Be aware of Leptospirosis during rainy season and floods

Enrique Ona warned the public against wading in floodwaters as leptospirosis cases in the country rose to 454 from January to May 21 this year.

The figure is higher by 74.6% compared to the same period in 2010. Persons affected by the disease were ages 1 month to 69 years, and were mostly men.

There were 32 deaths recorded compared to only 8 last year.

"The rainy season is not yet over, so we are reiterating our advice to the people to prevent leptospirosis by avoiding, as much as possible, wading in floodwaters. We emphasize that they should wear boots if wading cannot be avoided," Ona said in a statement.

Regions most affected by leptospirosis from January to May include Western Visayas with 131 cases, Bicol with 51 cases and Central Luzon with 50 cases.

The said areas were greatly affected by typhoons that hit the country in May.

Leptospirosis is an infection caused by direct exposure to bacteria found in animal urine and feces. Patients can get infected when they swallow floodwater or when bacteria enter the body through open wounds, eyes, nose, or breaks in the skin.

Symptoms include fever, chills, headache, and vomiting. In extreme cases, the disease may cause meningitis, renal failure, respiratory diseases, and even death.

Tropical storm "Falcon" brought heavy rains to Manila and surrounding provinces last week, causing floods in major and secondary roads.

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Causes of Leptospirosis, Symptoms, Prevention and treatment

Many are asking on what are the possible causes of Leptospirosis, Leptospirosis is caused by a spirochaete bacterium called Leptospira spp. There are at least 5 serovars of importance in the United States and Canada, all of which cause disease in dogs (Icterohaemorrhagiae, Canicola, Pomona, Grippotyphosa, and Bratislava).[5][6][7]

There are other (less common) infectious strains. Genetically different leptospira organisms may be identical serologically and vice versa. Hence, an argument exists on the basis of strain identification. The traditional serologic system is seemingly more useful from a diagnostic and epidemiologic standpoint at the moment (which may change with further development and spread of technologies like PCR).

Leptospirosis is transmitted by the urine of an infected animal and is contagious as long as it is still moist. Although rats, mice and moles are important primary hosts, a wide range of other mammals including dogs, deer, rabbits, hedgehogs, cows, sheep, raccoons, possums, skunks, and certain marine mammals are able to carry and transmit the disease as secondary hosts. Dogs may lick the urine of an infected animal off the grass or soil, or drink from an infected puddle. There have been reports of "house dogs" contracting leptospirosis apparently from licking the urine of infected mice that entered the house. The type of habitats most likely to carry infective bacteria are muddy riverbanks, ditches, gullies, and muddy livestock rearing areas where there is regular passage of either wild or farm mammals. There is a direct correlation between the amount of rainfall and the incidence of leptospirosis, making it seasonal in temperate climates and year-round in tropical climates.

Leptospirosis is also transmitted by the semen of infected animals.[8] Slaughterhouse workers may contract the disease through contact with infected blood or body fluids.

Humans become infected through contact with water, food, or soil containing urine from these infected animals. This may happen by swallowing contaminated food or water, or through skin contact. The disease is not known to be spread from person to person and cases of bacterial dissemination in convalescence are extremely rare in humans. Leptospirosis is common among water-sport enthusiasts in specific areas as prolonged immersion in water is known to promote the entry of the bacteria. Surfers and whitewater paddlers [9] are at especially high risk in areas that have been shown to contain the bacteria, and can contract the disease by swallowing contaminated water, splashing contaminated water into their eyes or nose, or exposing open wounds to infected water.[10] Occupations at risk include veterinarians, slaughterhouse workers, farmers, sewer workers, and people working on derelict buildings. Rowers are also sometimes known to contract the disease.[5]

Symptoms

Leptospiral infection in humans causes a range of symptoms, and some infected persons may have no symptoms at all. Leptospirosis is a biphasic disease that begins with flu-like symptoms (fever, chills, myalgias, intense headache). The first phase resolves, and the patient is briefly asymptomatic until the second phase begins. This is characterized by meningitis, liver damage (causing jaundice), and renal failure. The infection is often wrongly diagnosed due to the wide range of symptoms. This leads to a lower registered number of cases than exists. Symptoms of leptospirosis include high fever, severe headache, chills, muscle aches, and vomiting, and may include jaundice, red eyes, abdominal pain, diarrhea, and rash. Initial presentation may resemble pneumonia. The symptoms in humans appear after a 4–14 day incubation period.

