Kyasanur forest disease, KFD is a febrile disease associated with haemorrhage caused by kyasanur forest disease virus, a member of virus family of arbovirus & flavivirus and transmitted to man by bite of infected ticks.
japenese encephalitis is an important vector borne disease which carries a high mortality as well as high disability. it is a preventable disease and an effective vaccine is available for it.the vaccine is an important part of universal immunization program in india. Environmental modification and control of vector will go long way in the control of this disease.
Kyasanur forest disease, KFD is a febrile disease associated with haemorrhage caused by kyasanur forest disease virus, a member of virus family of arbovirus & flavivirus and transmitted to man by bite of infected ticks.
japenese encephalitis is an important vector borne disease which carries a high mortality as well as high disability. it is a preventable disease and an effective vaccine is available for it.the vaccine is an important part of universal immunization program in india. Environmental modification and control of vector will go long way in the control of this disease.
Epidemiology and control measures for Yellow fever AB Rajar
It is an acute infectious disease of short duration, with sudden
onset,fever,headache,prostration,nausea,epistaxis,buccal bleeding,hematemesis,malena and jaundice
Malaria epidemiology, clinical features & treatmentDr. Animesh Gupta
Malaria is a protozoal disease caused by infection with
parasites of the genus Plasmodium and transmitted by
certain species of infected female Anopheles mosquito.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?
Leptospirosis 2015
1. LEPTOSPIROSIS
DEPT. OF COMMUNITY MEDICINE, UPRIMS&R,
SAIFAI
UNDER GUIDANCE OF :
DR. A.M. DIXIT SIR
PRESENTED BY:
PRANJAL AGARWAL
ROLL NO. 55
2. INDEX
• HISTORY
• WHAT IS LEPTOSPIROSIS?
• AGENT
• SOURCE OF INFECTION
• HOST FACTORS
• ENVIRONMENTAL FACTORS
• MODE OF TRANSMISSION
• CLINICAL FEATURES
• BURDEN OF DISEASE
3. INDEX (CONT.)
• WORLD STATUS
• STATUS IN INDIA
• OUTBREAKS
• NICD GUIDELINES FOR PREVENTION & CONTROL
• TREATMENT OF LEPTOSPIROSIS
• INTERNATIONAL INITIATIVES
• INITIATIVES BY INDIA
• PREVENTION & CONTROL
• REFERENCES
4. HISTORY
• The spirochete was first isolated in Japan by
Inada in 1915 .
• Weil described the clinical disease in
1886.(WEIL’S DISEASE)
• Leptospirosis was known in China and
Japan by “rich harvest jaundice” and
“autumn fever”.
5. --RUDYARD KIPLING
• I KEEP SIX HONEST SERVING*
MEN. THEY TAUGHT ME ALL I
KNEW. THEIR NAMES ARE:
WHAT, WHY, WHEN, HOW,
WHERE & WHO.
*taken from Textbook of P.S.M. by K.Park 23rd edition Ch-3 :
Epidemiology
7. • Leptospirosis is essentially animal
infection by several serotypes of
Leptospira (Spirochetes) and
transmitted to men under certain
environmental conditions.
8. AGENT
• 2 species :
L. interrogans
•Pathogenic
L. biflexa
•Saprophytic
The leptospira serovars predominantly present
in India are
L.ictohaemorrhageae
9. SOURCE OF INFECTION
• Excreted in the urine of infected animals for a long
time.
• ANIMAL RESERVOIRS:
o Rodents – mice, rats and voles.
o Domestic animals – cattle, sheep, goat, water
buffalo, pigs, horses, dogs may act as carriers.
o RATS: R. norvegicus most important
Mus musculus reservoirs
10. HOST FACTORS
o AGE&SEX
human infection: accidental.
males > females due to greater occupational
exposure.
more frequent in age group 20-30 yrs
o HIGH RISK GROUPS
Agricultural workers
Fishermen, sewer workers
Lorry drivers and masons
11. ENVIRONMENTAL
FACTORS
• Drainage congestion and water logging
• Soil salinization
• Soil temperature
• Seasonal variation – Starts at the onset of
Rainy season & declines as the rains recede.
