Health Watch

Beware of Rat fever! - Wild rats!

Nadira Gunatilleke

Maybe you are living in the city and have nothing to do with paddy fields or mines. So may be you are thinking that you don’t need to worry about Rat Fever (Leptospirosis). But do not forget that you have a nice small garden where you often do gardening during the day and where wild rats play and dance in the night! May be you often clean up the drainages located inside your garden. We are talking about Rat fever.

The number of Rat fever cases reported from Sri Lanka in the past two months of this year is over 300. There are about five deaths reported during the same period.

This is a significant improvement of the condition when compared to last year’s situation. But still the threat is there and we need to be vigilant especially when the rains come.

All of us know very well that prevention is better than cure. Why do we have to put ourselves in danger when there is a clear way to prevent a disease?

According to the Director of the Epidemiology Unit of the Healthcare and Nutrition Ministry, Dr. Paba Palihawadana, the majority of the affected persons are belong to the working force of the country who are between the ages of 35 and 55.

The most affected districts are Colombo, Gampaha, Matara, Matale, Kandy, Kegalle, Ratnapura, Kalutara and few other districts.

Wild rats living in an open environment are more dangerous than the domestic rats.

The vulnerable people such as farmers, persons who clean drains, persons who work in mines, marsh lands, canals and persons who swim or play in contaminated water should contact the nearest PHI or MOH and obtain Doxycycline tablets and they should take two tablets before they start their work.

The tablets gives around 90 percent protection for a period of one week.

Then they should take two tablets again until they finish their work.

The public should avoid contaminated water such as flood water.

Paddy fields should be kept clean without garbage and places with still water. This is the harvesting season and farmers spend more on the paddy fields. The persons who have cuts and wounds (open injuries) in their legs should cover them properly before stepping into the paddy fields.

Rat fever is an infectious disease caused by pathogenic bacteria and live in the kidneys of animals such as rats, pigs, cattle, rodents, canines and wild mammals.

It comes to soil, water or food through their urine and enters into human body through cuts, wounds, nasal, oral, eye or mucous membranes.

The bacteria lives in the environment over a period of one month.

The main symptoms of Rat fever are abrupt onset of high fever, mild flu, chills, conjunctival suffusion, muscle tenderness (notable in calf and lumber areas), intense headache, jaundice area and decrease of passing urine.

The symptoms arise after 5 to 14 days of infection. It is very important to seek medical treatment as early as possible from a Government hospital.

The disease can be completely cured if medical treatment is given on time but it is difficult to save the life of a patient who seeks medical treatment when the disease comes to later stages where renal failure, heart failure and other symptoms appear.

Healthcare and Nutrition Ministry has decided to import ‘Biorat’ bacteria from Cuba shortly in order to curb leptospirosis. Biorat is a biological method that can be used to control rat fever.

The ministry has made this decision considering the fact that the existing chemicals only kill domestic rats and not wild rats living in paddy fields, drains and other places such as the open environment.

The ministry is now in the process of obtaining the permanent registration for `Biorat’ from the Pesticides Registration Department. If you are very concerned about your appearance, what you wear, what you eat and what you drink.

So why don’t you worry about cleanliness of your home garden?

Why do you wait for others (often it is the state) to come and clean the environment for you? Keeping your homegarden clean will keep you away from rat fever, dengue and many other diseases.

Answers for the health queries

1. Question on Bell’s palsy:

Spontaneous improvement of this condition usually occurs within few weeks. Then continuing recovery occurs but it may take even a year to become complete in some instances. Around 15 percent of patients are left with some residual weakness. Therefore, it is needed to help the patient, physically and psychologically till few weeks or months. If the weakness is progressing, reassessment of the condition may be necessary to distinguish from other lesions of the facial nerve.

2. Question on catarrh/Allergic Rhinitis:

This is a common condition characterized by variable nasal obstruction, watery rhinorrhoea, sneezing and reduction of smell.

The avoidance of responsible specific allergens is a good option if practical (house dust mite, dog hair, cat fur etc.). The drugs such as antihistamines, topical steroids are of value in controlling the condition. A prolonged course may be needed in reducing mucosal sensitivity.

3. Question on feeling of pins and needle:

Sometimes this type of feeling may be due to a pathological process affecting a peripheral nerve or nerves. Diabetes, Hypothyroidism, Rheumatoid arthritis could be included among probable common causes for neuropathies.

It is advisable to contact your family doctor to get investigated if necessary.

4. Question on pain, tiredness (person in the age of 69):

There are several complaints such as pain in the body, tiredness, nasal block etc. According to information given, serological (blood) investigations have been done and found normal.

There is a common topic today, called “Medically unexplained symptoms”. The symptoms or manifestations are defined as such when “the clinical presentation and the symptoms are incompatible with a known physical illness, and/or absence of relevant positive physical signs and/or absence of laboratory investigations supporting a diagnosis of a physical illness”.

As such it may be helpful in changing the life style to ensure relaxation, physically and psychologically. A balanced diet , adequate water, regular exercises such as walking and adequate rest and sleep at least 7 to 8 hours in a day will be needed for healthy life. It is necessary to get rid of thoughts related with problems in the past to have a balanced and peaceful mind.

