodaran, internal medicine specialist at Aster Speciality Clinic, International City, Dubai, put the window from five days to two weeks, with early symptoms typically including fever, headache especially behind the eyes, eye congestion and redness, muscle pain particularly in the legs, and nausea, vomiting or diarrhoea.

Dr Bashirat advised anyone who develops sudden fever, severe headache, red eyes or muscle pain, particularly in the calves or lower back, after exposure to floodwater, mud or animal urine to seek medical attention immediately, since the illness "can progress rapidly from a mild flu-like illness to life-threatening severe disease."

Red flags to watch

Both doctors stressed that leptospirosis "is known for mimicking ordinary viral fevers, influenza, and dengue" in its early stage, which is what makes it dangerous.

Dr Bashirat listed jaundice with dark, tea-coloured urine, pointing to liver injury; a sharp drop in urine output or leg swelling, suggesting kidney damage; unexplained bleeding or blood in vomit or stool; severe breathlessness or coughing blood-tinged sputum; and confusion, stiff neck or seizures, indicating nervous-system involvement.

Dr Deepak echoed this, summarising the red flags as "jaundice, reduced urine output, drowsiness, cough, breathlessness or chest pain."

Diarrhoea without fever

Diarrhoea can, rarely, appear without fever, particularly in elderly or immunocompromised patients, Dr Bashirat said, explaining that Leptospira bacteria can irritate the gut lining once in the bloodstream.

Patients should never self-treat, Dr Deepak warned, because "vomiting and diarrhoea can lead to dehydration and kidney failure if not closely monitored."

Telling it apart

Distinguishing leptospirosis from dengue or a viral fever early on "can be clinically challenging because they all start with sudden fever, headache and generalised body aches," Dr Bashirat said.

One clue is redness of the eyes without pus, which can appear within the first three to four days, whereas dengue more often causes pain behind the eyes. Muscle pain also differs: severe and localised to the calves and lower back in leptospirosis, versus wider joint and bone pain in dengue.

Dr Deepak said the key giveaways are "severity of fever with chills, muscle aches and history of exposure to stagnant water."

He added that a fever developing "within a week" of rodent exposure should raise suspicion, especially if similar illness has been reported in the same neighbourhood.

How fast it turns serious

Untreated, leptospirosis can move from mild fever and other symptoms to organ failure within three to seven days, and once severe complications begin, health "can deteriorate rapidly within 24 to 48 hours," Dr Bashirat said.

Dr Deepak pointed out that progression to a severe form can also happen around one week after fever onset.

Jaundice not always present

Both doctors said absence of jaundice does not rule out leptospirosis. "Approximately 80% to 90% of symptomatic leptospirosis cases are anicteric, meaning they occur without jaundice," Dr Bashirat said.

Dr Deepak also said that the illness "can occur without jaundice" too, and both doctors urged patients seeking treatment to always disclose to their doctor recent exposure to floodwater, mud, rodents, or a stay in a house that had been shut up for a long time.

Dr Deepak called this "a vital piece of history," especially for expats who fall ill after returning to the Gulf.

Risk in shut homes

Dr Deepak flagged a specific risk for expats returning home for the holidays. In houses left locked for months, "rats are a major source of leptospira breeding," he pointed out.

Before entering or cleaning such a home or dealing with rat infestation on the premises, he advised covering cuts or scratches with waterproof dressings, wearing rubber gloves and enclosed waterproof footwear, avoiding bare-skin contact with dust or droppings, ventilating the space before cleaning, and never touching rodents or droppings with bare hands.

Dead rodents or droppings should be cleared with a shovel or gloves, the area sprayed with a disinfectant such as bleach, and hands and skin washed thoroughly with soap afterwards, the doctors said.

Don't drown rats in buckets

Experts also flag one overlooked household habit: drowning trapped rats in buckets of water. Leptospira bacteria shed in rat urine can contaminate that water, and if it touches a cut, scrape or even a fresh nail-clipping wound, infection can follow.

Since symptoms typically take five to 14 days, and up to 30, to appear, the link to this everyday chore is easily missed.

Doctors advised avoiding bare-handed contact with such water contaminated with rat body fluids, and keeping wounds covered.

Staying safe

Dr Deepak said the risk from contaminated water or mud can persist for two to four weeks after water recedes in areas flooded during rainy season.

She recommended avoiding waterlogged areas, wearing protective clothing, and pursuing rodent eradication at home with proper precautions.

Dr Bashirat added that food should be kept in sealed, rodent-proof containers, drinking water treated or boiled during flooding, and a thorough shower taken with soap after any contact with floodwater, mud or contaminated surfaces.