12. • Heavy RAINS & FLOODS
• Poor housing
• Limited water supply
• Inadequate method of waste disposal
15. CLINICAL FEATURES
Two types of
leptospirosis are
described
ICTERIC
LEPTOSPIROSIS
ANICTERIC
LEPTOSPIROSIS
I.P. = 10 days with a range of 4 to 20
days
16. ICTERIC
LEPTOSPIROSIS
o It is the severe form of
the disease.
o It is characterized by
jaundice and is
usually associated
with involvement of
other organs.
o About 5-10% of
patients have these
type of manifestations
• ANICTERIC
LEPTOSPIROSIS
o It is the milder form of
the disease.
o Patients have fever,
myalgia but do not
have jaundice.
o Almost 90% Of
patients have this type
of illness.
17. SIGNS & SYMPTOMS
• Fever with chills
• Myalgia of calf, abdominal & lumbosacral muscles
• Conjunctival Suffusion
• Headache- throbbing, frontal
• Renal infestation- mild proteinuria with few
casts/cells
• Pulmonary infestation- cough/chest
pain/haemoptysis
• PETECHIAL hemorrhage
ANICTERIC
19. • JAUNDICE
• Fever(Same as in anicteric leptospirosis but may be
more severe)
• All the symptoms and signs of Anicteric along with
Organ Involvement.
ICTERIC
20. • ORGAN INVOLVEMENT-
ORGAN CLINICAL FEATURES
KIDNEY Decrease in urine output,
features of uremia
LIVER Jaundice, hepatomegaly
LUNG Cough, haemoptysis, dyspnoea
with increase in respiration
rate and basal crepts
HEART Hypotension, irregular pulse
BLOOD Bleeding tendencies
BRAIN Altered consciousness with
neck rigidity
22. BURDEN OF DISEASE
• BEARS EPIDEMIC POTENTIAL
• The annual incidence of leptospirosis is estimated
from 0.1 to 1 per 100 000 per year in temperate
climates to 10 or more per 100 000 per year in the
humid tropics.
23. MOST WIDESPREAD
ZOONOSIS
Leptospirosis is treatable
and preventable!
• If Leptospirosis is detected early, antibiotics
can be administered that can successfully
treat the disease.
25. WORLD STATUS
• 63% in AMERICAS (Brazil, Nicaragua, Argentina)
• 15% in WESTERN PACIFIC
• 14% in SOUTH EAST ASIAN REGION
• 08% in EUROPE
• Rest in AFRICAN & Eastern MEDITERRANEAN.
26. STATUS IN INDIA
Coastal Districts of
• Gujarat
• Maharashtra
• Kerala
• Tamil Nadu
• Andhra Pradesh HAVE REPORTED
• Karnataka OUTBREAKS
• Andamans
• Orissa
29. OUTBREAKS
• 1995 – 1998 – Prevalent in the United States only.
• 1999 - A post-cyclone outbreak was reported in Orissa, India
• 2002 – Outbreak after flooding in Jakarta, Indonesia
• 2002-05 – In South Gujarat
• 2000,2002,2005 – After flooding in Mumbai, Maharashtra
• 2008 – After flooding in Sri Lanka
• 2009 – After Cyclone in Philippines
• 2011 - Outbreak in Canyoning athletes in the Caribbean
island of Martinique.
30. • July, 2015 – Outbreak in Mumbai, Maharashtra
CASES : 21, DIED : 12
31. CAN WE PREVENT &
CONTROL
LEPTOSPIROSIS??
+
INITIATIVES TAKEN TILL
DATE.
H
32. Guidelines for
Prevention and Control
of Leptospirosis:
National Institute of
Communicable
Diseases (Zoonosis
Division) 2006
33. Recommended case
definition
Acute febrile illness with headache, myalgia and
prostration associated with any of the following:
• Conjuctival suffusion
• Meningeal irritation
• Jaundice
• Hemorrhages (from the intestines; lung bleeding is
notorious in some areas)
• Cardiac arrhythmia or failure
34. CASE
CLASSIFICATION
• Suspected: A case that is compatible with
clinical description.