The incubation period (time of exposure to first symptoms) in animals is anywhere from 2 to 20 days. In dogs the liver and kidney are most commonly damaged by leptospirosis. In addition, there are recent reports of a pulmonary form of canine leptospirosis associated with severe hemorrhage in the lungs similar to the human pulmonary hemorrhagic syndrome.[11][12] Vasculitis may occur, causing edema and potentially disseminated intravascular coagulation (DIC). Myocarditis, pericarditis, meningitis, and uveitis are also possible sequelae.[5] One should strongly suspect leptospirosis and include it as part of a differential diagnosis if the sclerae of the dog's eyes appear jaundiced (even slightly yellow). The absence of jaundice does not eliminate the possibility of leptospirosis, and its presence could indicate hepatitis or other liver pathology rather than leptospirosis. Vomiting, fever, failure to eat, reduced urine output, unusually dark or brown urine, and lethargy are also indications of the disease.

Prevention and treatment

Doxycycline may be used as a prophylaxis 200–250 mg once a week, to prevent infection in adventure travelers to high risk areas.[15] Treatment is a relatively complicated process comprising two main components: suppressing the causative agent and fighting possible complications. Aetiotropic drugs are antibiotics, such as cefotaxime, doxycycline, penicillin, ampicillin, and amoxicillin.

There are no human vaccines; animal vaccines are only for a few strains, and are only effective for a few months. Human therapeutic dosage of drugs is as follows: doxycycline 100 mg orally every 12 hours for 1 week or penicillin 1–1.5 MU every 4 hours for 1 week. In dogs, penicillin is most commonly used to end the leptospiremic phase (infection of the blood), and doxycycline is used to eliminate the carrier state.

Supportive therapy measures (esp. in severe cases) include detoxification and normalization of the hydro-electrolytic balance. Glucose and salt solution infusions may be administered; dialysis is used in serious cases. Elevations of serum potassium are common and if the potassium level gets too high special measures must be taken. Serum phosphorus levels may likewise increase to unacceptable levels due to renal failure. Treatment for hyperphosphatemia consists of treating the underlying disease, dialysis where appropriate, or oral administration of calcium carbonate, but not without first checking the serum calcium levels (these two levels are related). Corticosteroids administration in gradually reduced doses (e.g., prednisolone starting from 30–60 mg) during 7–10 days is recommended by some[citation needed] specialists in cases of severe haemorrhagic effects. Organ specific care and treatment are essential in cases of renal, liver, or heart involvement.

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What is scarlet fever?

Scarlet fever is a rash accompanied by a sore throat caused by the streptococcus bacteria.
The disease most commonly affects children, but can occur in any age group. The characteristic symptoms are a rash and a 'strawberry tongue'. The disease is treated with antibiotics and it is usually resolved without complications.
Very rarely, particularly if the condition remains untreated, the following complications may occur:
pneumonia
sinusitis
inflammation of the middle ear (otitis media)
rheumatic fever. Luckily, this seldom happens and is the exception rather than the rule
glomerulonephritis. Luckily, this seldom happens and is the exception rather than the rule.
It is a notifiable disease in the UK. This means that cases are required by law to be reported to a health officer or local government authority.
How is scarlet fever contracted?
A person can become infected with streptococcus either by touching or through airborne droplets. Scarlet fever appears together with a streptococcal sore throat. The incubation period - the time that passes from infection until the outbreak of the disease – is three to eight days.
What are the symptoms of scarlet fever?
A sore throat.
A temperature.
Headache.
Feeling generally unwell.
A rash that develops within 12 hours of the onset and rapidly becomes generalised.
The face is spared, but cheeks are flushed, and the child looks 'scarlet' except for the area around the mouth.
The rash fades after a few days, or sooner if treatment with antibiotics is given, following which the skin undergoes peeling.
The tongue has a thick, white coating that peels after four or five days, producing a red strawberry appearance.

