Water-borne diseases and conditions due to contaminated food include diarrhea (gastroenteritis, food poisoning), dysentery, typhoid, hepatitis, and leptospirosis. Many of these are common in the rains due to water contamination. Knowing the symptoms, and simple household protective measures can go a long way in controlling and preventing these water-borne diseases
Why is there more water and food contamination during the rains?
Increased contamination of water during rains is because of rain-water falling on garbage dumps, ditches and areas of waste which are rich in infection-causing organisms, and this water flows down as surface ‘runoff’ into our water sources.
When such contaminated water is directly consumed or when food contaminated with such water is eaten, the body can get exposed to these infective organisms (like bacteria, viruses and parasites), leading to what we call the ‘water-borne diseases.’
Which are the common water-borne diseases?
DIARRHEA AND DYSENTERY
These are the most common water-borne diseases, caused when water contaminated with bacteria, viruses or parasites is consumed, or when food contaminated or prepared with such water is eaten. That is why sometimes the word food poisoning is used. ‘Gastro-enter-itis’ means inflammation (itis) due to injury to the stomach (gastro) and intestine (enteral) lining which causes the symptoms.
Diarrhea may be caused by bacteria (commonest bacterium is E coli – also called traveler’s diarrhea due to roadside eating/drinking), some viruses or sometimes a parasite (called Giardia). Diarrhea caused by Giardia (Giardiasis) lasts for 2-4 weeks or longer with a bad taste in the mouth, foul-smelling greasy stools, belching, gas and weight loss, therefore Giardiasis should be suspected if any diarrhea lasts more than one week. In children under 5 years, a virus called Rotavirus can cause profuse watery diarrhea, fever, vomiting and abdominal pain, for which a vaccine is now available and given by 6 months of age to all children.
Dysentery (Diarrhea with blood and mucus in stools), can be caused by a parasite (Entamoeba) or by bacteria (commonest bacteria is Shigella). The main difference is that amoebic dysentery (amoebiasis) presents with around 6-8 motions/day with each motion having large amounts of foul-smelling, semi-formed stools that do not stick to the sides of the commode and contain dark red blood. The bacterial dysenteries present with >10 motions a day with each motion having small amounts of odorless, watery stools that stick to the sides of the commode and contain bright red blood.
Doctors may sometimes order a stool test to identify causative parasites or bacteria, or in some cases prescribe a combination of antibiotic-antiparasite medicines.
Preventing dehydration is the most important treatment for diarrhea and dysentery. Oral Rehydration Solution (ORS) is available in all chemists and these should be regularly taken mixing in clean boiled 1-liter water. Similar solutions can be prepared at home with half teaspoon salt and 6 teaspoons sugar in 1 liter clean boiled water. Hospitalization for giving intravenous fluids and antibiotics should be done if the patient is unable to take fluids orally and has developed signs of dehydration.
If symptoms of Worms, (commonly roundworms, thread/pinworms and sometimes tapeworms), are present especially in children, a stool test is helpful to detect worms and their type, followed by appropriate de-worming medication given by the doctor.
Typhoid is caused by a bacteria called Salmonella typhi (sometimes related bacteria called S.paratyphi may cause a similar illness).
The symptoms of typhoid can be quite similar to viral flu or some of the mosquito-borne fevers (like malaria and dengue), and all of these diseases spread much more in the rainy season. So usually a blood test (called Widal test) is done, along with blood ‘culture’ (to grow, isolate and confirm the presence of the causative bacteria). The doctor may simultaneously order blood tests for typhoid, malaria and dengue to confirm the diagnosis. Sometimes additional urine and stool tests may also be performed to confirm typhoid.
Typhoid is usually managed on an outpatient/ home-care basis. Treatment includes appropriate antibiotics, fluids to maintain hydration and supportive medicines for fever and pain. Diet should be soft and easily digestible like soft rice, with pulses (dal khichdi), cooked vegetables, coconut water, buttermilk, fruit juices, mashed bananas/apples and potatoes. Hospitalization is needed if the patient is unable to take fluids or medicines orally due to severe vomiting.
Typhoid recovers well with treatment but rarely, complications can occur, like perforation of the intestine with internal bleeding and spread of infection in the abdomen. Typhoid may also cause complications by affecting the lungs (pneumonia), heart (myocarditis, endocarditis), urinary bladder (cystitis), pancreas (pancreatitis) and brain-spinal cord (meningitis). The fatality rates are about 1 in 1000.
Typhoid Vaccination is available and now part of the childhood immunization schedule.
Water-borne Hepatitis is caused by 2 kinds of viruses (Hepatitis A and E virus), while the other forms of Hepatitis (B, C, D) are spread by blood contact and have more serious and long term consequences. Hepatitis as the name suggests is primarily an infection of the liver. Both Hepatitis A and E present with similar symptoms. Hepatitis A occurs mostly in children, however, it can affect adults also in whom it can rarely cause complications of liver failure (mortality around 5 in 1000). Hepatitis E mainly affects young adults, but in pregnant women, it can be severe with complications (sometimes fatal 1 in 5).
Diagnosis is made by a blood test to detect the hepatitis virus antibodies and monitored with Liver function tests (blood bilirubin, liver enzymes and protein levels).
Usually, water-borne Hepatitis resolves on its own with adequate fluid, rest and appropriate diet (balanced, nutritious diet, low on fats). In fact, no medicines are recommended as they put a load on the liver. Alcohol and smoking should be strictly avoided.
Vaccine for Hepatitis A is available, while for Hepatitis E currently it is only developed in China.
The bacteria that cause leptospirosis are spread through the urine of infected animals like rats, pigs, dogs and cattle. Humans can be infected through contact with water or soil containing animal urine. The bacteria can enter the body through a cut or scratch in the skin. Drinking contaminated water can also cause infection. Those people who wade/walk through puddles or accumulated rain-water are especially at risk.
A specific blood test is available to confirm the diagnosis. Antibiotics, fluids and supportive care for fever is the usual treatment, however, hospitalization is usually recommended as lung or kidney complications can occur, and the fatality rate is about 1 in 20.
PROTECTION AGAINST WATER-BORNE DISEASES
Prevention is better than cure
People who wade/walk through puddles or accumulated rain-water without appropriate protective footwear are especially at risk of Leptospirosis. They should wash their legs thoroughly on return.
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