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Leptospirosis

DHANVANTARI by BUDDHA BASNYAT, MD


Twenty-five year old Ram Devi Shakya presented to a hospital with high fever, conjunctivitis, muscle pain, and breathing problems for a week. She was treated for typhoid fever, but did not improve. Meningitis was considered, but this was ruled out with appropriate tests. Her condition continued to deteriorate, and her husband agreed to pay for her blood sample to be shipped to Mumbai for further tests. The doctors continued with three new antibiotics, but to no avail. She died on the tenth day of hospitalisation. The report from Mumbai came back later with the diagnosis of Leptospirosis.

Leptospirosis comes from Greek and means finely coiled organisms (spirochetes). In a study done at Patan Hospital and published in the American Journal of Tropical Medicine and Hygiene in 2004, leptospirosis ranked fourth (after typhoid, typhus and pneumococcal pneumonia ) as the cause of fever in over 800 consecutively admitted hospital patients. And yet for some reason this disease is under-emphasised in medical colleges and residency programs here. Many doctors in Nepal and India fail to consider leptospirosis in the differential diagnosis of fever.

Leptospires are organisms which persist in the kidneys of rats and other animals. Humans may be infected with rat urine. Exposure to rat urine ( for example from puddles of water on the roadside) through an abrasion on the skin followed by flu-like illness approximately one week later is typical of leptospirosis. Many patients with mild disease will have resolution of their symptoms. However some like Ram Devi Shakya may have severe leptospirosis, also known as Weil's Disease which is characterised by respiratory and renal complications. Diagnosis is usually established by finding eitherhigh serum antibodies against leptospiraor polychromase chain reaction (PCR) test to look for leptospira DNA. Neither test is readily available in Nepal.

Arguably, the drug of first choice for a patient with leptospirosis would have been the humble penicillin which is seldom used in Nepali hospitals. Hence the importance of knowing what are the specific fever-causing bugs in our community with which Nepalis may be infected and empirically treating with appropriate antibiotics based on that knowledge even when laboratory back up is pending (specimen sent abroad in this case) or unavailable.



1. sukha

This is a welcome change from the last article. The lady whom you have quoted ; I guess was a Nepali residing in  somewhere in Nepal ( not in  Yuma). And, I agree that leptspirosis is a problem in Nepal .

But,  I feel like reading information  at Wikipedia. For information, please check: http://en.wikipedia.org/wiki/Leptospirosis

I guess the wiki gives  better information.

Being a weekly newspaper, I wish that NT publishes a thought provoking articles. When you publish a mere  information, which neither gives entertainment, mentation  or provocation,  the buyers of NT will feel cheated.( unless you are a very fortunate and rare nepali, who can assess your website )

Publishing a photograph of coiled shaped creature adds no value to your article. How could this microscopic view of the pathogens will help the common man to understand the disease? May be I have I dim light. maybe  I don't have a stomach to enjoy it. Or,may be this reflects your lack of comprehension on writing.

Let there be stories of experiences, patients and their treating doctors. Let there be an exercise and a debate on nepali health plolicy. Let NT be the best in the  town, not just a another newspaper.

I hope you will take my suggestion in a good spirit. I also conjure the editor to make a note.

 



2. Dr manohar budhathoki
Present score- Sukha 1, Dr Basnyat 0. Although a medic myself and I appreciate the value of the writer's experience and opinion, i have to say Sukha has thoroughly outdone Dr Basnyat in this article and the following commentary. A debate on national health policy or more relevant topics would serve this paper's purpose better. Dr Basnyat should be writing these articles in a professional journal perhaps.


3. Ram Babu
Sukha  as usual needs to think much more clearly to help make his arguments more cogent and understandable. Dr Manohar, from the way Dr Basnyat writes his weekly piece, it seems to me like  he wants to entertain you as well and not just focus on  national health debates and such topics. So sit back and relax and enjoy the show.   


4. Funkybuddha917
Although I'm glad that there's a health related column by an MD in Nepali Times, I share the sentiments of the first two individuals who commented. This article and so many others before are very shallow. Rather than offering half the information one can find on sites like Wikipedia or WebMD, perhaps the writer should spend a little more time on doing research for the articles.

"In a study done at Patan Hospital and published in the American Journal of Tropical Medicine and Hygiene in 2004, leptospirosis ranked fourth (after typhoid, typhus and pneumococcal pneumonia ) as the cause of fever in over 800 consecutively admitted hospital patients." 

Here, it's not clear at all who the patients were. Since the study is from Patan Hospital, one can assume it's probably mostly people from Kathmandu valley and the proximity. But what would be really informative is telling in the article what the distribution of the disease is Nepal wide,  if it is more prevalent in certain places than the others, and in certain professions than the others, and what the preventative measures are. 

When you say "Leptospires are organisms which persist in the kidneys of rats and other animals", it's hard not to be afraid of one's own pet dog! 

And Mr. Ram Babu has no idea what he is talking about. Dr. Basnet wants to entertain us by offering Mrs. Shakya's demise? Enjoy which show? Leptospirosis? 

I agree completely with the first commenter's suggestions in making this column better, and I also hope the author takes these as constructive criticisms, for columns like these are, in essence, public service. 


5. the public
On the contrary, I still believe Dr. Basnyat wins hands down!
Way to go! I would give an A+++ for such type  of writing.
He never fails to amaze me with fascinating facts. We would want more of this in the future.


LATEST ISSUE
638
(11 JAN 2013 - 17 JAN 2013)


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