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Girl survives rabies without vaccination

An 8-year-old girl who contracted rabies — likely from a wild cat — is a rare survivor of the infection without having received the life-saving vaccine, hospital officials said Sunday.

Precious Reynolds, of Willow Creek, Calif., was treated by pediatricians at the University of California Davis Children's Hospital in coordination with federal and California health officials, the hospital said in a statement.

The hospital said she's the third person in the United States known to have recovered from the virus without having antiviral inoculations immediately after becoming infected, a figure confirmed by U.S. Centers for Disease Control and Prevention statistics on rabies cases.

Precious contracted the disease in April but it was not clear exactly when, which was why she did not receive the usual series of shots that follow animal bites and keep humans from developing symptoms, the statement said.

Health officials believe she got it from a feral cat she encountered near her elementary school in rural Humboldt County in northern California, but an infected animal could not be found.

Tests in early May revealed Precious had the disease after her grandmother took her to the doctor because of flulike symptoms that grew so serious her grandmother said they began to resemble polio.

Nurses at the hospital thought her chances were slim when she arrived at the pediatric intensive care unit.

"None of us thought she would leave the PICU," Krystle Realyvasquez, a nurse who cared for Precious, said in the statement. "When she did it was unbelievable."

The first such survivor — Jeanna Giese of Wisconsin — contracted the infection when she was bitten by a bat in 2004 when she was 14. Giese graduated from college last month.

The hospital said doctors followed the protocol first established with Giese. Precious was placed in a drug-induced coma as she received anti-viral medications.

She spent two weeks in intensive care undergoing the treatments, and immediately showed that her immune system was strong. She was then moved to the hospital's general pediatric unit, where she remained Sunday.

"From the very beginning, Precious had a very rapid, robust immune response to her infection, which is a significant contributor to why she survived," Dr. Jean Wiedeman, leader of the pediatric team, said in the statement. "She is truly a fighter."

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Scientists find genes linked to migraine headaches

Migraines are acutely debilitating headaches -- sometimes with an "aura", in which patients have the impression of seeing through frosted glass -- that strike up to 20 percent of the population.

Scientists describe the condition, which is three to four times more common in women, as a brain disorder in which neurons, or brain cells, respond abnormally to stimuli.

The precise cause is unknown, but inheritance is thought to play a significant role.

To assess the genetic component, Markus Schuerks of Brigham and Women's Hospital in Boston coordinated an international sweep of genomes in 23,230 women, 5,122 of whom suffered from migraines.

So-called genome-wide association studies compare differences between individuals across the approximately three billion pairs of basic molecular building blocks found in the human genetic code.

The study, published Sunday in the British journal Nature Genetics, is the largest to date of its kind. It found variations in three genes that showed up more frequently in migraine patients.

Two of them, known as PRDM16 and TRPM8, were specific to migraines, as opposed to other kinds of headaches.

TRPM8, in addition, was linked to migraines only in women. Earlier studies have shown that the same gene contains the genetic "blueprint" for a pain sensor, in both men and women.

The third suspect gene, LRP1, is involved in sensing the external world and in chemical pathways inside the brain.

"The brain of a person with migraine responds differently to certain stimuli, their nerve cells 'talk' differently to each other," explained Shuerks in an email.

"Many neurotransmitters are involved in this cross-talk and some seem to have a special role in migraines. LRP1 interacts with some of these neurotransmitter pathways and may thus modulate nerve responses that promote or suppress migraine attacks."

None of the genetic variants appeared to be connected specifically to migraines with or without auras.

The findings, published in Nature Genetics, were replicated in two smaller population-based studies, one in the Netherlands and the other in Germany, and in a clinical group followed by the International Headache Genetics Consortium.

"Inheritance of any of the genetic variants alters migraine risk by about 10 to 15 percent," said Schuerks.

The influence of these genes is probably not large enough to be immediately used as a diagnostic tool. But the result "is an advancement of the understanding of migraine biology," he said.

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Tips for dentists to avoid Rape

Manila police chief Robert Rongavilla on Friday gave several tips to dentists on how to avoid being victimized by a serial rapist who robs dentists after assaulting them sexually.

Among the tips he gave are the employment of male security, installation of CCTV cameras in clinics, keeping police hotline handy and taking photos of their patients.

