Diabetes Mellitus

Diabetes mellitus is a condition in which the pancreas no longer produces enough insulin
or when cells stop responding to the insulin that is produced, so that glucose in the blood cannot
be absorbed into the cells of the body. Symptoms include frequent urination, lethargy, excessive
thirst, and hunger. The treatment includes changes in diet, oral medications, and in some cases,
daily injections of insulin.
Diabetes mellitus is a chronic disease that causes serious health complications including renal
(kidney) failure, heart disease, stroke, and blindness. Approximately 14 million Americans
(about 5% of the population) have diabetes. Unfortunately, as many as one-half are unaware that
they have it.
Brief Background
Every cell in the human body needs energy in order to function. The body's primary energy
source is glucose, a simple sugar resulting from the digestion of foods containing carbohydrates
(sugars and starches). Glucose from the digested food circulates in the blood as a ready energy
source for any cells that need it. Insulin is a hormone or chemical produced by cells in the
pancreas, an organ located behind the stomach. Insulin bonds to a receptor site on the outside of
cell and acts like a key to open a doorway into the cell through which glucose can enter. Some of
the glucose can be converted to concentrated energy sources like glycogen or fatty acids and
saved for later use. When there is not enough insulin produced or when the doorway no longer
recognizes the insulin key, glucose stays in the blood rather entering the cells.
The body will attempt to dilute the high level of glucose in the blood, a condition called
hyperglycemia, by drawing water out of the cells and into the bloodstream in an effort to dilute
the sugar and excrete it in the urine. It is not unusual for people with undiagnosed diabetes to be
constantly thirsty, drink large quantities of water, and urinate frequently as their bodies try to get
rid of the extra glucose. This creates high levels of glucose in the urine.
At the same time that the body is trying to get rid of glucose from the blood, the cells are
starving for glucose and sending signals to the body to eat more food, thus making patients
extremely hungry. To provide energy for the starving cells, the body also tries to convert fats and
proteins to glucose. The breakdown of fats and proteins for energy causes acid compounds called
ketones to form in the blood. Ketones will also be excreted in the urine. As ketones build up in
the blood, a condition called ketoacidosis can occur. This condition can be life threatening if left
untreated, leading to coma and death.
Diabetes mellitus is a condition in which the pancreas no longer produces enough insulin or cells
stop responding to the insulin that is produced, so that glucose in the blood cannot be absorbed
into the cells of the body. Symptoms include frequent urination, lethargy, excessive thirst, and
hunger. The treatment includes changes in diet, oral medications, and in some cases, daily
injections of insulin.
The most common form of diabetes is Type II, It is sometimes called age-onset or adult-onset
diabetes, and this form of diabetes occurs most often in people who are overweight and who do
not exercise. Type II is considered a milder form of diabetes because of its slow onset
(sometimes developing over the course of several years) and because it usually can be controlled
with diet and oral medication. The consequences of uncontrolled and untreated Type II diabetes,
however, are the just as serious as those for Type I. This form is also called noninsulin-
dependent diabetes, a term that is somewhat misleading. Many people with Type II diabetes can
control the condition with diet and oral medications, however, insulin injections are sometimes
necessary if treatment with diet and oral medication is not working.
The causes of diabetes mellitus are unclear, however, there seem to be both hereditary (genetic
factors passed on in families) and environmental factors involved. Research has shown that some
people who develop diabetes have common genetic markers. In Type I diabetes, the immune
system, the body’s defense system against infection, is believed to be triggered by a virus or
another microorganism that destroys cells in the pancreas that produce insulin. In Type II
diabetes, age, obesity, and family history of diabetes play a role.
In Type II diabetes, the pancreas may produce enough insulin, however, cells have become
resistant to the insulin produced and it may not work as effectively. Symptoms of Type II
diabetes can begin so gradually that a person may not know that he or she has it. Early signs are
lethargy, extreme thirst, and frequent urination. Other symptoms may include sudden weight
loss, slow wound healing, urinary tract infections, gum disease, or blurred vision. It is not
unusual for Type II diabetes to be detected while a patient is seeing a doctor about another health
concern that is actually being caused by the yet undiagnosed diabetes.
Type 1 diabetes
Type 1 diabetes mellitus is characterized by loss of the insulin-producing beta cells of the islets
of Langerhans in the pancreas leading insulin deficiency. This type of diabetes can be further
classified as immune-mediated or idiopathic. The majority of type 1 diabetes is of the immune-
mediated nature, where beta cell loss is a T-cell mediated autoimmune attack.[2] There is no
known preventive measure against type 1 diabetes, which causes approximately 10% of diabetes
mellitus cases in North America and Europe. Most affected people are otherwise healthy and of a
healthy weight when onset occurs. Sensitivity and responsiveness to insulin are usually normal,
especially in the early stages. Type 1 diabetes can affect children or adults but was traditionally
termed "juvenile diabetes" because it represents a majority of the diabetes cases in children.
Type 2 diabetes
Type 2 diabetes mellitus is characterized by insulin resistance which may be combined with
relatively reduced insulin secretion. The defective responsiveness of body tissues to insulin is
believed to involve the insulin receptor. However, the specific defects are not known. Diabetes
mellitus due to a known defect are classified separately. Type 2 diabetes is the most common
type.
In the early stage of type 2 diabetes, the predominant abnormality is reduced insulin sensitivity.
At this stage hyperglycemia can be reversed by a variety of measures and medications that
improve insulin sensitivity or reduce glucose production by the liver. As the disease progresses,
the impairment of insulin secretion occurs, and therapeutic replacement of insulin often becomes
necessary
Medical Management
Diabetes mellitus a chronic disease which is difficult to cure. Management concentrates on
keeping blood sugar levels within normal limits. This can usually be via diet, exercise, and use of
appropriate medications (oral medications and insulin).
PATHOPSIOLOGY
Cerebrovascular Disorders – are those problems that result from
inadequate blood supply to the brain. Stroke is probably the first
disorder that comes to mind in considering cerebrovascular
disorders. Although stroke is the most common problem,
cereebrovascular disorders encompass other disorder of blood
supply to the brain.

