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McXtra Care Newsletter | July 2019

Why and What kind of Diseases spread during Monsoon?

We all love the rains but it also brings with it lot of infections which take their toll both on the urban and rural population. The diseases are mainly Air borne, Water borne or Mosquito borne.

The air during monsoon is cool and humid (filled with water vapor), even though the environmental temperature maybe high. Therefore, the air being heavier, circulates less. This helps viruses and bacteria to linger, and get transmitted more easily from person to person giving rise to more contraction and spread of common cold and Flu.

Increased contamination of water during rains is because of rain-water falling on garbage dumps, ditches and areas of waste which are rich in infection causing organisms, and this water flows down as surface ‘runoff’ into our water sources. When such contaminated water is directly consumed or when food contaminated with such water is eaten, the body can get exposed to these infective organisms (like bacteria, viruses and parasites), leading to what we call the ‘water borne diseases.’

When the rains come in, so do the mosquitoes, as stagnant water in puddles, pools, ditches, plant beds/pots and storage tank are perfect breeding ground for mosquitoes.

What are the symptoms of these diseases?

The symptoms of many of these diseases like Air borne Flu, Water borne Typhoid, and Mosquito borne Malaria, Dengue and Chikungunya are similar like High Fever (sometimes with chills and sweats), Body Pain, Headache, Dizziness, Weakness, sometimes rashes or nausea-vomiting and abdominal pain.

Therefore, often only blood tests can ascertain a confirmed and differentiated diagnosis. It is important to recognize the ALERT MEDICAL SIGNS when medical help should be sought immediately and also know who are in the high risk groups who are more likely to require hospitalization and more monitoring.

AIR BORNE DISEASES
Features	Common Cold	Flu
Causative virus	• Rhinovirus (50% cases), Coronavirus, RS Virus	• Influenza virus (types A, B or C)
Onset	• Over a few days	• Suddenly – over 24 hours
Sneezing, Running Nose	• Prominent	• Maybe present not always
Stuffiness of Nose	• Commonly present	• Maybe present not always
Sore throat, throat pain	• Usually sets in along or after the cold symptoms	• Maybe present not always
Cough	• Maybe present due to mucus going from nose to throat causing irritation • No chest discomfort	• Often present • Dry cough, with Chest discomfort • Lingers for 1-2 weeks after other symptoms resolve
Fever	• Usually absent (low grade fever maybe present in children	• Usually present (May be high 100-102 deg F)
Body ache, chills, Muscle pains	• Usually absent	• Usually present and prominent
Headache	• Usually absent to slight	• Usually present
Tiredness, Weakness	• Usually absent to slight	• Usually present
Duration	• 3-7 days	• 1-2 weeks
Prevention	• None	• Flu vaccine available

WATER BORNE DISEASES SYMPTOMS
Diarrhea Gastroenteritis Cholera	• Loose watery stools, with or without nausea, vomiting, and abdominal cramps • Fever maybe mild but is usually rare • Cholera is a disease with very watery diarrhea (looks like rice water) with nausea vomiting, abdominal cramps and rapidly developing dehydration
Dysentery (Amoebic or Bacterial)	• Diarrhea with blood and mucus in stools, abdominal and rectal pain • Nausea vomiting may or may not be present • Fever is quite common sometimes with chills
Worm infections	• Abdominal discomfort and cramps, nausea- vomiting, loss of appetite, itching in anal area, disturbed sleep, or wheezing/cough, weight loss • Worms may be passed and seen in stools. • More common in children especially 3-8 years age
Typhoid	• High sustained fever (up to 103–104° F), weakness, body-ache, abdominal pain, headache, diarrhea or even constipation, and loss of appetite. • Sometimes a rash of rose colored spots may develop • Some patients can have a dry cough
Hepatitis (Jaundice)	• Fever, jaundice (yellowing of skin and white of the eye), pain on the right upper side of abdomen, nausea, vomiting, indigestion, loss of appetite, weakness and dark urine
Leptospirosis	• High fever with chills, headache, body ache, jaundice, vomiting, diarrhea, abdominal pain, rashes, red eyes

MOSQUITO BORNE DISEASES
Disease	Type of Mosquito	Mosquito biting timing and pattern	Differentiating features and symptoms
Malaria	Anopheles	• Indoor and Outdoor biter • Night biting pattern • Usually enter the house between 5 – 9 pm • Start biting by late evening peaking at midnight and morning hours	• Fever is typically cyclical (though may not always clearly manifest this way) with a cold chills stage, hot fever stage and then a sweating stage • Rashes are rare • Joint pains not usually severe • Eye pain (pain behind the eyes, or on moving the eyes) is rare • Rarely brain symptoms (encephalopathy – in cerebral malaria)
Dengue	Aedes	• Indoor biter • Day biting pattern • Most active 2 hours after sunrise and 4-5 hours before sunset Can bite in well-lit areas in the night	• Fever is constantly high • Rashes on the face and arm • Bleeding spots under the skin or nosebleeds. Joint pains are mainly experienced in shoulders and knees • Eye pain is common but eye redness is rare
Chikungunya			• Fever is usually constantly high • Rashes are more common on torso, and arm • Joint pains with swelling seen in hands, wrist, leg and feet are a characteristic and can sometimes last for months and even years after other symptoms are gone Eye pain is common but eye redness is rare
Zika			• Fever is relatively not as high (<101oF) • Rash starts on the face and spreads throughout the body • Joint pains are not usually severe • Eye pain and Redness of the eyes (conjunctivitis) is seen • Dangerous for pregnant women – causes organ defects and abnormalities in the newborn
Japanese Encephalitis	Culex	• Indoor biter • Bite any time of day • Mostly fly after noon and bite most actively in the night	• Mainly affects children in select pockets (endemic) areas • Brain symptoms (encephalitis) like confusion, disorientation, abnormal movements, delirium and seizures