• Confirmed: A suspect case with positive
laboratory test.
35. Laboratory criteria for
diagnosis
Collection and Transportation of serum sample
Labelling and transportation of the sample
Collection of clinical samples for isolation of
leptospires
blood
urine
CSF
Other specimen include autopsy tissues such as
kidney or liver.
38. TREATMENT AT
PHC/CHC/DIST. HOSPITALS
IN ENDEMIC AREAS
• CLINICAL SUSPECT- Tab. Doxycycline 100 mg twice
daily for 7 days.
• MILD DISEASE & RAPID IMMUNODIAGNOSTIC TEST
+VE - Inj. Crystalline penicillin 20 lacs I.U. i.v. every 6
hrly in adults for 7 days.(CHILDREN - 2 – 4 lacs
units/kg/day for 7 days.)
• IF FEATURES OF ORGAN DYSFUNCTION PRESENT,
REFER TO HIGHER CENTRE.
39. TREATMENT AT MEDICAL
COLLEGE/ TERTIARY
CENTRE
2 STEP
TREATMENT
CHEMOTHERAPY
ORGAN
SPECIFIC CARE
Adults : T. Doxycycline
100 m.g. twice a day for
seven days;
Children : < 6 yrs.
Cap. Amoxy/Ampicillin
Organ specific
and symptomatic
treatment.
40. INTERNATIONAL
INITIATIVES
• INTERNATIONAL LEPTOSPIROSIS SOCIETY
The International Leptospirosis Society Inc. (ILS) was
formed in 1994 to promote knowledge on leptospirosis
through the organisation of regional and global
leptospirosis meetings.
43. Leptospirosis Burden
Epidemiology Reference Group
(LERG)
• The LERG, an advisory group to the DirectorGeneral
of the WHO on the epidemiology of leptospirosis,
was established in 2009 following an informal WHO
consultation in 2006.
• The Objective„:
to provide estimates for human leptospirosis
worldwide, according to age and sex and by WHO
region
44. INITIATIVES BY
INDIA
• A Pilot Project on Control of Leptospirosis was
approved as a “New Initiative” in the 11th Five Year
Plan in 5 endemic states with the objective to
reduce the morbidity and mortality in pilot project
areas.
• Proposal for Leptospirosis control in the 12th
Plan
45. Proposal for Leptospirosis
control in the 12th Plan
AIM : To expand and implement the strategy for prevention
and control of Leptospirosis developed during 11th Plan in all
the endemic states during the 12th Plan period.
NCDC is the nodal agency for this project.
The thrust areas of the project are-
—Early diagnosis & treatment of Leptospirosis
—Strengthening of lab & patient management facilities
—Training of manpower
—IEC in the community
—Inter- sectoral coordination
BUDGET : Rs. 3.69 crores
48. PREVENTION &
CONTROL
Protection of people against contagion by available
means.
Health education
Vaccination of animals
Rodent control
Mapping of water bodies for establishing a proper
drainage system
Health impact assessment of developmental projects
Leptospirosis should be made a reportable disease in all
endemic states
Chemoprophylaxis
49. VACCINATION OF
ANIMALS
Species Name of the
vaccine
Dog Novivac-DHPPI-2L
Eurican-DHPPI-2L
Vanguard-DHPPI-2L
Duramax-DHPPI-2L
Cattle Leptavoid
Spirovac
Leptoferm-5
Cattle & swine Farrowsure-Plus
50. REFERENCES
1. Textbook of Preventive & Social Medicine by K.Park
2. Report of the Second Meeting of the Leptospirosis
Burden Epidemiology Reference Group 2011
3. Leptospirosis situation in the WHO South-East Asia
Region
4. Sethi S, Sharma N, Kakkar N, Taneja J, Chatterjee SS, et
al. (2010) Increasing Trends of Leptospirosis in Northern
India: A Clinico- Epidemiological Study. PLoS Negl Trop
Dis 4(1): e579. doi:10.1371/journal.pntd.0000579
5. A Global Research Agenda for Leptospirosis ER Cachay,
JM Vinetz J Postgrad Med. Author manuscript; available
in PMC 2008 March 20.Published in final edited form as:
J Postgrad Med. 2005; 51(3): 174–178.