Cerebrovascular accident (CVA) or storke os infraction (death) of

a specific portion of the brain due to sufficient blood supply. Stoke
can occur from an occlusion (blockage) of one of the major vessel,
or hemorrhage within the brain. The blood vessel affected
determines the area and extent of infarction.

Etiology:

Narrowing or complete closure of one of the vessels supplying the

brain is the most common cause of CVA. The most common cause
of CVA are thrombosis, embolism and hemorrhage . Stroke is less
common from vascular compression or arterial spasm.

Risk factor related to stroke:

>Cardiac disease: myocardial infarction, coronary artery disease,

left ventricular hypertrophy .

> Hypertension, Smoking, oral contraceptives use, obesity Family

history of stroke

Medical Management:

>medical management and control of diabetes, hypertension and

cardiac disease decrease the stroke factors these disease
present.Client need education regarding the interaction of various
diasease processes and how this disease can increased the
severity of each other.

>Medical Management of the client after CVA is directed toward

(1) Preserving life,(2) Minimizing residual deformity,(3) reducing
ICP (4) preventing extension or recurrence.

> The client placed at bed rest with the head elevated to 30% to
reduced ICP and facilitate venous drainage. Sometimes, external
ventriculostomy drainage is used for few days to reduce pressure
from cerebrospinal fluid (CSF) accumulation. Blood pressure and
the level of consciousness (LOC) are closely monitored. The goal
is to maintain blood pressure enough to prevent another stroke or
hemorrhage but not to the point at which cerebral perfusion is
decreased. Because many clients with hemorrhagic stroke have a
history of hypertension it is common to maintain their systolic
blood pressure at 150 to 160 mmHg.

