Leptospirosis- Know How to Guard Against it and Stay Healthy
Leptospirosis is a water-borne disease that occurs in the rainy season.
It is caused by an organism called Leptospira, which is shed by rats, dogs, cattle, etc., through their urine. These animals are the carriers of this organism and they harbor it in their urinary system without getting affected.
When their urine gets diluted in the water puddles during the rains, they can infect human beings by direct entry through the intact skin.
Leptospirosis is prevalent worldwide with India, some African and South American countries leading with a large number of cases yearly.
Shown below is the distribution map the disease worldwide-
What is leptospirosis?
In my last two blogs on Infectious disease, I had discussed Malaria and Dengue.
Both are transmitted by mosquitoes. Whereas Malaria is caused by a parasite called Plasmodium, Dengue by the Dengue virus, Leptospirosis is caused by a spiral bacteria called the Leptospira.
As per the WHO definition, it is:-
I will now show some pictures below which will explain the disease in detail with signs, symptoms, and complications.
What is Leptospira look like?
This is a spiral bacteria called Leptospira interrogans.
It is found mostly in the urine of rats, dogs, and cattle.
How is this disease spread?
The figure below shows the different ways on how we get leptospirosis:-
Having known its transmission, you can see how it can be prevented by taking a few precautions in the rainy season[discussed at the end]
What are its Signs and Symptoms of Leptospirosis?
Signs and symptoms vary in different people. The picture below shows the symptoms mostly found in patients suffering from leptospirosis.
It shows that the disease as 2 phases, namely the Acute phase and the Immune phase.
The acute phase is the one where the patient is sick but can be treated successfully.
The immune phase is the one where complications as shown in the picture occur and mostly lead to complications which requires hospitalization.
A rash appears on the skin sometimes as shown below-
How many types of Leptospirosis are there?
There are 2 types of leptospirosis:-
In the first type, there is no jaundice. That is why it is termed Anicteric. They may have all other symptoms like headache, body ache, skin rash, and other features as shown in the picture of signs and symptoms above.
In the Icteric type, the patient has severe jaundice and other parts of the body get involved. There is internal hemorrhage[bleeding] within organs like stomach, eyes, kidney, etc. This ultimately leads to multi-organ failure and death.
Weil’s disease is a major and fatal complication of leptospirosis and is as described below-
If you are having any of the above symptoms, you should contact your family physician.
Shown below is a picture of the effect of a severe form of leptospirosis wherein the platelet count of the patient low and internal bleeding occurs.
The eyes show seepage of blood in the sclera[white part of the eye] and is called conjunctival suffusion.
What laboratory investigations your doctor may advise?
If your doctor is suspecting that you are suffering from leptospirosis, he/she may order the following tests:-
Patients should have plenty of fluids, soups, etc. along with medicines prescribed by your doctor.
Paracetamol- to reduce fever.
Antibiotics:-Doxycycline 100 mg twice daily for a week to 10 days;
Antiemetics[anti-vomiting]-like domperidone to prevent vomiting;
Anti-inflammatory pain killers like diclofenac, ibuprofen,nimesulide
Glucose powder- for severe fatigue.
Intravenous Dextrose saline to correct dehydration.
You may also be suggested by your family physician regarding the prevention of the disease in other family members by prescribing some medicine like doxycycline once a day for 2 weeks. Kindly do not treat yourself – this disease can be fatal. Weil`s disease is a serious condition that needs hospitalization.
Prevention Of Leptospirosis-
Having said all this, you can prevent this disease by
Avoiding barefoot walking in water flooded on roads in the rainy season,
Use good rubber or all-season shoes,
Try to avoid wetting your feet in the muddy waters during the rainy season.
Some precautionary measures for the prevention of leptospirosis as suggested by the WHO is as shown below:-
Let’s have a quick recap of what we have learned today-
I hope I have explained all the details of this deadly disease. You can very well prevent leptospirosis if you follow all the precautions I have mentioned above.
Contaminated water in the rainy season is the main source of infection. Here again, wearing rubber gloves and shoes can go a long way in preventing the disease.
For more on Leptospirosis, Click Here.
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Malaria fever is only next to Dengue and chikungunya spread by mosquitos. In this disease, a female anopheles mosquito[shown below] is a culprit. They feed in the night on human blood and breed during the daytime.
These mosquitoes transmit the malaria parasite from person to person by their bites.
Why I am writing this article?
As you all know, I am a General Medical practicing in Navi Mumbai, India. Every monsoon after a few days of heavy rains, water stagnates at many places serving as breeding places for Dengue and Malaria causing mosquitos. Many patients with fever attend my clinic. They are either suffering from Malaria or dengue.
