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 Fever & Infection

July 2011
Brace Yourself for the Rains
Dr V Ramasubramanian
 
Monsoons may be fun for the poets amongst us but it also ushers in a host of infections in its wake. The rainy season is associated with the arrival of several infections either through the contamination of water or food, infections transmitted by mosquitoes like dengue and malaria or viral infections related to the cooler weather.

 


Food and Water Borne Diseases
  • Contamination of food or water often causes diarrhoeal illness during the monsoons. Most diarrhoeal diseases are self-limited and need only supportive treatment in the form of replacement of water and salts preferably orally. Intravenous fluids and antibiotics may be required for severe diarrhoea associated with vomiting.
  • Typhoid with high-grade fever and loose stools is another illness. The diagnostic test is a blood culture as the Widal test is not dependable. Antibiotics are needed for two weeks. Five percent of cases can relapse.
  • Cholera can occur as epidemics during the rains especially when flooding occurs. Profuse diarrhoea can lead to rapid dehydration and even death. Rapid fluid replacement is mandatory.
  • Leptospirosis can occur due to contamination of animal urine with drinking water or stagnant rain water. The organisms may enter the body through the oral mucousa or skin and result in fever with severe body pains. Rarely kidney failure or jaundice may occur. Diagnosis is done by testing for antibodies in blood. Simple penicillin or doxycycline will cure the infection.
Vector Borne Infections
  • Breeding anopheles mosquitoes cause malaria. Attacks of severe fever with shivering are common. A peripheral blood smear test to identify the species of malaria is warranted before treatment with anti-malarials.
  • Dengue can occur as epidemic.It is spread by aedes or ‘tiger’ mosquitoes.Children or adults experience fever, severe headache, body pains and a rash at times.Investigations reveal a low white blood count and platelet count.The fever usually settles in 4 – 5 days and the platelets recover soon after.Severe cases may present with bleeding under the skin or from the gums and rarely from the gut. Shock may rapidly lead to death especially in children.Hospitalisation and aggressive supportive measures are warranted.
Respiratory Infections
  • Virus related cough and cold are very common after getting drenched in the rain. This is due to the sudden cooling of the body resulting in an enhanced susceptibility to viral infections. These infections require symptomatic treatment with warm fluids,paracetamol and anti-histaminics.
  • The flu virus can affect people all through the year in tropical countries like India.It can occur more often during the cooler rainy season.It presents with fever,cough,cold,runny nose and severe body pains of abrupt onset.Though most of these settle in a few days,rare viral pneumonia or super added bacterial infections may require hospitalization.Deaths are seen in about a one in thousand flu cases,especially in children under five years and the elderly.As the flu occurs in epidemics and can involve a large section of the community,significant number of deaths may result.
Brace Yourself
  • Most of the infections can be avoided or easily managed.
  • Keep an umbrella or raincoat handy.
  • In case you get wet,dry your hair and change into dry clothes and have warm fluids at the earliest.
  • Refrain from wading through stagnant water.
  • In the event of a severe cold,cover your nose and mouth while sneezing or coughing. Use tissues to wipe your nose and discard them at once.
  • Keep children with flu like symptoms at home.
  • Boiled water stored hygienically is the safest, but filtered water is acceptable.
  • Ensure water does not stagnate in your neighborhood in discarded vessels,pots or tyres,so that mosquitoes don’t breed there.
  • Get your flu shot every year.
Dr. V. Ramasubramanian is Consultant, Infectious Diseases Apollo Hospitals,Chennai.


    
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