5. Question on drug allergy - allergy to pain killers:

A large number of pains relieving medications are belonged to the group of NSAID (Non-Steroidal Anti-Inflammatory Drugs) that are closely related to Aspirin. Diclofenec, Ibuprofen, Piroxycam, Indomethazine are some of drugs in the NSAID list.

NSAID allergy is estimated to be present in approximately 1 percent of the general population. According to the information given in this question, even a paracetamol which is in the list of another pain relieving drugs has caused problems. It is important that any person with a known or suspected allergy to a drug consult with their physician before using any product that may be related to the group of drugs, causing allergies.

It is advisable to meet a physician as there are few drugs which may be tolerated well with the persons having this type of allergies.

World Glaucoma Day celebrated on March 12

Nadira Gunatilleke

Glaucoma is a disease in which the optic nerve is damaged, leading to progressive, irreversible loss of vision. It is often, but not always, associated with increased pressure of the fluid in the eye.

The nerve damage involves loss of retinal ganglion cells in a characteristic pattern. There are many different sub-types of glaucoma but they can all be considered as a type of optic neuropathy.

A person may develop nerve damage at a relatively low pressure, while another person may have high eye pressure for years and yet never develop damage.

Untreated glaucoma leads to permanent damage of the optic nerve and resultant visual field loss, which can progress to blindness. Around 12 percent of the total population of Sri Lanka suffer from Glaucoma and 5.7 million persons in the world suffer from Glaucoma.

Glaucoma can be completely cured if diagnosed early and treated properly. Diabetics, eye injuries, wearing thick spectacles can cause Glaucoma. Persons who are above the age of 40 and who have family history are in the high risk category.

Sri Lanka celebrated World Glaucoma Day on March 12. A special eye clinic was held at the Colombo National Hospital to mark this day and around 500 patients were examined during the clinic.

Sexually transmitted infections:

A social issue

Sexually Transmitted Infections (STI) have been present since ancient times as described by Egyptians long ago. Greek and Romans in the field of medicine have reported on these diseases.

World Health Organization (WHO) estimated, 340 million new cases in 1999 among men and women aged 15 to 49 years. We are living in the region of South and Southeast Asia in which the largest number of new infections occurred. Next in line are the sub Saharan Africa, Latin America and the Caribbean.

As the main mode of transmission is through an unprotected sexual contact these infections are called STI. However diseases of the genital area are not necessarily transmitted through sexual contact.

In addition to the main way of transmission, some STIs can be transmitted through blood ( HIV, Syphilis etc) or through an infected pregnant mother to an unborn child.(HIV, Syphilis, Gonorrhoea, Non Gonococcal cervicitis etc).

A large number of STIs are caused by bacteria, viruses and parasites. The common diseases vary from country to country. In Sri Lanka Genital herpes, Genital warts, Syphilis, Gonorrhoea, Non Gonococcal urethritis/cervicitis and Tricomoniasis commonly occur. Genital Herpes and Genital warts are caused by viruses. Syphilis, Gonorrhoea and Non Gonococcal Urethritis/cervicitis are caused by bacteria and Trichomoniasis is caused by a parasite. Most of these diseases, namely, Syphilis, Gonorrhoea, Non Gonococcal Urethritis/cervicitis and Trichomoniasis can be completely cured when the patient gets proper treatment at correct time.

Even those curable diseases can cause problems and complications if there is delay in receiving treatment.

Out of the STIs in Sri Lanka, Genital Herpes and Genital warts are reported predominantly. It has become a family and social issue as those infections which are viral in origin, have the ability to reappear in time to time during the life.

In generally three main symptoms, occurring in STIs are genital ulcers, genital discharge and genital lumps. The genital ulcers are seen in Syphilis and Genital Herpes.

The genital discharge is seen in Gonorrhoea, Non Gonococcal urethritis/cervicitis and Trichomonisis .

The genital lumps are seen in Genital Warts.

Commonly there is a psychological disturbance of the people on developing disease manifestations in genital region. Genital ulcers, genital discharge and genital lumps could be seen even in diseases, other than STIs.

Genital ulcers could be seen in drug reactions and in the fungal infections such as candidiasis. Genital discharge occurs in bacterial vaginosis and candidiasis. Genital lumps could be seen in benign penile papille and sebaceous cysts. These are not STIs and it is vital to get necessary medical advice and treatment on appearing these symptoms. If it is a STI both the patient and the partner should be treated at the same time even if the partner is free of clinical manifestations as the infection has been exchanged among them.

STIs causing genital ulcers

Syphilis: The infective organism is a bacteria, called treponema pallidum. When infected the patient may develop the stage of primary syphilis, in about 9 to 90 days. The main clinical manifestation is a painless and deep ulcer usually single. It is completely curable but if not treated the patient may proceed to secondary syphilis in about 3 to 6 months.

Dr. Shantha Hettiarachchi

Coordinator

Mass Communication

Publicity Unit

Health Education Bureau

Ministry of Healthcare

and Nutrition.

To be continued