51. REFERENCES(CONT.)
6. Human leptospirosis: Guidance for diagnosis,
surveillance and control 2003
7. Leptospirosis – An Overview: TK Dutta, M
Christopher; JAPI , VOL. 53, JUNE 2005, 545-51
8. The Prevention & Control of Leptospirosis by John
TJ, J POSTGRAD MED September 2005 Vol 51 Issue 3
9. NCDC Newsletter Volume 4, Issue 1, January-
March, 2015
10.NCDC Newsletter Volume-1, Issue-1, October 2012
11.NCDC Newsletter July–September 2014 Volume 3,
Issue 3
23 sero-groups and 200 serovars recognized from various parts of the world.
Agricultural workers such as rice fi eld planters, sugar cane and pineapple fi eld
harvestors, livestock handlers, labourers engaged in canal cleaning operations are
subjected to exposure with leptospires which have reservoir in rodents, cattle,
swine, sheep, goats etc.
Some occupational groups are –
Fishermen, sewer workers and all those persons who are liable to work in rodent
infested environment.
Lorry drivers and masons - As lorry drivers may use contaminated water to wash
their vehicles and masons may come in contact with the organisms while preparing
the cement and sand mixture for construction work with contaminated water.
Drainage congestion and water logging
Heavy concentrated rainfall leaves a lot of surplus water. Developmental activities
like canal network, roads and railway lines obstruct natural drainage of rain water
causing its accumulation for longer periods. The water logged areas force the
rodent population to abandon their burrows and contaminate the stagnant water
by their urine. The farmers and agricultural labourers working in the water logged
contaminated fi elds catch the infection.
3.3 Soil salinization
In fact, salinity and water logging are inter-linked problems. The salinity of
the soil provides favorable environment for survival of leptospires for months
together.
3.4 Soil temperature
The soil of endemic areas in general has lower base saturation and the mean annual
soil temperature at the depth of 50 cm is 220C or more and the difference between
mean summer (June-August) and mean winter (December-February) temperature
is less than 50C. This favors the survival of leptospires for long durations.
Seasonal variation
Leptospirosis is usually a seasonal disease that starts at the onset of the rainy
season and declines as the rains recede. Sporadic cases may occur throughout the
year.
7. High
Direct- lepto can enter body thru skin abrasns or intact mucous memb by direct cont with urine or tissue of inf animal
Indirect- thru contact of broken skin with soil water or vegetation contam by urine of inf animals or thru ingestion of food contam by leptospirae
Droplet infectn- thru inhalation while milking cows or goats by breathing air polluted with droplets of urine.
Fever - Patients have remittent fever with chills. It may be moderate to
severe.
• Myalgia-It is a very characteristic fi nding in leptospirosis. Calf, abdominal
& lumbosacral muscles are very painful & severely tender. This symptom is
very useful in differentiating leptospirosis from other diseases causing fever.
There is associated increase in serum Creatinine Phosphokinase (C.P.K.) which
helps in differentiating leptospirosis from other illnesses.
• Conjunctival Suffusion- There is reddish colouration of conjunctiva. Very
useful sign in leptospirosis. Usually bilateral, most marked on palpebral
conjunctiva, it may be associated with unilateral or bilateral conjunctival
haemorrhage.
• Headache - Usually intense, sometimes throbbing, commonly in frontal
region. It is often not relieved by analgesics.
• Renal manifestations - Some form of renal involvement is invariable in
leptospirosis. It usually occurs as asymptomatic urinary abnormality in the
form of mild proteinuria with few casts & cells in the urine. Severe renal
involvement in the form of acute renal failure, (which occurs in icteric
leptospirosis) is rare.