ALERT SIGNS -SEEK MEDICAL HELP OR OPINION IMMEDIATELY

• High Fever with chills or sweats
• Severe weakness, unable to or greatly reduced fluid/food intake
• Severe headache, pain in/below/behind the Eyes, Ear pain, or Neck stiffness
• Nausea, vomiting or abdominal pain
• Joint pains, swelling or stiffness
• Breathlessness, Chest pain, Wheezing or Wet cough with phlegm
• Rashes or bleeding spots on the body or nose bleeds
• Signs of Dehydration
• Neurological signs – Confusion, loss of orientation, delirium, or convulsions
• Fever beyond five days or returning after a few days of being absent

High risk patient group – (have more complications or need for hospitalization)

• Children 65 years and Pregnant Women
• People with diseases which lower immunity like HIV/AIDS
• Pre-existing Diabetes, High BP, heart disease, Lung conditions (like Asthma, Bronchitis, smokers), Liver or Kidney disease
• Travelers, Migrants and Non-native population

Recognize the 10 Signs of Dehydration

• Racing pulse/heart-beat and breathing

• Increased thirst

• Dry lips/mouth Sticky tongue

• Dry skin – when pinched, does not snap back

• Confusion, Reduced alertness, Sleepiness

• Sunken eyes

• Headache, dizziness

• Decreased urination and dark colored urine

• Extreme cases – fainting or fits (seizures)

• In children – crying but no tears

The Doctor may order blood tests to establish diagnosis sometimes along with stool test and urine test depending on symptoms and suspected condition. In certain conditions, repeated blood tests for monitoring may be needed like falling/improving Platelet counts in Dengue.

Diseases caused by parasites (Malaria, Amoebic dysentery, Giardia diarrhea), bacteria (Typhoid, Leptospirosis food poisoning and traveler’s diarrhea due to road-side eating) and worms have specific treatment with specific Anti-parasitic, Antibiotic and Deworming medicines available, whereas the other conditions which are caused by Virus have no specific treatments.

Treatment consists of maintaining hydration with fluids, appropriate diet, rest and medicines for fever and pain.

Most of these conditions can be managed by home care or outpatient basis, however Hospitalization for giving intravenous fluids, antibiotics and close monitoring is done if patient is unable to take fluids orally has developed signs of dehydration, is continuously vomiting, is a high risk patient or has developed complications.

Trending feature

Dietary recommendations for Monsoon related fevers and illnesses

Dietary foods during common cold and flu
*Include*	*Avoid*
• Soups-Broths • Rice-lentils (Dal-khichdi) • Herbal/green teas with ginger/honey/tulsi (basil) • Coconut water • Butter milk • Boiled/cooked vegetables • Fruits like oranges, lemons, berries, pomegranates, apples	• Caffeinated and carbonated beverages • Alcohol • Milk and milk products (yogurt/curd which is not cold can be eaten) • Oily, fatty or foods high in flour or sugar • Raw vegetables • Chilled drinks and foods

Diet in Diarrhea/Dysentery
*Include*	*Avoid*
• Bananas, mashed apples • Rice-lentils (Dal-khichdi) • Yogurt/Curd • Coconut water • Vegetable soups • Toast • Boiled chicken or fish	Whole wheat foods • Citrus fruits • Milk- products (cheese/butter) • Tea, Coffee • Raw vegetables • Processed foods • Red meats, Pork, Beef

Preventing dehydration is the most important treatment for diarrhea and dysentery. Oral Rehydration Solution (ORS) is available in all chemists and these should be regularly taken mixing in clean boiled 1 liter water. Similar solutions can be prepared at home with half teaspoon salt and 6 teaspoons sugar in 1 liter clean boiled water.

In Typhoid, and Mosquito borne Fevers, diet should be soft and easily digestible like soft rice, with pulses (dal khichdi), cooked vegetables, coconut water, buttermilk, fruit juices, mashed bananas/apples and potatoes. Hospitalization is needed if patient is unable to take fluids or medicines orally due to severe vomiting.

Hepatitis balanced, nutritious diet, low on fats should be taken. In fact, no medicines are recommended as they put a load on the liver. Alcohol and smoking should be strictly avoided.