Children and the elderly are more susceptible to a severe form of malaria. To make this aware to all my readers, I decided to write a comprehensive article describing everything you may want to know about the disease.
My motto has always been-Prevention is Better than Cure! That is the sole purpose of this a,rticle.
I request all my readers to read the article until the end tounderstand it fully. If possible, bookmark this on your browser so that you can referto it anytime in the future.
What is Malaria and what causes it?
It is a form of fever that can make you very sick. Dengue fever discussed in my previous article[click here to read] was caused by a virus.
Malaria is caused by a protozoan parasite called Plasmodium and is transmitted/spread by the bite of mosquitos.
A Brief History of Malaria-
Many centuries ago, malaria existed in the gorillas in the African subcontinent. They were transmitted to human beings by Anopheles mosquitoes.
From Africa, the disease spread all over the world and is still causing havoc in South America, India, China, and other countries. This picture map shows how Malaria is ruling in different countries-
Transmission of Malaria parasite – The Pathophysiology of Malaria-
One should know how one gets Malaria. The picture shown below shows how exactly the malarial parasite is transmitted and spread by the female anopheles mosquito.
As the parasite enters the human body, it undergoes various stages. This goes on until it is picked up again by another mosquito. So, less or no exposure to mosquito bites should be your first concern.
Types of Species of Malaria parasites-
There are 4 types of malaria parasites-called Plasmodium[P.]– depending on which part of the world they are found-
1. Plasmodium Falciparum-
Found almost all over the world. This the most dangerous of the four varieties. India is also a host to this parasite. It can cause a severe form of malaria affecting the brain[Cerebral Malaria] and the kidney[Black water fever].
Fever occurs every daywith rigors[shivering] and can reach up to 107° Fahrenheit.
2. P.Vivax –
This is also found worldwide, is less dangerous but can cause severe illness. Found in India. The disease caused by this variety is milder but can sometimes mimic P.Falciparum.
Fever can occur on alternate days or every 4th day.
Such type of malaria is found in Latin America and many Southeast Asian countries including India[rare]. This has a very low presence and is not that dangerous.
Found mostly in the Far East countries like Malaysia, Thailand, Vietnam. and China. Incidence is the same as that of P.Ovale.
Signs and symptoms of Malaria-
All the symptoms are related to the phases of the development of the malarial parasite in the body and circulating blood[see the pathophysiology picture above]. The fever usually occurs in the schizont and merozoite stage, that is when the parasite enters the bloodstream from the liver[merozoite stage] to enter the red blood cell.
Next is when it breaks from the RBCs [ schizont stage]
The major symptoms of this disease are-
Pyrexia or fever can range anywhere from 100°F to 107°F. The fever is intermittent. Depending on the type of malaria they are further classified as follows-
Tertian fever- This occurs every 48 hours in P.Falciparum, P.Vivax, and P.Ovale.
Quartan Fever- this occurs in P.Malariae
Malignant fever- This is a feature of severe P.Falciparum malaria. It can lead to multi-organ failure[more on this in complications] and ultimately death if not treated in time. These patients need to be admitted to an ICU unit.
B] Rigors or Shivering-
Just before the fever begins, the patient starts shivering vigorously with the chattering of teeth. This called rigor. This is also called the Cold Stage.
C] Severe headache and body ache-
Fever and shivering are followed by severe headache, body ache, and pain in the eyes.
D] Vomiting, diarrhea, cough-
A few patients have severe bouts of vomiting and some, diarrhea [Seen in Intestinal malaria- a rare occurrence]. This can lead to the patient getting dehydrated and lethargic.
E] The Signs-
As the disease progresses, there is an enlargement of the liver and another organ called the spleen due to which there is a pain in these organs.
The liver gets enlarged because the parasites are multiplying there[ hepatic schizont stage].
Spleen is known as the graveyard of RBCs. After the release of the parasite from RBCs, the RBCs are scavenged by the spleen, enlarging it as the disease progresses.
F] Recovery phase-
The above symptoms last for a good 2-3 hours. After this, the recovery begins with the patient feeling very tired and wanting to sleep.
What are the laboratory investigations?
Blood tests commonly recommended are
a] Complete blood checkup[CBC]- this will, in almost all cases, show-
Anemia i.e. low hemoglobin levels
Reduced RBC count
Decreased Platelet count[ normal range 1.5 to 4.5 lakhs]
b] Smear for malaria parasite[MP] to confirm the diagnosis and show
Type of malaria parasite
The percentage of affected RBCs-more than 2% can lead to severe complications and death.
Stage of development of the parasite, for eg., Schizont, or trophozoites or merozoite stage.
c] You can also have an immunological card test to confirm the type of malaria.
Having understood the Signs and symptoms, we now move to the treatment part.