• Pulmonary manifestations - Manifested in most cases through cough &
chest pain and in few cases by haemoptysis. Severe involvement leading to
respiratory failure does not occur in anicteric leptospirosis.
• Hemorrhage- Hemorrhagic tendencies are also present in some cases.
leptospirosis remains one of the top ten infectious hazards reported globally in the Event Management System (EMS).
More than half of these leptospirosis alerts (63%) occurred in the Americas Region, particularly in Brazil (142 alerts), Nicaragua (45) and Argentina
In the wake of hurricane Mitch in 1995, an outbreak of leptospirosis with pulmonary haemorrhages was reported in Nicaragua. In 1998, there was an outbreak in the continental United States. 1998 also saw an outbreak in Peru and Ecuador following heavy flooding. A post-cyclone outbreak was reported in Orissa, India in 1999.
Major outbreaks in South-East Asia were reported in the past due to cyclone in Orissa (1999), flooding in Jakarta (2002), Mumbai (2005) and in Sri Lanka (2008)
) Prevention and Control of Leptospirosis The outbreaks of leptospirosis, an emerging zoonotic disease, are increasingly been reported from many states/UTs such as A& N Islands, Kerala, Gujarat, Tamil Nadu and Karnataka. In addition, cases have also been reported from Goa, Andhra Pradesh and Assam.. The proposal is to expand and implement the strategy developed during 11th Plan in all the endemic states during the 12th Plan period. The strategy evolved and guidelines formulated will be shared and distributed to all endemic states. The suspected cases of leptospirosis will get timely and appropriate treatment and awareness in community will help in reducing mortality and morbidity due to leptospirosis. An amount of Rs. 3.69 crore is proposed in 12th Plan to carry out this activity
2.2 Activities in the 11th Plan A pilot project on Control of Leptospirosis was approved as a New Initiative in the 11th Five Year Plan in March, 2008 and was carried out in 5 endemic states. The project was carried out in 4 districts of Gujarat (Surat, Navsari, Valsad and Tapi), 2 districts of Kerala (Kottayam and Allepey), 2 districts of Tamil Nadu (Villupuram and Thiruchirapalli,) 4 districts of Maharashtra (Ratnagiri, Thane, Sindhudurg, Raigad ) and 2 districts of Karnataka (Mangalore & Shimoga). The objective of the pilot project was to reduce the morbidity and mortality due to Leptospirosis in pilot project areas. 2.3 Budget A total of Rs. 2.36 Crores allocated, of which Rs. 2.31 Crores spent. 2.4 Pilot Project Strategies • Reduction of morbidity • Strengthening laboratory diagnostic capacity • Strengthening of patient management facilities • Developing trained manpower • Creating awareness regarding timely detection and appropriate treatment of patients 2.5 Outcome of the Pilot Project Clinically suspected Leptospirosis patients in leptospira-endemic project areas during rainy season were given presumptive treatment of leptospirosis at PHCs. All suspected leptospirosis cases whether positive or negative with rapid immunodiagnostic test having features of organ dysfunction were immediately shifted to higher centre. With the implementation of the 194 components of pilot project strategy there has been reduction in morbidity and mortality due to leptospirosis in pilot project areas. The strategy for prevention and control of leptospirosis has been found to be feasible and implemenable and shall be provided to the States for further implementation. 2.6 Gaps in the 11th Plan The Pilot project was carried out only in five endemic states of the country. The remaining endemic states were not covered. The intersectoral coordination was inadequate during the implementation of Pilot project in the 11th five year plan. 195 2.7 Proposal for Leptospirosis control in the 12th Plan The proposal is to expand and implement the strategy for prevention and control of Leptospirosis developed during 11th Plan in all the endemic states during the 12th Plan period. The strategy evolved and guidelines formulated will be shared and distributed to all endemic states. 2.7.1 Does the strategy need change/paradigm shift? The strategy of the pilot project was critically reviewed in different meetings chaired by DGHS and in the meetings of Standing Committee on Zoonoses. The strategy was found to be effective and implementable and can be provided to the States for further implementation. Thus there is no change required or proposed in the strategy. 