Transient Ischemic Attack

Defination:

TIAs are brief reversible episodes of neurologic dysfunction

caused by temporary, focal erebral ischemia. A TIAs ia analogous
to angina pectoris.TIAs are also called intermittent
cerebrovascular insufficiency or “mini- stroke”

Most strokes aren't preceded by TIAs. However, of the people who've had one or more
TIAs, more than a third will later have a stroke. In fact, a person who's had one or more
TIAs is more likely to have a stroke than someone of the same age and sex who hasn't.
TIAs are important in predicting if a stroke will occur rather than when one will happen.
They can occur days, weeks or even months before a major stroke. In about half the
cases, the stroke occurs within one year of the TIA.

Etiology:
During a TIAs,a transient decrease occurs in the blood supply to a
focal area of the cerebrum or brain stem. Many factors can cause
this ischemia. Occlusive disease of the extracranial cerebral
vessel is the most common cause of TIAs. The most frequent site
od occlusion is the origin of the internal carotid artery, In addition
to the carotid artery system, occlusions may occur in the
vertebrobasilar system, emboli can cause also TIAs, common
source of emboli include the heart valves and breakdown of
plaque.

Risk factors;

The risk factor and preventive measures of TIAs are essentially

the same of those of CVAs. The pathophysiology is also similar the
major differences are the duration and permanency of symptoms.

Medical Management:

Preventing the progression of a TIA to CVA is the goal of medical

management. Antihypertensives, antiplatelet drugs or aspirin
may be prescribed, In some instances, warfarin (Coumadin) may
be administered to prevent clot development. Every effort is
made to be determine the cause of the TIAs.
Gastroenteritis- is an inflammation of the stomach and intestinal tract that primarily
affects the small bowel. It is associated with abdominal cramps, diarrhea, vomiting and
fever.

Acute gastroenteritis is a common and costly clinical problem in children. It is a largely self-limited disease
with many etiologies. The evaluation of the child with acute gastroenteritis requires a careful history and a
complete physical examination to uncover other illnesses with similar presentations. Minimal laboratory
testing is generally required. Treatment is primarily supportive and is directed at preventing or treating
dehydration. When possible, an age-appropriate diet and fluids should be continued. Oral rehydration
therapy using a commercial pediatric oral rehydration solution is the preferred approach to mild or
moderate dehydration. The traditional approach using "clear liquids" is inadequate. Severe dehydration
requires the prompt restoration of intravascular volume through the intravenous administration of fluids
followed by oral rehydration therapy. When rehydration is achieved, an age-appropriate diet should be
promptly resumed. Antiemetic and antidiarrheal medications are generally not indicated and may
contribute to complications. The use of antibiotics remains controversial. (Am Fam Physician
AcuteAcute gastroenteritisgastroenteritisgastroenteritis could be more simply called a long, and potentially
lethal bout of stomach flu. The most common symptoms are diarrhea, vomiting and stomach pain, because
whatever causes the condition inflames the gastrointestinal tract. AcuteAcuteAcute
gastroenteritisgastroenteritisgastroenteritis is quite common among children, though it is certainly possible for
adults to suffer from it as well. While most cases of gastroenteritisgastroenteritisgastroenteritis last a few days,
acuteacuteacute gastroenteritisgastroenteritisgastroenteritis can last for weeks and months.
Etiology :
That can cause of gastroenteritis is usually a virus or bacteria. The virus varies and often referred to as
“flu” In staphylococcal food poisoning, the bacteria produce a toxin when infected foods are allowed to
remain warm for a time before being eaten.
Risk factor;
Viral gastroenteritis is often associated with crowds and frequently occurs more in the fall and winter
months. Yearly, different vaccines are available for viral enteritis, based on the likely viral source for that
given year.
The risk factor for gastroenteritis caused by food poisoning are improper handling and storage of food or
food handling by individuals .
Medical management:
Management of gastroenteritis includes resting the GI tract, and fluids. Rest with nothing by mouth until
the vomiting has stopped is the best intervention .

Pyelonephritis – is an inflammation of the renal pelvis caused by bacterial infection.

