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A MICROTEACHING IN HEALTH EDUCATION STRATEGIES

INTRODUCTION

Leptospirosis originally was thought of as being an occupational disease, and approximately 30-50% of human cases are occupation-related. Groups at increased risk include people who work in close contact with animals or the urinecontaminated material.

Farmers, veterinarians, sewer workers, miners, milkers, meat handlers, slaughterhouse workers, field workers, pet shop owners, and the military are considered to be at higher risk,

but due to protective measures and increased awareness, the occupational risks have declined. In developed countries, most cases are associated with poor living conditions or with outdoor recreational activities

such as swimming in ponds or rivers, canoeing, windsurfing, and waterskiing which also present significant risk of infection as well.

1883

it was recognized as an occupational disease of sewer workers. 1886 first description (by Adolf Weil) of the clinical manifestations seen in 4 men.Severe jaundice, fever, and hemorrhage with renal involvement 1916 the causal agent was identified by Inada and Ito in Japan.

The disease is seen worldwide and is mostly sporadic in temperate climates and possibly endemic in tropical climates. Most cases occur during the rainy season in the tropics and during the late summer or early fall months in temperate climates.

1994-Nicaragua-

Leptospirosis spread through a large population due to widespread flooding. 1998-athletes participating in a triathlon in Illinois swam in Lake Springfield and developed the disease. Here in the Philippines, floods and contaminated water are the common sources of Leptospirosis.

WHAT IS LEPTOSPIROSIS?
Leptospirosis

is called a ZOONOSIS because it is a disease of animals that can be transmitted to humans. An infectious disease caused by a particular type of bacteria called a spirochete transmitted by rats as well as by skunks, opossums, raccoons, foxes, pigs, cattle.

STAGES OF LEPTOSPIROSIS
FIRST STAGE (last for 3-7 days) Severe Headache Muscle pain Chills Nausea and Vomiting Back Pain Joint Pain Neck Stiffness Cough

SECOND STAGE Headache Vomiting Rash Aseptic Meningitis Photosensitivity (sensitivity of the eye to light)

THIRD STAGE(WEILS SYNDROME)


Jaundice(yellow

skin and eyes) decreased or no urine output hypotension(low blood pressure) Anemia (decreased no. of RBC) Red spots on the skin bloody sputum Brain damage kidney and liver damage

TRANSMISSION
Ingestion

of the contaminated water and food. Humans can become infected upon contact of the contaminated material with abraded skin or by mucous membranes.

CAUSES OF THE DISEASE Exposure to the bacteria that have been shed by an infected animal, and in 90% of cases it will be their urine Contaminated water that is subsequently drunk. Broken skins, cuts and scrapes. waterlogged skin (such as when skin is immersed in contaminated water for a long time.)

PREVENTION
Wear

proper protective clothing, boots, and gloves to minimize exposure to Leptospira. Have pets and farm animals vaccinated against Leptospira. Avoid swimming and wading in ponds, streams, and lakes with open cuts and sores.

Maintain

proper rodent control in areas where people and their pets could be exposed to the bacteria. Wash hands after handling animals or contaminated material.

WHO ARE AT RISK?

Farmers

Veterinarian

Miners

Pathogenic: capable of causing illnesses. Saprophytes: creatures that feed from decaying organic material.

RISK FROM CONTAMINATED FOOD OR DRINK


Urine

from a carrier animal must come into contact with the food or drinks directly. The items consumed without cooking or washing.

IMMEDIATE ACTION FOLLOWING EXPOSURE EARLY RECOGNITION OF EXPOSURE -The most important factor in saving lives is to recognize the risks, so if you are accidentally exposed to something you believe to be contaminated you can seek help without delay.

EARLY

USE OF ANTIBIOTICS Antibiotics are very effective if given early in the infection, but less so in later days and weeks - so getting antibiotics as soon as possible is also important. EARLY BLOOD TESTING finally, your doctor needs to confirm if you actually have been infected or not and for that they will need to take a blood sample.

CHANCES OF CATHING THE INFECTIONS IN RIVERS/LAKES/PITS The chances of infection are therefore quite low. The chances that being exposed to contaminated water would lead to infection depend on what you do in the water. Swimming is the highest risk activity as there is no way to prevent some ingestion and skin contact, though other activities such as fishing, waterskiing, sailing, ad kayaking can also present risk.

EXPOSURE TO WATER

The vast majority of human cases are from contaminated water. Recreational exposure is next, with cases amongst swimmers being the obvious top group.

EXPOSURE TO ANIMALS

The dominant carriers are rats, but many other rodents and small mammals can take the role depending on the location, such as raccoons, squirrels, field mice, etc. however rats are naturally incontinent and so spread far more urine than other species.

ENDEMIC EXPOSURE
Visitors and residents of countries where the bacterium is widespread (such as the Indian subcontinent) are likely to be exposed to contaminated water as a matter of course. In these cases it is almost impossible to prevent exposure, and the best option is to be aware of the early symptoms and react to them.

PATHOPHYSIOLOGY

Pathogenic: capable of causing illnesses. Saprophytes: creatures that feed from decaying organic material.

INCUBATION PERIOD Usually about 7-10 days (range 2 30 days) CAUSATIVE AGENT Leptospira interrogans or spirochetes.

PHATOGENESIS
The

bacteria penetrate the mucous membranes or breaks in the skin, multiply in the bloodstream and are carried to all parts of the body.

EPIDEMIOLOGY
Wide

range of animal hosts chronically excretes the bacteria in their urine, causing contamination of natural waters and salts. Organism remains infectious for long periods of time under warm, moist, and neutral conditions.

PREVENTION AND TREATMENT Avoid contact with animals urine. Vaccines prevent disease in domestic animals may not prevent urinary carriage. Various antibacterial medications are useful in treatment of Leptospirosis, but only if given early in the disease.

DISINFECTING AREAS OF GROUNDS, PONDS, OR WATER FEATURES Flowing water (rivers, springs, etc.) cannot be chemically treated at source, so if the water is being abstracted for drinking it needs to be disinfected at that stage, not while still running across the ground.

Swimming

pools and some water features will use chlorination tablets, and these are very effective. Freshwater springs used to supply drinking water (for houses and campsites) should be sealed from source if possible, to avoid contamination from all causes, not just leptospires.

Hard

surfaces such as concrete rapidly dry out, and so are of no significant risk except during prolonged periods of rain.

DISINFECTING SURFACES AND MATERIALS


Any

commercial brands of cleaning products, but any product with a proven antibacterial action (disinfectants, bleaches, alcoholbased solutions, etc.) will be effective against leptospires even if they are not mentioned on a label.

The

fact leptospires are very intolerant of acid - a solution of acetic acid (vinegar) or citric acid (lemon juice) will work as a disinfectant, for example to wash hands on a camping trip. Alcohol is also effective but requires a greater concentration.

REFERENCES:

http://medicaldictionary.thefreedictionary.com/leptospirosis http://medicaldictionary.thefreedictionary.com/leptospirosis McGraw-Hill Concise Dictionary of Modern Medicine. 2002 by The McGraw-Hill Companies, Inc. The American Heritage Medical Dictionary Copyright 2007, 2004 by Houghton Mifflin Company. Published by Houghton Mifflin Company . All rights reserved.

Prepared by: Hernandez, Maria Jeanette J. Year & Section: HCS II-201

Submitted to: Emerita Abendanio, R.N, MAN PROFESSOR