Preventing ‘Rat Fever’ (Leptospirosis) with penicillin tablets

Prof. Upali Illangasekera (MD, FRCPE, FCCP)

Associate Prof. Medicine Peradeniya Medical Faculty

Leptospirosis (colloquially called ‘Rat fever’) has claimed several precious lives in different parts of the country. Death is usually caused by kidney or liver failure and rarely by involvement of the heart (‘myocarditis’).

Most patients affected by the illness are from the middle or lower socio-economic classes. Early recognition and treatment would prevent these unfortunate deaths. A number of doctors as well as educated lay persons have contributed articles to the press about this dreaded illness.

As in most other illnesses prevention is of paramount importance in Leptospirosis. This is particularly relevant in a poor country such as ours where the state has to expend its precious and limited resources in treating these patients for an illness which could be prevented.

As in other illnesses caused by infections Leptospirosis too could be prevented by lifestyle measures such as wearing protective foot wear and avoiding places known to be contaminated by the urine of the field rat which carries the organism. The other well established measures such as immunisation has not been adopted for this illness.

However a drug which is used in the treatment could be used in its prevention so that it is available in the persons blood stream at the time of exposure thereby destroying the organism causing Leptospirosis.

The technical term for the use of a drug in the prevention of an infection is called ‘chemoprophylasix’. The drugs used for this purpose includes penicillin and doxycycline. The latter is more expensive and is not freely available in our country.

The Department of Medicine, Faculty of Medicine, University of Peradeniya recently carried out a field study in a high transmission area of Leptospiross in the Yatinuwara and Udunuwara electorates to determine the effect of penicillin in the prevention of this illness. The total adult population of these two electorates was 215607 from which as ample of 800 were selected for the study.

The research team was lead by Prof. Upali Illangasekera and assisted by Prof. S.A.M. Kularatne, Dr. Kumari Pussepitiya, Dr. Nalaka Premaratne and Dr. Ranjith Kumarasiri and funded by the World Health Organisation. The study was conducted on a ‘double blind randomised control design’ where a drug and a ‘placebo, (a similar looking drug but which is inert) is administered to two identical groups of people who are exposed to the illness.

The study is ‘double blind’ since the patient as well as the doctor is unaware whether a person is on the active drug or the ‘placebo’. The results of such experiments are accepted as valid by the scientific community and was infact published in the South Asian Journal of Tropical Medicine and Public Health (Sept. 2008 issue).

This study revealed that oral penicillin (penicillin tablets) may be effective in the prevention of Leptospirosis in those who are exposed. This drug is relatively cheap and easily available. We advocate that it should be taken at a dose of two tablets twice a day at least two days before a person gets in to a paddy field and continued for two weeks after he no longer is in the field.

However we wish to caution that it should not be taken without the supervision of a medical officer particularly those who have a history of allergy to drugs.

Twins stole the show at Medical Crossword draw - 35

Three-year-old twins, stole the hearts of all present at our 35th HealthWatch Medical Crossword draw held last week at WISH auditorium at Delkanda, Nugegoda.

They were the first twins in that age group in South East Asian region to have undergone the latest cochlear implant surgery for hearing loss from birth, thus making medical history for cochlear implants.

The medical professional team comprising Prof. Colvin Goonaratna, Dr. A.D.K.S. Yasawardena ENT Surgeon, Dr. Kelum Palpola and Audiologist

and Director WISH who were invited to launch the crossword draw having seen the history making twins in cochlear implants chose to get them to launch the draw, by picking the first two winners in the Crossword No. 35, which they did carried by their mother, to the applause and appreciation of all present, thus steeling the event with their cochlear baby performance.

Student winner wins again

Another interesting thing that happened at this draw was the first prize winner in Crossword No. 33. Ajuma Najumudden, 21-year-old medical student who was invited to pick a winner, picking her own entry for a prize, which was applauded by all present, and made Prof. Colvin to comment, that it could be a record in Crossword draws.

Vitamins C, E don’t protect against cancer: studies

Vitamins C and E do not appear to reduce the risk of cancer, according to a pair of new studies which debunk earlier research suggesting supplements might provide some protection against the often deadly ailment.

Some 15,000 men aged 50 and older participated in the study, which included an eight-year follow-up period, but neither vitamin appeared to appreciably reduce their cancer risk, according to the studies appearing in the January 7 issue of the Journal of the American Medical Association (JAMA).

The findings are disappointing news for the more than half of American adults take vitamin supplements — many in the hope of warding off illness. They appear to refute earlier observational studies that linked use of vitamins E and C with reduced risk of certain forms of cancers, including cancer of the prostate.

