Nicaragua has declared a national state of emergency due to a spike in cases and deaths from leptospirosis. Leptospirosis is typically spread through contact with water or plants that have been contaminated by the urine of infected animals (most often rodents). Recent heavy rains and flooding have created ideal condition for its spread. So far, 146 cases and 16 deaths have been confirmed with more cases and deaths suspected. Untreated, it can lead to kidney damage, meningitis, liver failure, respiratory distress, and death. Leptospirosis is rare in the United States with half of the 100-200 cases each year occurring in Hawaii. In the US and Canada, leptospirosis is more often a veterinary disease; diagnoses have increased substantially in dogs during the last decade.