Etiology:
Sometimes an infection may be a primary disease, as happens with calculus, malignancy,
hydronephrosis, or trauma that has reduced host resistance.
Acute pyelonephritis – often occurs after bacterial contamination of the urethra or after instrumentation
such as catherization or cystoscopy.
Acute pyelonephritis is associated with the development of renal abscesses perinephric
abscesses, emphysematous pyelonephrits that can lead to renal failure.
Medical management:
Acute pyelonephritis: Intervention aims at eliminating the pathogenic organism with appropriate
antibiotics as identified by urine culture and sensitivity study and removing any co,ponent contributing to
decreased host resistance. If calculi are found during the work up for the cause of recurrent infection,
appropriate treatment as instituted.

Acute Glomerulonephritis-
Definition:
Glomerulonephrits is a term that encompasses a variety of disease, most of which are caused by an
immunologic reaction that, in turn, results in proliferative and inflammatory changes within the glomerular
structure Two forms of glomerulonephritis are included in the category of acute
glomerulonephritis:postinfectious glomerulonephritis and infectious glomrulonephritis.

Etiology
Classically , the causative system based factor is a beta – hemolytic streptococcal infection
elsewhere in the body although other organisms may be responsible. Typically it occurs about 21 days
after respiratory or skin infection.
Glomerulonephritis, primary
Acute glomerulonephritis
>postinfectious glomerulonephritis
>infectious glomerulonephritis
>Focal Glomerular sclerosis
* Infectious glomerulonephritis is also associated with bacterial viral or parasitic infectious elsewhere in
the body. It differs from postinfectious glomerulonephritis in that it occurs during or with in afew days of
the original infectious process.
Medical management
Medical interventions aims to eliminate antigens to alter the client’s immune balance and to inhibit or
alleviate the inflammation for prevention of further renal damage an improvement of the kidney
Plsmapheresis may be used in some research protocols for certain types of glomerulonephritis, including
rapidly progressive glomerulonephritis.

Hepatic Encephalopathy
Definition –encompasses a spectrum of central nervous system (CNS) disturbances. These
disturbance may appear in sonjunction with severe liver injury, liver failure, or portal
shunt,

Etiology: of this disorder is the liver’s inability to metabolize ammonia to form urea that is
then excreted. Ammonia is a CNS depressant . Changes during the initial stages the hepatic
encephalopathy include reduced mental alertbess confusion, and restlessness. Loss of
consciousness, seizure, and irreversible coma occur in the terminal stage.
Medical management The goals of intervention for client with hepatic encephalopathy are
(1) control further degenerative processe, (2) correct present metabolic imbalancs, and (3)
preserve remaining physiologic functioning.
Five principles guide intervention in hepatic encephalopathy:
1. reduce protein in the intestine. Reducing dietary protein erves to reuce protein in the
intestine. If no other precipitating factors are present, this alone may eliminate symptoms.
2. Prevent gastrointestinal bleeding, or, if it occurs, quickly remove the blood from the
gastrointestinal tract with lactulose enemas.
3. Reduce bacterial production of ammonia. Neomycin and lactulose are useful
paharmacologic agents for this purpose.
4.Eliminate fluids and electrolytes imbalances, hypoxia, infection, and sedation.
5. Maintain sfety and function in the unconscious client. The immobile client who lacks
reflexes is vulnerable to numerous complications.
1
>
Liver cirrhosis
Definition:
Cirrhosis is the liver is the disorganization of the liver Arrchitecture by widespread fibrosis
and nodule formation Cirrhosis occurs when the normal flow of blood, vile, and hepatic
metabolites is altered by fibrosis and changes in the hepatocytes, bile ductules, vascular
channels and reticular cells.

