LEPTOSPIROSIS AND PREVENTION.

The disease and identification.

The disease due to leptospirosis is normaly known as Weils disease and also known as spirochaetosis, icterus gravis, etc in various parts of the world. In kerala, in Malayalam it is known as ELIPANI(rat fever) not rat bite fever. It is a sudden febrile animal borne infection charecterised in human beings by fever , icterus, albumen in urine,bleedings , severe headache and pain in the body, skin rashes, enlargement of liver, prostration and passing of bile in urine and faeces and loose motions and abdominal pains and continiues with irregular fever which starts from 4 th day onwards and lasts for a week or upto 10 days after that fever comes down and after 14 the day the healing starts.

Causal organism.

Leprospira icterohaemorrhagiae is the organism. It is a slender, closely wound, very actively motile spirochaeta varying in length from 1m to 4m. The spirals are shallow and regular , each half m in length, thin and acutely bent as a crook. It is found in the blood, urine, ceribrospinal fluid and sputum of the patient. They can be demonstrated by a dark ground illustration by the day in the urine.It can be cultivated on Naguchi's medium or in a mixture of peptone. Besides these types of Europeon strains,there are fifty named strains of Leptospira with varying invasive potentialities.

Source and reservoir of infection.

The natural reservoir of infection are the rats and the field mice. These rodents are tolerent to the spirochaeta and not suffer from the disease. The organism is excreted in their urine  and faeces,The disease also occur in dogs but the sudden source of infection to man is through the soil contaminated with infective excereta, specially urine.

The incubation period and period of infectivity.

The normal incubation period is one week with a range of six to eight days rarely and may go upto 13 days. Route and mode of transmission to man is through microscopic abrasions occured during work in soil,drains.sewers, etc. Bathing in contaminated water has a given rise to outbreaks. It may occur among farmers, sewer workers,miners,fishmongers and other workers during out breaks. Urine of the patient can be infective from the end of first week onwards from 10 to 25 th day, may extend upto 2 months. Rats are infective during their life. Man possess no natural immunity. Aquired immunity is not solid or remains for long time. The disease occure as severe or mild attack depending upon the type of infecting organism.

Geographical prevalence of the disease.

The disease is virulent in warm countries. The disease was early thought to be prevalent in Japan.  It is endemic in Holond, Congo, coastal Germany, Africa, Sudan, Indonenesia, Malayasia and other countries.

PREVENTION AND CONTROL.

Rat control in vulnarable areas like coastal side and sorrounding areas,sewers in towns and urban areas, etc. Protective clothing for workers, in vulnerable trades like sewer workers and divers,etc. Swimming in infected pools should be avoided. Attendants in hospital should wear protective clothing. Disinfection of items used by patient including urine,faeces, etc, and terminal disinfection also carried out. Naguchi prepared a vaccine for giving to persons enggaged in hazardous professions.

HEALTH CARE

PREVENTION IS BETTER THAN CURE.

Personal hygiene: Regular bowel habits are important for maintaining good health. It is cultivated by regularity in its act. A daily bath is essential to maintain a healthy skin and to avoid communicable skin diseases. Using of too much soap is not good always. Hair should be washed regularly and should be kept short to avoid dirt accumulating in it. Nails accumulate dirt and pathogenic organisms and introduces them dirt to food if hands are not washed properly and in the skin also if one happens to scratch it. They should be kept short. Eyes,ears,nose and throat should be cleaned before before brushing the teeth. Cold and hot baths respectively cool down the body in summer and warm it in winter. Teeth should be brushed after every meal,but at least after the last meal of the day. A proper brush should be used for cleaning the teeth. Eyes should not be rubbed always or wiped with dirty hands. A clean handkerchief should be used for wiping the eyes and another for cleaning the nose,and while sneezing or coughing. Fingers should not be used for cleaning nose and ears. It is a dirty habit and may damage the ear drum or nasal mucosa. The nose should not be blown too much violently as it results in driving the mucous discharge up the Eustachian tube and may rupture the ear drum. Communal shaving by a barber may cause sycosis or tenia infection or other skin diseases. Spitting indiscriminately or coughing,sneezing with out use of handkerchief are bad habits which help to spread the respiratory infection,and such habits should be discouraged. Tobacco or betel chewing in public places must be prohibited and the habit of spitting can be curbed.

FOOD HABIT.

