On 06 Jul, 2024, Seniors Today hosted their weekly Health Live webinar with Dr Farah Ingale, Director- Internal Medicine at the Fortis Hiranandani Hospital, Vashi who spoke on and answered questions about General Health Management during Monsoon Season.
Dr Farah Ingale is Director-Internal Medicine, Fortis Hiranandani Hospital Vashi. Dr Ingale boasts over three decades of professional experience in the hospital setting. She holds an MBBS, MD (Medicine), DFID (Diabetes), PHFI (Diabetes), MCard, and FICIC. Renowned as one of the most experienced doctors in her field, Dr Ingale is dedicated to promoting health awareness and a healthy lifestyle. She has published numerous papers on topics including Diabetes, Renal Disorders, ARF, Immunomodulation, Renal Sepsis, Kidney function, and metabolism. Additionally, she has been honored with the Silver Jubilee Memorial Prize for achieving first place in FMT.
Water is an essential component of life but it can be dangerous too. And can bring in a host of problems to us.
Every person uses about 326L of water in a day and in the monsoon season half of the worlds’ hospitals are filled with patients suffering from water borne diseases. The incidence of which goes up to about 80% in the monsoon season and 2.2 million people die every year due to water borne diseases- which makes it a serious problem.
Monsoon season makes us susceptible to many diseases as the dampness and the stagnant water make for a perfect breeding ground for many diseases causing microorganisms.
Just to name a few- typhoid, jaundice, diarrhoea- are very common in this season. Other ailments such as viral ailments, common cold, hepatitis and leptospirosis (monsoon related illness which can be life threatening) are also on a rise during the monsoon season.
The reason why people become more susceptible to illnesses during the monsoon season is because of the sudden change in temperature and humidity causes the growth and survival of germs and also the contaminated and stagnant water harbours all the germs that at a later stage transmit infections to human beings by various means which can be through food, water, hands, flies.
Mosquitoes also breed during the monsoon season and which is why we also get a lot of mosquito/ vector transmitted diseases, such as malaria, dengue fever, chickunguniya, etc. in the monsoon season.
In the monsoon season we get polluted water pooled and rain water collected areas- all of which harbour various organisms.
Monsoon diseases are mainly water borne and gastrointestinal. But this is also the time when mosquitoes breed, leading to vector borne disease transmission.
Elderly people, especially due to them invariably being suffering from other comorbidities, elderly on immunosuppressive therapy or suffering from cancer- all leading to a weaker immune system are more susceptible to infections.
Water harbours bacteria, viruses, protozoa and fungi.
Water borne diseases include bacillary dysentery, cholera and typhoid.
Bacillary dysentery is caused by Shigella and the patients present with:
- Loose stools
- Abdominal pain
- Cramps
- Blood and mucus in stools
- Dehydration
- Could become toxic
Which is why it is important to maintain a nutritious and hygienic diet.
Cholera again is a water borne disease caused by Vibrio cholerae wherein the patient presents with:
- Watery diarrhoea which is white in colour and is also called rice water stools. It has a fishy odour.
- The characteristic of cholera motions which is like opening a tap and the water gushes out without amount of abdominal pain or cramps
- The copious amount of the water loss can make you severely dehydrated
- The severe dehydration can lead to peripheral circulatory failure
For this too, it is important to consume hygienic and nutritious diet and avoid outside food items and boil your water before consumption.
If you do have loose stools, it is important to keep yourself hydrated. Take lots of oral fluids and Oral Rehydration Solution. If you are still unable to keep yourself hydrated, that is when the patient needs to be given IV fluids, antibiotics and supportive medicines.
You can know if your hydration status is proper by:
- Checking the colour of your urine: ideally it should be pale yellow. If your urine is slightly darker, it means you might have some dehydration- there may not be any symptoms when you have some dehydration and all you need to do is increase your fluid intake. In severe dehydration the colour of your urine is darker and you may have severe symptoms such as dryness of mouth, shortness of breath, headache, nausea, vomiting, loss of appetite, confusion, fever.
Typhoid/ Enteric fever is caused by Salmonella typhii and Shigella. The presenting symptoms include:
- Continuous high grade fever
- Headache
- Diarrhoea
- Abdominal pain
This is managed by giving symptomatic treatment, antibiotics, oral/ IV fluids, and supportive care.