Rongavilla gave the tips during a closed-door briefing with officers of the Philippine Dental Association. He said the briefing was also an opportunity for them to compare the various incidents of sexual assaults on dentists.

The police chief said the suspect usually poses as a patient to get into the clinics. There is possibly one person perpetrating the crime based on the handwriting he left in patient records.

Rongavilla said initial examination of the penmanship suggests the same person perpetrated the crime. He declined to reveal how many have been victimized.

He said he asked women's desks to coordinate with each other so that data can be integrated.

He said they have not ordered DNA testing yet. The police chief said the investigation has not reached that stage because the suspect used many names and they have to come up with an artist's sketch first.

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Ovarian cancer screening doesn't save lives

Women screened annually for ovarian cancer were just as likely to die from the disease as women who didn't have regular screening, concludes a large new study that found screening did not catch the cancers earlier as it is intended to do.

Calling into question the effectiveness of current ovarian cancer screening techniques, the researchers also found that more of the women screened annually had surgery to remove their ovaries and suffered complications related to false-positive test results -- meaning a screening test suggested they had ovarian cancer when they really didn't.

The finding is in line with other recent research that suggests annual screening doesn't prevent deaths from the disease, which kills most women within 5 years of their diagnosis (see Reuters story of May 18, 2011.)

According to the National Cancer Institute, 1 in 72 women will get ovarian cancer. But symptoms usually don't start until the cancer has spread, so most women who are diagnosed already have an advanced stage of the disease that is harder to treat.

Doctors have hoped that screening women regularly could help catch ovarian cancer earlier, when patients have a better long-term outlook.

"We know with ovarian cancer that when the disease is detected in stage 1 you can have 85-90 percent 5-year survival," said Dr. Christine Berg, one of the new study's authors from the National Institutes of Health. "The question is, can you detect the cancers that are destined on to be stage 3 or unfortunately stage 4 at an early enough stage that you can intervene?"

The current study was part of a larger trial looking at the effectiveness of screening for prostate, lung, colorectal and ovarian cancers. Berg and her colleagues randomly split almost 70,000 women into two roughly equal-sized groups -- one that got yearly screening for ovarian cancer between 1993 and 2001, with both blood tests and ultrasounds, and one that didn't.

The researchers then followed women in both groups until 2010, through questionnaires and a national registry of deaths, to see how many were diagnosed with ovarian cancer and how many died of the disease.

Out of about 34,000 women in each group, 212 women in the screening group were diagnosed with ovarian cancer, and 118 of them died from the disease. That compared to 176 diagnoses and 100 deaths in the group that didn't get regular screening.

Also in both groups, more than three-quarters of women who were diagnosed with ovarian cancer already had stage 3 or 4 disease.

The results are published in the Journal of the American Medical Association, and were presented last weekend at the American Society of Clinical Oncology annual meeting in Chicago.

Berg's team also recorded more than 3,000 cases of false-positives in the screening group, and of those, more than 1,000 women who didn't end up having ovarian cancer had surgery because of a positive test result. Those surgeries resulted in serious complications, including infection or cardiovascular complications, in 163 women.

"Many people will say, 'Oh it's just a blood test, oh it's just an ultrasound, what's the harm?'" Berg told Reuters Health. "The harm is you might have unnecessary surgery that could hurt you."

The combination of blood tests and ultrasounds that her team tested "shouldn't be used for screening in the average-risk woman," she said. "I don't think it's working at all."

Berg said that it's possible that a modified form of the blood test -- which looks for a protein that hints at the presence of ovarian cancer cells - will help doctors identify early cases of ovarian cancer. But she said that researchers need to understand more about how ovarian cancers grow and spread to find the best early detection strategy.

"In the meantime," Berg added, "I think women who are high risk for ovarian cancer based on family history of the disease or a personal history of breast cancer -- they should see a specialist...to consider being tested for genes that predispose to ovarian cancer. But for the normal-risk woman, I don't think we have a screening strategy."

The U.S. Preventive Services Task Force, a federally supported expert panel, also recommends against routine screening for ovarian cancer.

SOURCE: http://bit.ly/jxhmC9 JAMA, online June 4, 2011.

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