The habit of eating food at fixed times,from healthy sources where it is well and hygienically cooked,preserved,protected and served. It should be eaten in a sanitary surroundings with out fly or dust nuisance or bad odours. It should be served by hygienic food handlers in a hygienic manner. Personal hygiene before and after eating is very important. Hands and mouth must be washed before and after eating. Teeth should always be cleaned with a brush or finger while washing the mouth after eating. The habit of using  a toothpick is not good as it harms teeth and gums. Eating between should be avoided by persons of advancing age. Over consumption of oils, vanaspathi or pure ghee is not beneficial as it usually believed.When people get into good food habits detest eating in unhygienic places and unwholesome food.

WATER HYGIENE.

Water should be consumed from an authorized or a known safe source in adequate quantity. Laziness in adhering to this habit may  cause infections of gastrointestinal disease,specially during rainy season and extreme summer while journeys by train or road. Arrangements should be made to facilitate these habits by the persons themselves while traveling. Pure cool drinking water should be carried to maintain fitness and to prevent effects of heat during long journey.

EXERCISE.

The human body requires regular exertion. lack of exercise leads to obesity, muscular laxity, low vital capacity, low katabolism, low cardiac tolerance and low threshold for physical and emotional stress. Physical activity is a stimulus to the growth of children and adolescence and promotes mental relaxation in adults. It produces and enhances resistance against heart diseases,respiratory infections, prevents obesity and mental and physical well beings. Exercise should, but, not to be so excessive as to cause extreme fatigue, as like all other stimuli, it becomes a stress producing factor if it is excessive. It should be enough to produce pleasant fatigue demanding relaxation. Relaxation and sleep are necessary for recovery of the body from fatigue by vanishing biochemical products and psychological effects of physical and mental exertion. Sleep should be sound with out any artificial aids. A sound sleep is necessary from ill health, good feeding and sufficient physical and mental exercises,comfortable thermal environments and also freedom from pests like bed bugs, mosquitoes,rats and so on ; comfortable garments, bed, and bed linen and freedom from noise. Men get used to sleeping with open windows and uncovered faces. During winter and rainy season adequate clothes and blankets must be put for warmth while sleeping.

RECREATION.

Healthy out door and indoor games, recreational outings, visit to places of historical and cultural interests, hobbies like music, photography or handicraft , and  other re-creative pastime engagements for using leisure in healthy habits produces a healthy attitude of life,those prevent temptation to indulge unhealthy activities, aimless loitering,quarrelsome behavior and provides relaxation with out dullness or drowsiness. Ethical,religious,moral teaching keeps the mind of people geared to healthy thought and action.

DRINKING AND SMOKING.

It is not necessary in any form for nutrition. The higher regular consumption may lead to diseases of liver, stomach, kidneys,heart and nervous system causing alcoholic cirrhosis, stomach ulcers, psychic ailments and cancers of mouth, throat, food pipe and stomach. Regular consumption leads to compulsive drinking and further on to addiction and later confirmed 'alcoholism' its classical stage which is harmful to the body and mind. Alcoholism is a disease needing psychological treatment. Chronic alcoholism may lea to obesity and its effects. Heavy smoking is another unhealthy habit. Tobacco is not essential for a healthy or happy life. Excessive smoking started in early life causes addiction and increased incidence of lung cancer and higher incidence heart diseases. It also causes peptic ulceration, gastric cancer and tremors. Withdrawal symptoms or denial of smoking to a person used to it are similar to withdrawal of any other material of addiction like irritability, lack of concentration, restlessness,etc.

OBESITY.

An excessive deposit of fat in the body with an increase in body weight  more than 10 percent above normal for the age,sex,height,etc. Fat in the body is deposited in the fat depots such as over the abdominal wall, buttocks,thighs and over the shoulders and the back. In addition to this deposition extra fat in intestinal tissues in the body, bone marrow, around the heart, spleen and liver and kidneys and also higher lipids circulating in the blood. Obesity is associated with serious disease processes. Premature death rate is more amongst obese persons. It is one of the major factor of heat diseases. Obesity increases the rate amongst diabetes 4 times who get cardiovascular diseases about 1.5 times. The most important and most universal cause for obesity is over eating and lack of exercise. Obesity decreases exercise tolerance. The only 2 ways of preventing it are regular exercises and a restricted dietary specially the fat producing items like ghee, oil, sugar. Active preventive measures against diseases and change in mode of life becomes necessary under certain conditions. Care of family and school children's' health care is a link between the maternity and child health care and the general community health care.