Health Tips

Health Tips

House-Hold, Society and Community Health tips to prevent Monsoon related Disease spread

Hygiene of Hands, Water and Food
	Hand washing	• Wash hands thoroughly with water and soap for at least 20 seconds, rubbing hands together well and scrubbing all surfaces (palms, nails, in-between fingers, top of fingers). Children to be taught and supervised. • Hands should be washed especially before preparing food, before and after eating food, after using toilet, after coming from outside, after handling animals, soil (like in gardening), garbage, and after cleaning up feces/changing baby diapers • Wash hands and use hand sanitizer before and after assisting or handling someone with diarrhea or any other water borne disease.
	Drinking clean, safe water	• Don’t drink untreated water directly from taps, street/roadside or sources like rivers, springs, ponds, streams • During travel use bottled water of standard brands only • Ensure your drinking water (household, building tank, wells) is purified, clean and safe by doing any of the following: • Boiling – Roll boiling (once bubbles form) for at least 10 minutes and store this water in the same container with a lid or covered • Chlorine tablets (as Halazone- 4mg tab/1 liter water, Chlorine or Hypochlorite 0.5 gram tablet/20 liters water) or bleaching powder (10 gram powder- 1 teaspoon/75 liters water) can be added. (30 minutes of minimum contact time) • Ceramic filters – candles should be cleaned by scrubbing with a brush under running water and Boiling at least once a week. Not effective against viruses Reverse Osmosis (RO) filters – (servicing to be done at least 6 monthly)
	Eating clean, safe food	• Wash in clean water and peel all raw vegetables and fruits before eating • Consume pasteurized dairy products (milk, cheese, yogurt and ice cream) and avoid raw milk • All meats should be thoroughly cooked. Prevent contact of cooked with raw foods (like raw meat, and poultry) • Wash hands before handling food and between handling different food items • Thoroughly clean all utensils, appliances and work surfaces in kitchen before and after cooking with detergent and preferably hot water • No food should be left open • Food left out or unrefrigerated for more than 2 hours after cooking should preferably not be consumed • No person with symptoms or confirmation of water borne disease should be allowed to handle kitchen items or food, until certified as recovered by the doctor or at least 3 days of being symptom free or post recovery

People who wade/walk through puddles or accumulated rain-water without appropriate protective footwear, are especially at risk of Leptospirosis. They should wash their legs thoroughly on return.

Health Tips against Mosquitoes

Preventive measures against mosquito breeding and biting

• Use of Insecticide-Treated mosquito Nets (ITN) for sleeping especially for children
• Indoor Residual Spraying (IRS) with mosquito insecticides in houses, common corridors, around buildings (especially gardens and potted areas), workplace and public transport
• Only using Plug in vaporizing Mats and Liquids (containing Transfluthrin/Prallethrin), without regular IRS or applying mosquito repellents, has limited effectiveness
• Avoid burning coils
• Waste disposal in closed bins
• Covering water storage containers
• Cleaning storage tanks every 3 months and using mosquito proof strainers/screens and flap valves
• At least once a week emptying or throwing out items holding stagnant water like flowerpots, trash-bins, containers, tires, buckets, tubs, toys, or pools
• Wearing protective water-proof footwear when walking in rain and puddles
• Permethrin can be used to treat clothes to keep them mosquito proof – usually lasts for 3-4 washings (do not use on skin)

Mosquito Repellents Use

• Use appropriate mosquito repellents indoors and outdoors – available as skin creams/lotions/gels/sprays, and as fabric patches/roll on
• Some common mosquito repellents in use for long and well studied for their safety and effectiveness are –

• Chemical – N N Diethyl Benzamide (most common), Picaridin
• Plant based (natural) – Citronella, Eucalyptus, Peppermint, Lemon

Do’s and Don’ts:

• Apply repellent creams/lotions/sprays on exposed skin, not under clothing
• Do not apply repellent creams/lotion near eyes, mouth and ear opening. If using repellent spray, first spray on hand then apply on face (do not spray on face directly)
• Apply sunscreen first, then mosquito repellent if using both together
• Avoid insect repellent in babies and use clothing covering arms and legs instead, and cover baby strollers with mosquito net
• For children < 3 years, do not use a mosquito repellent which mentions oil of lemon eucalyptus (OLE) or para-menthane-diol (PMD) on its label in the composition
• Do not use repellents over cuts, wounds, or irritated skin
• Avoid inhaling repellent spray mist and do not use near food

Mind Tickle

Solve the crossword below with the clues given

	Across
	1 – Adequate fluids prevent this from happening
	3 – Water borne infection of the liver
	5 – Air borne infection for which vaccine is available
	7 – Disease caused by a bacteria from unclean food
	9 – Common symptom of all mosquito borne diseases

	Down
	1 – Diarrhea with blood in stools
	2 – Increased __________ of water is seen in rains
	4 – The organism causing most mosquito and airborne diseases for which no specific treatment is available
	6 – These tablets help purify water
	10 – Mosquito borne infection with bleeding spots and decreased platelets