Leptospirosis

Doc, can I be infected with Leptospirosis by just wading through the floodwaters? Leptospirosis is a disease that is caused by pathogenic spirochetes of the genus Leptospira, often acquired by human via contact with fresh water contaminated by rat, bovine, or canine urine. The disease is also acquired during adventure travel or vacations that involve water sports or hiking, or even as a consequence of flooding (by wading through floodwater) which is the usual case here in the Philippines. Pathogenic spirochetes is passed via infected animals urine (commonly rats in flooded places) which penetrates broken skin, wounds, mucus membranes and even conjunctiva.Persons at high risk are primarily those expose to fresh water flooding , rescuers during flood calamities, workers working in flooded construction sites, fresh water activities like farming, hiking and swimming across streams.Sign and symptoms of persons infected with Leptospirosis follows a 7-12 day incubation period, wherein in 90% of cases are Anicteric Leptospirosis . High fever( Temperature > 38 centigrade), headache, muscle pain, conjunctivitis(red eyes), skin rash are the most common complaints. Patients may also exhibit hepatomegaly and splenomegaly.In the other 10% of cases, persons may suffer a more severe Icteric Leptospirosis (Weil's Syndrome) wherein there is usually fever , jaundice(yellow skin),icteric sclera, hypotension, azotemia, hemorrhagic vasculitis.The PSMID or Philippine Society for Microbiology and Infectious Diseases, Inc. came out with antibiotic chemoprophylaxis that may be given to persons at risk.A) LOW RISK individuals are those with a single history of wading in flood or contaminated water and absence of wounds, cuts or open lesions of the skin.Doxycycline (hydrochloride or hyclate) at 2 capsules of 100 mg single dose within 24 to 72 hoursB) MODERATE RISK individuals are those with a single historyof wading in flood or contaminated water and the presence of wounds, cuts,or open lesions of the skin, OR accidental ingestion of contaminated water.Doxycycline (hydrochloride or hyclate) at 2 capsules of 100 mg OD for 3-5 days to be started immediately within 24 to 72 hours from exposure.C) HIGH RISK individuals are those with continuous exposure(defined as those having more than a single exposure or several days such as those residing in flooded areas, rescuers and relief workers) of wading in flood or contaminated water with or without wounds, cuts or open lesions of the skin. Swimming in flooded water and ingestion of contaminated water are also considered high risk.Doxycycline (hydrochloride or hyclate) at 2 capsules of 100 mg once weekly until the end of exposureIt should be emphasized that before taking such prophylaxis , the patient should consult a physician so that contraidications and side-effects of the drug be fully explained and also be it known that antibiotic prophylaxis are not 100% effective.The most effective preventive measure is avoid wading in floods and contaminated water and if this can not be avoided, wear boots, goggles, overalls and rubber gloves, and also wash with soap and water, and if possible apply disinfectant after exposure.Leptospirosis treatment is primarily with antimicrobial therapy and supportive treatments (eg. Paracetamol for fever). In uncomplicated infections that do not require hospitalization, oral Doxycycline has been shown to decrease duration of fever and most symptoms. Patients admitted in hospitals should be treated with intravenous penicillin G therapy.
Images from Google, DOH Website

Luslos or Hernia

Doc, i have this painless bulge on my balls, may luslos po ba ako?

A 24 year old male came to the clinic complaining of a painless bulge on his scrotum or balls which was on an off for more than a month. After taking a thorough medical history and physical examination, the patient was diagnosed as having Luslos or Indirect Inguinal Hernia.

A hernia, as defined by Astley Cooper in 1804, is a protrusion of any viscus from its proper cavity. The protruded parts are generally contained in a sac-like structure, formed by the membrane with which the cavity is naturally lined. A hernia occurs when part of an organ (usually the intestines) protrudes through a weak point or tear in the thin muscular wall that holds the abdominal organs in place.Inguinal hernia appears as a bulge in the groin or scrotum. This type is more common in men than women.

As in this patients case, Indirect Inguinal Hernia(the most common) follows the tract through the inguinal canal that results from a persistent process vaginalis. The inguinal canal begins in the intra-abdominal cavity at the internal inguinal ring, located approximately midway between the pubic symphysis and the anterior iliac spine. The canal courses down along the inguinal ligament to the external ring, located medial to the inferior epigastric arteries, subcutaneously and slightly above the pubic tubercle. Contents of this hernia then follow the tract of the testicle down into the scrotal sac.

On the other hand, a Direct Inguinal Hernia usually occurs due to a defect or weakness in the transversalis fascia area of the Hesselbach triangle. The triangle is defined inferiorly by the inguinal ligament, laterally by the inferior epigastric arteries, and medially by the conjoined tendon.

Inguinal hernia accounts for 96% groin Hernias while the other 4% are Femoral hernia. The gender predisposition is Male with a 9 to 1 ratio and is bilateral in 20% of cases. Children account for 5% of Inguinal Hernia cases.

Once the diagnosis is confirmed, Herniorrhaphy,is recommended which is opening the hernial sac and returning the contents to their normal place, obliterating the hernial sac, and closing the opening with strong sutures.

Images from Google.