Etiology:
The exact causes of cirrhosishave not been clearly identified. Genetic predisposition with
afamilial tendency, as well as a hypersensitivity to alcohol is seen in alcoholic cirrhosis
Laennec’s or micronodular cirrhosis is most commonly found in a client who
chronically abuse alcohol. Howeverl it is also found in nondrinkers. The quantity of alcohol
that causes the diffuse scarring of micronodular cirrhosis varies from client to client

Cerebrovascular accident: The sudden death of some brain cells due to lack of oxygen when
the blood flow to the brain is impaired by blockage or rupture of an artery to the brain. A CVA is
also referred to as a stroke.
Symptoms of a stroke depend on the area of the brain affected. The most common symptom is
weakness or paralysis of one side of the body with partial or complete loss of voluntary
movement or sensation in a leg or arm. There can be speech problems and weak face muscles,
causing drooling. Numbness or tingling is very common. A stroke involving the base of the brain
can affect balance, vision, swallowing, breathing and even unconsciousness.
Cerebrovascular accident or stroke (also called brain attack) results from sudden interruption of
blood supply to the brain, which precipitates neurologic dysfunction lasting longer than 24 hours.
Stroke are either ischemic, caused by partial or complete occlusions of a cerebral blood vessel by
cerebral thrombosis or embolism or hemorrhage (leakage of blood from a vessel causes
compression of brain tissue and spasm of adjacent vessels). Hemorrhage may occur outside the
dura (extradural), beneath the dura mater (subdural), in the subarachnoid space (subarachnoid),
or within the brain substance itself (intracerebral).
Risk factors for stroke include transient ischemic attacks (TIAs) – warning sign of impending
stroke – hypertension, arteriosclerosis, heart disease, elevated cholesterol, diabetes mellitus,
obesity, carotid stenosis, polycythemia, hormonal use, I.V., drug use, arrhythmias, and cigarette
smoking. Complications of stroke include aspiration pneumonia, dysphagia, constractures, deep
vein thrombosis, pulmonary embolism, depression and brain stem herniation.

A stroke (sometimes called an acute cerebrovascular attack) is the rapidly developing loss of
brain function(s) due to disturbance in the blood supply to the brain. This can be due to ischemia
(lack of glucose & oxygen supply[1]) caused by thrombosis or embolism or due to a hemorrhage.
As a result, the affected area of the brain is unable to function, leading to inability to move one
or more limbs on one side of the body, inability to understand or formulate speech, or inability to
see one side of the visual field.[2]
A stroke is a medical emergency and can cause permanent neurological damage, complications,
and death. It is the leading cause of adult disability in the United States and Europe. It is the
number two cause of death worldwide and may soon become the leading cause of death
worldwide.[3] Risk factors for stroke include advanced age, hypertension (high blood pressure),
previous stroke or transient ischemic attack (TIA), diabetes, high cholesterol, cigarette smoking
and atrial fibrillation.[4] High blood pressure is the most important modifiable risk factor of
stroke.[2]
The traditional definition of stroke, devised by the World Health Organization in the 1970s,[5] is a
"neurological deficit of cerebrovascular cause that persists beyond 24 hours or is interrupted by
death within 24 hours". This definition was supposed to reflect the reversibility of tissue damage
and was devised for the purpose, with the time frame of 24 hours being chosen arbitrarily. The
24-hour limit divides stroke from transient ischemic attack, which is a related syndrome of stroke
symptoms that resolve completely within 24 hours.[2] With the availability of treatments that,
when given early, can reduce stroke severity, many now prefer alternative concepts, such as
brain attack and acute ischemic cerebrovascular syndrome (modeled after heart attack and
acute coronary syndrome respectively), that reflect the urgency of stroke symptoms and the need
to act swiftly.[6]
A stroke is occasionally treated with thrombolysis ("clot buster"), but usually with supportive
care (speech and language therapy, physiotherapy and occupational therapy) in a "stroke unit"
and secondary prevention with antiplatelet drugs (aspirin and often dipyridamole), blood
pressure control, statins, and in selected patients with carotid endarterectomy and
anticoagulation.[2
Strokes can be classified into two major categories: ischemic and hemorrhagic.[7]
Ischemic strokes are those that are due to interruption of the blood supply, while
hemorrhagic strokes are the ones which are due to rupture of a blood vessel or an
abnormal vascular structure. 80% of strokes are due to ischemia; the remainder are
due to hemorrhage. Some hemorrhages develop inside areas of ischemia
("hemorrhagic transformation"). It is unknown how many hemorrhages actually
start off as ischemic stroke.[2]