2.7.2 Ownership The roles and responsibilities of various components at centre, state and intersectoral level shall be clearly defined in consultation with the states. 2.7.3 Capacity building Training of professionals regarding prevention, diagnosis, management and control of Leptospirosis will be undertaken. This will help in early case detection and proper management of the patients. 2.7.4 Inter-sectoral co-ordination Sensitization of other sectors viz. veterinary and agriculture will be undertaken to establish intersectoral coordination for prevention and control of Leptospirosis. 2.7.5 Strengthening of patient management facilities Funds will be provided for strengthening the existing patient management facilities. 2.7.6 Information, Education and Communication IEC will enhance awareness in the general public regarding prevention and control of Leptospirosis. The awareness will result in early reporting of cases to treatment facilities. 2.7.7 Monitoring of the activities The activities would be periodically monitored and evaluated by undertaking visits to the endemic areas. On day to day basis monitoring will be done by the designated officers of the state governments. 196 2.7.8 Outcome The suspected cases of leptospirosis will get timely and appropriate treatment and awareness in community will help in reducing mortality and morbidity due to leptospirosis in endemic states. 2.7.9 Budget The estimated total cost is Rs. 3.69 Crores
is of particular value as a serological screening test because of its relative simplicity in comparison to the MAT (Microscopic Agglutination Test).
Lepto dip-stick, Lepto lateral flow and Lepto Tek Dri Dot assays are based on IgM detection.
15.1 Protection of people against contagion by available means
Hygienic methods such as avoidance of direct and indirect human contact with
animal urine are recommended as preventive measures. Workers in fl ooded fi elds
should be cautioned against direct contact with contaminated water or mud and
should be advised to use rubber shoes and gloves. In case of any cuts or abrasion
on the lower extremities of the body, the worker should apply an antiseptic
ointment e.g. betadine, before entering the fi eld and after exit.
15.2 Health education
The main preventive measure for leptospirosis is to create awareness about the
disease and its prevention. This has to be carried out by an intensive educational
campaign.
15.3 Vaccination of animals
Leptospiral vaccines confer a limited duration of immunity. Boosters are needed
every one to two years. Vaccination should however be very selective and used
only in endemic situations having high incidence of leptospirosis. The vaccine
must contain the dominant local serovars. While this prevents illness, it does
not necessarily protects from infection and renal shedding. Details of vaccines
available are listed below:
22 Guidelines for Prevention and Control of Leptospirosis
Species Name of the vaccine Company
Dog Novivac-DHPPI-2L
Eurican-DHPPI-2L
Vanguard-DHPPI-2L
Duramax-DHPPI-2L
Intervet, Norway
Merial, France
Pfi zer, Animal Health, USA
Fortdodge Lab, USA
Cattle Leptavoid
Spirovac
Leptoferm-5
Schering Plough Animal Health, UK
USDA, USA
USDA, USA
Cattle & swine Farrowsure-Plus Pfi zer Animal Health, USA
15.4 Rodent control
It is established beyond doubt that rodents are the major reservoirs of bacterium
Leptospira interogans with more than 200 serovars. Possibly in a human infested
area, where signifi cant number of Leptospira cases are reported, selective rodent
control measures should be undertaken.
15.5 Mapping of water bodies for establishing a proper drainage system
The mapping of water bodies and human activities in water logged areas should
be carried out. This will help to identify the high risk population. Farmers may be
educated to drain out the urine from the cattle shed into a pit, instead of letting
it fl ow and mix with water bodies (rivers, ponds etc.)
15.6 Health impact assessment of developmental projects
Health impact assessment should be made mandatory for all developmental
projects along with environmental assessment
15.7 Leptospirosis should be made a reportable disease in all endemic states.
15.8 Chemoprophylaxis
During the peak transmission season Doxycycline 200 mg, once a week, may be given
to agricultural workers (eg. paddy fi eld workers, canal cleaning workers in endemic
areas) from where clustering of cases has been reported. The chemoprophylaxis
should not be extended for more than six weeks.