One of the two studies — the Selenium and Vitamin E Cancer Prevention Trial (SELECT) — found that vitamin E or selenium supplements, whether taken alone or in combination, appear not to reduce the risk of prostate cancer, which is the second leading cause of cancer death in the United States.

“It may be time to give up the idea that the protective influence of diet on prostate cancer risk can be emulated by isolated dietary molecules given alone or in combination to middle-aged and older men,” Peter Gann of the University of Illinois at Chicago reflected in a JAMA editorial.

AFP

Reuters Health News Summary:

Following is a summary of current health news briefs

Cancer to pass heart disease as No. 1 killer

Cancer is on pace to supplant heart disease as the No. 1 cause of death worldwide in 2010, with a growing burden in poor countries thanks to more cigarette smoking and other factors, global health experts said on Tuesday. Globally, an estimated 12.4 million people will be diagnosed with some form of cancer this year and 7.6 million people will die, the U.N. World Health Organization’s International Agency for Research on Cancer said in a report.

Obesity may raise headache risk

Being overweight or obese may increase the likelihood of having severe headaches and migraines, new study findings suggest. An increased prevalence of headache may be associated with being underweight as well.

In analyses of 7,601 adult men and women, Dr. Earl S. Ford and colleagues at the U.S. Centers for Disease Control and Prevention in Atlanta, report that being overweight or obese increased the likelihood of headache by 1.2- to nearly 1.4-times.

Nuts boost health benefit of Mediterranean diet

Adding nuts to a traditional Mediterranean diet rich in fruit and vegetables appears to provide extra health benefits, Spanish researchers said on Monday.

A daily serving of mixed nuts helped a group of older people manage their metabolic syndrome, a group of related disorders such as obesity, high cholesterol, high blood pressure and abnormal blood sugar, Jordi Salas-Salvado of the University of Rovira i Virgili in Spain and colleagues said.

Smartest men may also have highest sperm

The smarter the man, the higher the quality of his sperm, new research published in the journal Intelligence shows.

But women having difficulty conceiving shouldn’t question their partner’s intelligence and men who aren’t quite geniuses should not worry about their ability to father children, lead researcher Rosalind Arden of Kings College London told Reuters Health.

“This is scientifically interesting, but unimportant in terms of people’s likelihood of conception or fertility,” she said in an interview.

Flu shot half dose just as good for younger adults

A half dose of flu vaccine may work just as well as the full dose for healthy adults under 50 — a finding that could help stretch supplies in the event of a future vaccine shortage, researchers said on Monday.

The study involved about 1,100 U.S. adults, about half of whom were given a half dose of influenza vaccine in November and December 2004 and the rest were given a full dose.

Mobile phone chip to counter radiation unveiled

Belgian health products distributor Omega Pharma will launch a chip it claims can counter potentially damaging radiation from mobile phones and has high hopes for its sales. The company, which sells non-prescription products such as wart treatments, pregnancy tests and sun tan lotions to pharmacists, unveiled the E-waves phone chip on Tuesday, a day before its launch in

Belgium. REUTERS

Statin treatment does not cause cancer

Dr. D. P. Atukorale

There are misconceptions in the minds of some physicians that persons who develop very low levels of LDL (bad) cholesterol following treatment with statins develop cancer following the publication of an article in a recent issue of the American Journal of Cardiology by Alsheik - Ali (volume 50, 2007).

Above report also has caused some fear and apprehension among patients who are being treated with statins which is a group of cholesterol lowering drugs commonly prescribed by physicians for elevated LDL cholesterol. In a very recent report in the same journal (volume 52, 2008) same authors say that satins, despite producing marked reductions is LDL cholesterol are not associated with an increased risk of cancer.

The authors now say that the previous reports of patients getting cancer had nothing to do with statins and the authors are of the opinion that statins are quiet safe for patients having high LDL cholesterol.

It is noteworthy that cancer cells can reduce the level of LDL cholesterol in the body long before the appearance of the clinical signs of cancer and the low LDL cholesterol level is due to tumour cells catabolizing LDL at a higher rate than normal rate. Thus this low LDL level is the result and not the cause of cancer. Subjects with latent cancer produce low LDL cholesterol irrespective of whether they receive statins or not. Anyway most of the physicians do not prescribe statins to patients with normal or low cholesterol-levels.

Low LDL cholesterol levels have been observed for as long as 10 years before signs of cancer are detected clinically. Other chronic diseases such as alcoholic dependence (addition) are also associated with low LDL Cholesterol.

Every person with very low LDL cholesterol is not a potential case of cancer and a very rare condition called hypobeta-lipoproteinaemia does very nicely with LDL levels as low as 10mg to 20mg and these people sometimes have long lifespans. To conclude neither statin treatment itself nor the low LDL levels induced by statins increases the risk of cancer.