Ischemic stroke
Main articles: Cerebral infarction and Brain ischemia
In an ischemic stroke, blood supply to part of the brain is decreased, leading to dysfunction of
the brain tissue in that area. There are four reasons why this might happen:
1. Thrombosis (obstruction of a blood vessel by a blood clot forming locally)
2. Embolism (obstructiond due to an embolus from elsewhere in the body, see below),[2]
3. Systemic hypoperfusion (general decrease in blood supply, e.g. in shock)[8]
4. Venous thrombosis.[9]
Stroke without an obvious explanation is termed "cryptogenic" (of unknown origin); this
constitutes 30-40% of all ischemic strokes.[2][10]
There are various classification systems for acute ischemic stroke. The Oxford Community
Stroke Project classification (OCSP, also known as the Bamford or Oxford classification) relies
primarily on the initial symptoms; based on the extent of the symptoms, the stroke episode is
classified as total anterior circulation infarct (TACI), partial anterior circulation infarct (PACI),
lacunar infarct (LACI) or posterior circulation infarct (POCI). These four entities predict the
extent of the stroke, the area of the brain affected, the underlying cause, and the prognosis.[11][12]
The TOAST (Trial of Org 10172 in Acute Stroke Treatment) classification is based on clinical
symptoms as well as results of further investigations; on this basis, a stroke is classified as being
due to (1) thrombosis or embolism due to atherosclerosis of a large artery, (2) embolism of
cardiac origin, (3) occlusion of a small blood vessel, (4) other determined cause, (5)
undetermined cause (two possible causes, no cause identified, or incomplete investigation).[2][13]
[edit] Hemorrhagic stroke
Main articles: Intracranial hemorrhage and intracerebral hemorrhage

CT scan showing an intracerebral hemorrhage with associated intraventricular hemorrhage.

Intracranial hemorrhage is the accumulation of blood anywhere within the skull vault. A
distinction is made between intra-axial hemorrhage (blood inside the brain) and extra-axial
hemorrhage (blood inside the skull but outside the brain). Intra-axial hemorrhage is due to
intraparenchymal hemorrhage or intraventricular hemorrhage (blood in the ventricular system).
The main types of extra-axial hemorrhage are epidural hematoma (bleeding between the dura
mater and the skull), subdural hematoma (in the subdural space) and subarachnoid hemorrhage
(between the arachnoid mater and pia mater). Most of the hemorrhagic stroke syndromes have
specific symptoms (e.g. headache, previous head injury). Intracerebral hemorrhage (ICH) is
bleeding directly into the brain tissue, forming a gradually enlarging hematoma (pooling of
blood).[citation needed]
The following are the symptoms of Cerebrovascular accident:
• Headache
• Dizziness and confusion
• Visual disturbance
• Slurred speech or loss of speech
• Difficulty of swallowing
Risk factors:
• Age
• High blood pressure – weakens the walls of arteries
• Atherosclerosis – narrowed artery channels
• Heart disease – cause blot clot in the heart that may break off and migrate to the brain.
 • Diabetes mellitus – accelerated degeneration of small blood vessel
• Smoking – increase the risk ofhypertension
• Polycythemia – a raised level of red cells in the blood.
• Hyperlipidemia – high level of fatty substances in the blood

Definition & Background:

• a bacterial zoonotic disease caused by spirochaetes of the genus Leptospira that affects
humans and a wide range of animals, including mammals, birds, amphibians, and reptiles
• first described by Adolf Weil in 1886 when he reported an “acute infectious disease with
enlargement of spleen, jaundice and nephritis”
Causative Agent:
• Leptospira-genus bacteria was isolated in 1907 from post mortem renal
tissue slice
• commonly found: Leptospira pyrogenes, Leptospira manilae, & other species
like L. icterohemorrhagiae, L. canicola, L. batavia, L. Pomona, L. javinica
• in animals often is subclinical; an infected animal may appear healthy even
as it sheds leptospires in its urine; humans are dead-end hosts for the
leptospire
Predisposing Factors:
• age: < 15 years of age
• sex: male
• season: rainy months
• geographic: prevalent in slum areas
Source of Infection
Infection comes form contaminated food and water, and infected wild life and domestic animals
especially rodents.
1. Rats ( L. leterohemoragiae) are the source of Weil’s disease frequently
observed among miners, sewer, and abattoir workers.
2. Dogs (L. canicola) can also be the source of infection among veterinarians,
breeders, and owners of dogs.
3. Mice (L. grippotyphosa) may alos be a source of infection that attacks
farmers and flax workers.
4. Rats (L. bataviae) are the source of infection that attacks ricefield workers.
Modes of Transmission
Incubation Period:
• 6 – 15 days/ 2 – 8 weeks
• Clinical Manifestations:
1st stage: Septicemic/ Leptospiremic Phase (4 – 7 days)
- onset of high remittent fever, chills, headache, anorexia, nausea & vomiting,
abdominal pain, joint pains, muscle pains, myalgia, severe prostration, cough, respiratory
distress, bloody sputum.
• 2nd stage: Immune/ Toxic Phase (4 – 30 days)
- if severe, death may occur between the 9th & 16th day
Complications:
• pneumonia
• iridocyclitis, optic neuritis
• peripheral neuritis

Prognosis:
• cause of death: renal & hepatic failure
• dse usually last 1 – 3 weeks but may be more prolonged; relapse may occur
Treatment:
• specific measures: beneficial if done < 4 days of dse
Treatment
Leptospirosis is treated with antibiotics, penicillin (Bicillin, Wycillin), doxycycline (Monodox), ibramycin, or
erythromycin (E-mycin, Ery-Tab). As of the early 2000s, however, many doctors prefer to treat patients
with ceftriaxone, which is easier to use than intravenous penicillin. Ciprofloxacin may be combined with
other drugs in treating patients who develop uveitis. It is generally agreed that antibiotic treatment during
the first few days of illness is helpful. However, leptospirosis is often not diagnosed until the later stages
of illness. The benefit of antibiotic treatment in the later stages of disease, however, is controversial. A
rare complication of antibiotic therapy for leptospirosis is the occurrence of the Jarisch-Herxheimer
reaction, which is characterized by fever, chills, headache, and muscle pain.
Patients with severe illness will require hospitalization for treatment and monitoring. Medication or other
treatment for pain, fever, vomiting, fluid loss, bleeding, mental changes, and low blood pressure may be
provided. Patients with kidney failure will require hemodialysis to remove waste products from the blood.
Prevention
Persons who are at an extremely high risk (such as soldiers who are training in wetlands) can be
pretreated with 200 mg of doxycycline once a week. As of the early 2000s, there are no vaccines
available to prevent leptospirosis in humans, although such vaccines have been formulated by
veterinarians for dogs, swine, and cattle.
There are many ways to decrease the chances of being infected by Leptospira. These include:
• Avoid swimming or wading in freshwater ponds and slowly moving streams, especially those
located near farms.
• Do not conduct canoe or kayak capsizing drills in freshwater ponds. Use a swimming pool
instead.
• Boil or chemically treat pond or stream water before drinking it or cooking with it.
• Control rats and mice around the home.
• Have pets and farm animals vaccinated against Leptospira.
• Wear protective clothing (gloves, boots, long pants, and long-sleeved shirts) when working with
wet soil or plants.
Dengue and dengue haemorrhagic fever is a viral illness that is spread from human-to-human by the
bite of dengue virus-carrying mosquitoes. It has become the most common arboviral illness (infections
caused by viruses transmitted by arthropods such as mosquitoes and ticks) transmitted worldwide,
with about two fifths of the world's population now at risk. It is becoming a major public health
problem.
Dengue infection causes a severe flu-like illness and is known as dengue fever. Some patients who
have suffered dengue fever from one of four serotypes of dengue virus may be re-infected with
another dengue serotype and develop a more severe form of dengue fever called dengue
haemorrhagic fever. This is a leading cause of serious illness among children in some Asian countries
and can lead to dengue shock syndrome, which may cause death.