India has seen a shift in its rains. Concretisation leading to quick water logging, environmental change leading to torrential rains instead of the earlier prolonged continued drizzles and increased awareness of monsoon water as a resource and blessing, has struck deeper cords. While all are extremely grateful for every micro-drop of rain, the torrents and quick water loggings certainly have a way of inducing a sense of foreboding.
Subtle but undeniable, is the additional need to ensure preventing the accompanying health hazards. Concretisation does not prevent, nay it worsens, the development of unhygienic conditions especially in the absence of a culture of basic preventive measures and leads to water-related diseases which, may manifest in a short time, or occasionally, cause subtle symptoms and remain undiagnosed until they present due to disease-related worsening severity or complication. While it is easy to say that early diagnosis is important, the eye does not see what the mind is not looking for. Dr Rajesh Jaria, Consultant Internal Medicine, Hinduja Hospital, Khar reviews some of these diseases prevalent during monsoon.
Influenza (Cold and Flu)
The common cold is known to all and used as an example in school to teach about highly contagious diseases. Caused by a virus, spread via person to person air transmission, infecting the upper respiratory tract and bringing non-ominous misery for 3 to 7 days with nasal congestion, myalgia (body ache), a sore pharynx and feverishness more than fever, influenza epitomises the tenet, the more we progress the worse things seem to get.
The common cold which earlier was hardly noticed; today has an ominous twist to it in the form of swine flu, and one needs to watch for a high-grade fever, undue malaise and myalgia and an angry red throat, especially if the patient has a known underlying disease such as hypertension or diabetes. It is always advisable to consult a doctor especially if there is doubt. Swine flu is just another cold needing no treatment in most. However, few patients are unable to fight this viral disease well.
Such patients treated on time, and swine flu is another cold for them too, but untreated, it can lead to serious conditions and become life-threatening. The art is to identify which patient will need treatment. Preventing a common cold and many other viral diseases for that matter, is almost a mathematical function of a balanced nutritious diet, exercise with a fair bit of regularity and activities that help maintain an optimal immune system with vaccination being an additional available tool.
It is a bacterial infection also called salmonellosis after the causative Salmonella bacteria is the result of ingestion of contaminated food or drink, following a faecal-oral route of spread, when somebody, somewhere in your food processing chain, did not wash hands properly after passing stool and yet audaciously handled the food you later consumed. Clinically diagnosed by fever, a relatively low heart rate, liver and spleen enlargement and on tests with a low white cell count, positive serology and the gold standard of a blood or stool culture, typhoid can also present with severe abdomen pain, headache and vomiting. Ensuring that food handlers maintain an almost obsessively compulsive level of hygiene standard is the single most effective preventive measure. Similar to salmonellosis is shigellosis and amoebiasis, the latter being a parasitic infection and the former bacillary dysentery.
Hepatitis A and Hepatitis E
Hepatitis is often referred to as jaundice. It is a contagious liver infection again following food/drink faecal-oral contamination and the causative virus (virus – not bacteria) is hepatitis A virus. Fever, jaundice (yellowing of the white of the eyes, skin and dark urine colour), abdominal pain, anorexia, malaise and easy fatigue are hall marks. Again strict attention to hygiene detail such as washing hands, using barriers while handling food (gloves) and ensuring immunity optimization are protective measures. A vaccine is available.
It is primarily an occupational hazard for those in direct/indirect contact with the urine of animals but can be viewed as a water borne monsoon related disease when water contaminated with infected urine of rats (rodents) or other animals contacts with human skin. It is endemic in a tropical city such as Mumbai with maximum cases in young male adults during the rainy season.
Pollution of city water supply may result in an outbreak of disease. Severe epidemics are related to water recreational activities. Clinical signs vary from asymptomatic to severe; with a range of non-specific symptoms but fever, chills, rigors, severe headache, muscle aches, jaundice, anorexia, conjunctival suffusion, arthralgia, myalgia, vomiting, diarrhea, abdominal pain, photophobia, red-eye, mucosal rash, skin rash, cough, breathlessness, chest pain, haemoptysis, anuria, oliguria, hypotension, stiff neck, delirium, meningitis, splenomegaly, lymphadenopathy and hepatomegaly are all in the spectrum.
Diagnostic confirmation by serology or isolation of the pathogen from clinical specimens (blood/CSF/urine) is easy, provided a suspicion for the same is raised and investigated. Early treatment may shorten the duration and reduce the severity of the disease. Environmental detection is an important control measure with an effective surveillance system.
This fever is caused by a virus transmitted by mosquito bite, also called break-bone fever. Since mosquito numbers rise in monsoons – so does Dengue. Fever with severe joint and muscle pain (hence bone-breaking fever), headache, exhaustion and rash are presenting signs but the main dread of the scrooge is from its two known, rare, but deadly complications – DHF [Dengue Hemorrhagic Fever] and DSS [Dengue Shock Syndrome] which if they occur are usually life-threatening conditions. There is no specific treatment.
Rest and fluid intake (oral rehydration) is the mainstay of treatment. Pain relievers should be taken under physician supervision. Haemoglobin, hematocrit and platelet counts should be monitored and in-hospital management considered depending upon the patient condition and ability to imbibe fluids.
One of the most common monsoon-related diseases, malaria, is caused by mosquito bites and as mosquitoes breed in water, prevalence increases in monsoons. Transmitted by the sting of a female Anopheles mosquito it comes in four forms P. vivax, P. ovale and P. malariae and the most dangerous P. falciparum which can lead to cerebral malaria.
Text-book picture of malarial illness is rare and includes three stages viz. cold, hot and sweating stage where fever starts with shaking chills, lasts 15 minutes to 1 hour (cold stage), followed by high-grade fever lasting 2 to 6 hours (hot stage) followed by profuse sweating and fever subsides over 2-4 hours. Febrile paroxysms accompanied by headache, and restlessness are transient and with normalisation of the temperature the individual feels completely normal.
In vivax malaria, fever recurs once every 48 hours and is called as tertian malaria, similar in ovale malaria too. In falciparum infection (malignant tertian malaria), this pattern may not be seen often and paroxysms are more frequent (sub-tertian). In P. malaria infection, relapse occurs every 72 hours and is called quartan malaria. Malaria is typically diagnosed by the microscopic examination of blood using blood films or with antigen-based rapid diagnostic tests.
General preventive measures during monsoon season may help:
- Drink boiled water or water cleaned by an effective purifier.
- Use barriers such as gloves to avoid the transmission of disease-causing bacteria.
- Wash hands often and well-using soap. Sanitizers are effective but nothing can replace hand washing. Cover one’s own mouth and nose while coughing or sneezing.
- Use mosquito repellents/nets.