monsoon fevers

That feverish feeling Your Health DR GITA MATHAI The monsoon may be over but it has left behind the rash of mysterious illnesses it brought with it. All across the country, people are still suffering from high fever, rashes and head and body ache — but the causes are different. There have been deaths from dengue, encephalitis (brain fever) and malaria. While not fatal, chickungunya, influenza, jaundice and typhoid too are making their presence felt. If someone you know “feels sick and feverish”, don’t panic. Get a digital thermometer and check the temperature. Body temperature varies, depending on age, physical activity and time of day. An early morning temperature higher than 37.2°C (>98.9°F) or a late afternoon temperature higher than 37.7°C (>99.9°F) is considered fever. There has been an upsurge in the number of dengue cases this year with reports of fatalities. Four distinct types of viruses cause dengue. So just because you had it once doesn’t mean you are immune. Dengue starts with high fever, red rash, headache, painful blood shot eyes, and severe backache. The fever subsides on its own after 3-4 days, only to return with a vengeance a few days later. The dangerous dengue haemorrhagic fever is caused by two or more sequential infections of different types. The fever is followed by bleeding, falling blood pressure, circulatory collapse and shock. The diagnosis of dengue is confirmed by enzyme linked immunoassay (Elisa) and haemagglutination blood tests. There is no specific treatment or immunisation. Symptomatic treatment with paracetamol helps. If there is bleeding or a falling platelet count, blood transfusions may be required. Malaria sets in with headache, high temperature and diarrhoea. The fever returns every alternate or third day with shivering and sweating. It is diagnosed by checking blood smears. Medication is curative. It is important that treatment be given as soon as possible. Chickungunya sets in suddenly with high fever, red rashes, muscle aches and excruciating pain in the small joints of the hands and feet. Once the fever subsides, the joint pain remains for around 10-15 days in the young, 1-2 months in the middle-aged and 3-6 months or even up to five years in older people. There is no specific curative treatment. Colds occur several times a year, usually when the weather changes. It causes a runny nose, cough, headache, chills, fever and body ache. Influenza or “flu” starts with fever (102-104°F) and symptoms similar to the common cold except in a more severe form. Encephalitis means high fever that may cause seizures or loss of consciousness. The monsoons cause flooding in urban areas. Water stagnates and sometimes the water supply gets contaminated. This leads to diarrhoea, dysentery and hepatitis. In addition, the rodents who get flushed out of their habitat can spread leptospirosis. This is characterised by high fever, severe headache, chills, muscle aches, and vomitting. It may include jaundice, red eyes, abdominal pain, diarrhoea, and rash. There is a lot of overlap between the symptoms of these illnesses. So blood tests are required for an accurate diagnosis. Influenza, typhoid and hepatitis A can be prevented with immunisation. The influenza vaccine has to be taken every year, usually in November. The typhoid vaccine has to be repeated every three years. The hepatitis A vaccine is administered in two doses six months apart for lifetime immunity. Immunisation is also available for Jap B encephalitis. Dengue, malaria, chickungunya and viral encephalitis spread through mosquito bites. Breeding of mosquitoes should be prevented. Mosquito repellent gels, especially ones containing lemon grass oil, are fairly efficient. It is better to apply it to clothes than on skin. Don’t use them on children younger than a year or on pregnant women. • As you walk, turn over discarded tyres, bottle caps and coconut shells so that water does not stagnate inside • Put a handful of salt into air conditioning and cooler trays so that mosquitoes cannot breed • Do not place trays under potted plants. Empty pots and vases regularly • Fix mosquito meshes on open tanks, wells, and doors and windows • Ornamental fish that eat mosquito larvae, such as Gabusia and Poecili (guppy) should be added to public ponds, canals and sewers • Sleep inside a mosquito net to prevent bites. Wear full-sleeved shirts, full pants and covered shoes for the same reason Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in Share on emailShare on printShare on facebookShare on twitterMore Sharing Services

dandruff

Flaky, itchy and embarrassing

Your Health DR GITA MATHAI

Poor hygiene is not to blame Dandruff affects 90 per cent of the population at some time in their lives. It itches uncontrollably and produces an ungroomed appearance, with unsightly white flakes on the hair and clothing. Even newborn babies may develop a greasy, flaky scalp called "cradle cap". This, fortunately, disappears within a few months. Our skin is in a continuous process of renovation. It grows outwards, then dies and is shed. Normally, this is a well-regulated orderly process which takes a little more than 20 days and goes unobserved. In people with dandruff, the process is uncoordinated. The cycle completes itself rapidly in a week or less. Thus there is excessive shedding. The dead cells then cluster together and are visible as clumps or flakes of white material. Although dandruff is not infectious, it is associated with an organism called Malassezia (formerly called pityrosporum). This is a fat-eating, yeast-like fungus that feeds on the sebum secreted by hair follicles. It is present on the scalps of normal healthy individuals without causing problems. At certain times, overgrowth of Malassezia occurs, resulting in irritation and increased skin cell turn over. A large number of dead skin cells are then formed. As these cells fall off, the natural oil from the scalp makes them stick together. This makes the cells white and visible. The sudden overgrowth is caused by a change in the biochemical environment of the scalp. This may be precipitated by the natural hormonal fluctuations of adolescence or aggravated in adult life by stress, illness, neurological disorders and diseases of the immune system. It is a misconception that poor hair hygiene causes dandruff. Actually, excessive use of soaps and shampoos can damage the sensitive skin of the scalp. Dandruff may be confused with other dermatological conditions with a similar appearance, like psoariasis or seborrhic dermatitis. The diagnosis has to be confirmed before treatment is initiated. Treatment has to be individualised. As dandruff is chronic, treatment may have to be continued lifelong. • Mild forms can be controlled with daily cleansing using a gentle shampoo. This reduces oiliness and the build up of dead cells. Baby shampoos can be used as they are mild. • If there has been poor response to the above, one of the various anti-dandruff shampoos sold over the counter can be tried. These contain a range of active ingredients like zinc pyrithione, coal tar, salicylic acid or selenium sulphide. Trial and error will help to determine the most suitable shampoo. Some of these might leave the scalp dry. A conditioner or a non-greasy hair oil can be massaged on the scalp after shampooing. • After cleansing, the hair can be rinsed with a mug of water in which an aspirin tablet has been dissolved. • Ketoconazole shampoos contain a broad-spectrum anti-fungal agent. They may work even when other shampoos have failed. • Dandruff treatment is filled with folklore and word-of-mouth home remedies. Some natural shampoos containing henna, tulasi and neem are effective for some people. In others, if the product is contaminated there may be an allergic reaction. Use one of these shampoos daily until the dandruff is controlled. After that, use it two or three times a week. Sometimes, alternating shampoos of two or three different groups is more effective. The shampoo may have to be left on the scalp for a few minutes to give the active ingredients time to act before it is rinsed. The instructions on the container must be strictly followed. It is better to consult a dermatologist if the dandruff does not improve after a month of self-care. More aggressive treatment with steroid lotions may be required. The risk of persistent dandruff can be reduced by – • Eating a healthy diet with adequate proteins, vitamins and minerals, particularly iron, zinc and calcium • Reducing stress • Adequate exercise, preferably outdoor as sunlight reduces dandruff • Shampooing the hair regularly • Avoiding chemicals like hair sprays, styling gels, mousses and hair waxes Dandruff does not cause or aggravate baldness and hair loss. It is harmless and can be tackled with a little time and effort. Dr Gita Mathai is a paediatrician with a family practice at Vellore. If you have any questions on health issues, please write toyourhealthgm@yahoo.co.in