Treatment Of Malaria:-
Drugs used commonly in the treatment are:-
Chloroquine- This the most prescribed drug[ eg. Lariago, Nivaquin]. This is a 3-day course.
Primaquine-Given after Choroquine dose is over. Should be taken for 14 consecutive days. I usually prescribe folic acid tablets[Folvite] with primaquine, as there is always acute folate deficiency in malaria.
Mefloquine-rarely given nowadays;
Quinine-Dosage depends upon body weight.
Artesunate-Given in severe malaria. The dosage depends upon the severity of malaria.
Artemether- Same as Artesunate
etc. to name a few.
Let your family physician decide the dosage and the type of medicine to be prescribed to you.
Kindly do not attempt to self-treat yourself as these medicines have severe side-effects. Better to leave it to your Family physician to take care of you.
Along with the antimalarial drugs you will also be prescribed-
Paracetamol[ Crocin, Calpol, Pacimol] for fever;
Domperidone[Domstal DT, Domperon] for nausea and vomiting;
Chlorpheneramine[Avil] to prevent shivering and itching:
Intravenous[IV] fluids if patients are vomiting continuously, with 5% glucose or ringer lactate. This can prevent severe dehydration.
A word of Caution-
If you have G-6PD deficiency or anyone in your family has this, kindly let your doctor know about it. This can prevent severe complications of malaria treatment.
G-6PD deficiency causes a condition called Hemolysis, wherein the RBCs in the blood are destroyed. Some antimalarials, especially Chloroquine and Primaquine, can cause severe hemolysis leading to jaundice and death in G-6PD deficient patients.
This consists of-
Plenty of fluids, preferably with glucose or some powder like Vital-Z, Enerzal;
Adequate bed-rest until full recovery. Avoid doing any form of exercise during the treatment period.
Complications of malaria-
Two types —P.vivax, and P.falciparum— are very common in India. Out of these two, P.vivax is less dangerous than P.falciparum.
The later one can cause multi-organ failures like-
Kidney failure-wherein you may pass coffee-colored urine[so-called black-water fever],
Brain fever -also called cerebral malaria, where the patient can go into a coma
Blindness -due to choking of eye blood vessels, etc.
These patients need urgent admission in the hospital because they are very sick and need intravenous fluids like glucose-saline etc. and also to prevent complications of malaria, like coma, dehydration, congestive cardiac failure, etc.
Is there any immunity to the disease?
There is a small group of people having what we call the Sickle Cell Traitwho are immune to malaria. People with Sickle cell trait are found immune to malaria. The reason is the parasite requires a lot of oxygen to survive. This is less in Sickle cell trait as the RBCs of these people are deformed i.e. shaped like a sickle.
These traits are found in tribals and poor people who lack money to get treated. These people over the years develop natural immunity in the form of deformed RBCs from trying to fight the disease.
Can you Prevent Malaria?
Yes, definitely. I would like to add a few words on the prevention of malaria because prevention is far better than cure. Kindly follow the following steps:-
I preferably advise chemoprophylaxis if at least one member from the family has suffered from malaria.
What is Chemoprophylaxis? Is there a vaccine?
So far, no vaccine has been found for preventing malaria. Therefore, prevention or prophylaxis with drugs is the only way out.
Chemoprophylaxis is basically a medicine given to prevent disease. In Malaria, chloroquine is prescribed 2 tablets a week to all the family members who had a member suffering from the disease.
Other than that, a tablet combination of Pyrimethamine and Sulfadoxin[Reziz] is given on a monthly basis.
Some personal observations which can be useful to all-
Use full-sleeved hosiery material shirts and pants-the the mosquitos find it difficult to pierce through these types of clothes.
Never wear dark or black colored clothes-it camouflages the mosquitos[you can see them hiding in dark places or on furniture that is dark-colored].
If you see a large mosquito parking on the ceiling, it is mostly a female anopheles one. Aedes Aegypti mosquitoes are small and will hide under furniture.
What else should you do to prevent malaria?
I personally use mosquito repellents such as mosquito repellent coils, patches, fabric roll-ons, window nets etc. These are easily available online. See below –
What can you as readers do to make the world a better place to live in-
Friends, as you all know the whole world is up against the Covid-19 pandemic. During this period, Malaria can overlap with the COVID-19 pandemic.
There is a saying “Sharing is Caring”. I have done my bit by getting this article to you. Now, you can contribute, without spending a penny by sharing this information with all those you love and care for.
Do this now by clicking on the Social Media icons in this article with a small note” Read this article”.
Alternately, if you have a Twitter account, you can just click on the quote below-
Know your diabetes and live a happy, trouble-free life
Today, as I am writing this article, all over the world Diabetes Mellitus is spreading like wildfire with barely any solution to end it. What we as human beings, have achieved is control over the signs, symptoms, and complications of the disease.