Vaccines are available for cholera- which can give you protection for 6-9 months. The ideal time to take cholera vaccine is before the beginning of the monsoon season. It is given intramuscularly.
Vaccines against typhoid are also available which gives you protection for upto 2-3 years. And every 3rd year a booster dose is advised. It is viable as an oral and even an intramuscular vaccine.
Other parasitic diseases which are water borne include amoebiasis, worm infestations, leptospirosis, and malaria.
Leptospirosis:
During the monsoon season, there is stagnant water in man-made water bodies such as ponds, lakes and also stagnation of water in the road sides, the rodent and digs excrete in the water and the urine of the rodents and dogs has the protozoa Leptospira which contaminates the stagnant water. If you waddle through that water, barefooted, you can get infected by the protozoa which might enter our circulation through a break in your skin such as cuts and bruises and diabetic patients with callouses, ulcerations and break in skin.
These patients can present with:
- Malaise
- Fever
- Rashes over the body
- Redness of eyes
- Jaundice
- Kidney failure
- Respiratory failure
These patients often require dialysis and ventilator support.
These patients are managed with IV antibiotics, artificial ventilation, dialysis and other supportive measures.
The best way is prevention. Some preventative measures for leptospirosis include:
- Wearing protective shoes, especially for those who are occupationally exposed
- Do not waddle in stagnant, collected water
- Rodent control
- Chemoprophylaxis with Doxycyllin in individuals that are exposed or at a higher risk of exposure to leptospirosis
Malaria has 4 types of malarial parasites, which are:
- Plasmodium falciparum
- P. ovale
- P. vivax
- P. malariae
In our country we more commonly see P. vivax and P. falciparum. P. falciparum is more common and responsible for causing 50% of all malarial infections and is the most dangerous of all, it can be lethal. P. vivax too can lead to serious disease.
Plasmodium is transmitted from one person to another with the bite of a female anopheles mosquito which bites during dusk and dawn and needs a blood meal to feed her eggs.
The patient presents with:
- Fever with chills. It can also lead to febrile convulsions in a child or in a patient with cerebral malaria.
- Vomiting
- Diarrhoea
- Pallor will be present
- Anemia
- Jaundice
- Cough
- Malaise
- Body ache
- Liver and spleen can be palpated on per abdominal examination
- Severe and complicated malaria can lead to cerebral malaria where the brain is affected. The patient may become unconscious, have seizures, land in a coma.
- Acute renal failure
- Low blood sugar levels
- Metabolic acidosis
- Circulatory collapse
Diagnosis is done by:
- Simple peripheral blood smear test where in which and thin blood smear sample is taken and checked for malarial parasite
- Antigen capture kits
- PCR- not done since it is more expensive
Treatment is done with:
- Anti-malaria drugs which give the patient complete cure if detected and managed timely.
- Treatment for further progression and transmission of disease
Hepatitis A and E are viral disease which are transmitted more during the monsoon season.
Hep A and E are transmitted via the faeco-oral route via contaminated food and water.
The patient can present with:
- Fever
- Body ache
- Loss of appetite
- Nausea and vomiting
- Dark coloured urine
- Yellowish discolouration of the eyes, skin
- Can also cause fulminate liver failure.
Since it is a viral infection, there is no definitive treatment. The treatment includes:
- Symptomatic treatment
- Strict bed rest
- Supportive care
- Good nursing care
- Adequate nutritional support
- Fat restriction
- Liberal use of sugars and carbohydrates
- Adequate hydration
Vaccine is also available for Hep A which is given as a double dose in children below the age of 9 years. And above 9 years is a single dose.
Dengue fever is also known as break bone fever. It is an acute communicable disease whichbis caused by a virus and transmitted by the female Adese egyptian mosquito. It is a day time feeder. They breed on clean water. Dengue viruses are or 4 types:
- Den 1
- Den 2
- Den 3
- Den 4
These dengue viruses since they’re of 4 types, thus you may get infected by the dengue virus unto 4 times in your life.
About 50 Million cases of dengue are seen worldwide, annually. The incidence is highest in the tropical and subtropical regions.
Each types leads to lifetime immunity and short term cross immunity.
But they can be severe and fatal infections.
The incubation period is between 3-14 days.
Presenting symptoms include:
- Fever
- Headache
- Muscle and joint pain
- Nausea and vomiting
- Rashes on the body
- Hemorrhagic manifestation due to drop in the platelet count
- Itching
- Metallic taste in mouth