Is there any way to eliminate DM? Well, as far as I have known, in all my 35 years of medical practice, you cannot do away with it totally.
But, in the early stages, also known as Impaired Glucose Tolerance or Pre-diabetes, you can prevent it from advancing to its full-fledged form. This can save one from the suffering and the cost of treatment, not to mention man-hours lost due to co-morbidities like heart failure, kidney failure, stroke, urinary tract infection, obesity, etc.
As mentioned in my last post, there are 4 types of diabetes. In this article, I will be highlighting the signs and symptoms of DM.
The Signs and Symptoms of Diabetes-the 3 Ps
The signs and symptoms [S/S] common to all the types of diabetes are in the form of this 3 Ps:–
This means frequent urination. A person feels like passing urine, more so at night. This disturbs the sleep of the person with diabetes.
This means excessive intake of water. Due to excessive urination, the diabetic patient develops mild dehydration which causes excessive thirst and drinking more and more water.
This means excessive hunger. Even though there is enough sugar in the blood, it is not available for uptake by tissues. This is especially so in obese patients and is called insulin resistance. The satiety center in the brain sends a signal to the digestive system to absorb more glucose and that is why one feels hungry.
The picture shown below illustrates the signs and symptoms of both Type1 and Type 2 Diabetes Mellitus-
Other common signs and symptoms of Diabetes Mellitus
Apart from these 3 major signs and symptoms [S/S] discussed above, there are many more S/S due to the co-morbidities of DM. This I will cover as we move forward.
Type 1 Diabetes-Signs and symptoms-
If you look at the illustration shown above, apart from the s/s mentioned earlier[3Ps], those words shown in black are common for both types of DM. The words shown in blue will give you an idea of the other signs and symptoms of Type1 DM. Clicking on the blue words will give you the detailed information.
The Co-Morbid conditions-
1] Yeast [candida] infections of-
2] Delayed healing of Wounds.
There is slow healing of wounds as there is an excess of sugar in the blood. This excess sugar is a good medium for the growth of infection-causing bacteria.
3] Nerve Problems-Neuropathy-
Due to excess sugar in the blood plasma, the myelin sheath surrounding the nerves coming out from the spinal cord undergoes degeneration. This causes tingling/pinprick sensation and numbness in the area supplied by these nerves. This occurs mostly in the limbs, more so in the legs.
The excess sugar in the blood, which is not utilized by tissues due to insulin resistance in Type2 diabetes get converted into fats. It is stored in fatty tissues in the abdomen causing a rise in the girth of the abdomen gradually. This is called Central Obesity. This leads to a substantial increase in weight causing other problems like breathlessness, an increase in BP, arthritis, etc.
5] Blurring of vision
Uncontrolled diabetes can lead to blurring of vision due to changes like opacity in the lens of the eye leading to early cataract. The nerve supply of the eyes can also get affected causing blindness- a condition called retinopathy.
Fungal infection of nails[onychomycosis] and scalp[tinea capitis], as shown below are very common in both types of diabetes. They are stubborn infections and take a lot of time to heal.
This is passing of proteins in the urine. Diabetes mellitus in the long run affect the kidney also. They manifest as a decrease in the filtration rate, known as GFR. This ultimately causes a condition called nephropathy which leads to Chronic Kidney disease or Kidney failure.
8] Acanthosis nigricans-
There is a darkening or velvety appearance of the skin in areas like axilla, nape of the neck known as Acanthosis Nigricans.
9] Gangrene of feet-
Diabetes causes a condition called diabetic microangiopathy which leads to loss of blood supply to fingers and toes. This causes swelling and infection of the feet.
Sometimes you need amputation of the gangrenous part like the picture shown here⇒
The picture shown here is of one of my patients who had to undergo amputation of the toes due to severe infection leading to gangrene. Had it not been amputated, the patient would have lost his foot and probably his whole leg.
Some of the S/S is a part of complications of Diabetes, which I will discuss in detail when I come to the complications part of the series.
Depending upon the signs and symptoms of diabetes your doctor will initiate the appropriate treatment. Patients should comply fully and follow the instructions of his/her family physician. This will get the best results and prevent complications of diabetes.
Next in line-
Having said this, we will now proceed to find out what are the lab tests we have to carry out to confirm if one is a diabetic:-
1] Blood sugar fasting and post-lunch;
2] Hba1c [glycoslated haemoglobin];
3] C-peptide test to know the level of insulin in the blood and the health of the pancreas.
4] Serum insulin level to know whether it is Type 1 or Type 2 diabetes in adults.
We will study the interpretation and implications of these tests in Part 4 of this series.