Wednesday, October 1, 2008

The Symptoms and Treatment of Leptospirosis

Leptospirosis is a bacterial disease that affects humans and animals. It is caused by the bacteria of the genus Leptospira. Leptospirosis is often referred to as Swineherd’s disease, swamp fever, cane-cutter fever, mud fever, canicola fever, hemorrhagic jaundice, icterohemorrhagic fever, rice-field fever, Stuttgart disease and Weil’s disease. Outbreaks are usually caused by exposure to water that is contaminated with the urine of an infected animal. The organism enters the body when the mucous membranes or abraded skin comes in contact with the contaminated environmental source. The infection causes a systemic illness that often leads to renal and hepatic dysfunction.

Leptospirosis was first recognized as an occupational disease of sewer workers in 1883. Occupational exposure accounts for approximately 30-50% of human cases. Occupational groups that are at risk include farm workers, veterinarians, pet shop owners, field agricultural workers, abattoir workers, plumbers, meat handlers and slaughterhouse workers, coal miners, workers in the fishing industry, military troops, milkers and sewer workers.

In 1970 Leptospirosis was also recognized as a recreational disease. Recreational activities that put you at risk include traveling to tropical areas, canoeing, hiking, kayaking, fishing, windsurfing, swimming, waterskiing, wading, riding trail-bikes through puddles, whit-water rafting and other outdoor sports that are played in contaminated water. Camping near and traveling to endemic areas also add to the risk of exposure to Leptospirosis.

Leptospirosis can cause a wide array of symptoms in humans, but some infected persons may have no symptoms at all. Symptoms include high fever, severe headache, chills, muscle aches and vomiting. Other more severe symptoms include jaundice (yellow skin and eyes), red eyes, abdominal pain, diarrhea and rash.

Clinical signs that have been reported in dogs include fever, vomiting, abdominal pain, diarrhea, refusal to eat, severe weakness, depression, stiffness, sever muscle pain and inability to have puppies. Sometimes pets do not have any symptoms. Younger animals are more seriously affected than older animals.

If no treatment is received kidney damage, meningitis, liver failure and respiratory distress could develop. Meningitis is an inflammation of the membrane around the brain and spinal chord. Leptospirosis usually begins abruptly with high fever.

Diagnosis is made by reviewing the history of exposure and clinical suspicion. Blood tests rarely confirm illness in time to affectively treat it, but they can be used to confirm presence of the disease later on. Diagnosis can be confirmed early by identifying Leptospira in cultures of blood, urine or cerebrospinal fluid samples. Diagnosis is also made by detecting antibodies against the bacteria in the blood.

Infected people who don’t develop jaundice usually recover. Jaundice indicates liver damage. This increases the death rate to ten percent. The death rate increases more in people over Sixty years of age. Doxycycline, an antibiotic, can prevent the disease. It is given to people that are exposed to the same source as an infected person. Penicillin, ampicillin and similar antibiotics are given to treat the disease. The more severe infections are treated intravenously with antibiotics.

There are one to two hundred cases of Leptospirosis reported every year in the United States. Fifty percent of these cases occur in Hawaii.

Female Genital Mutilation

Female Genital Mutilation is the partial or total removal of the female external genitalia, which includes the clitoris labia, mons pubis (the fatty tissue over the pubic bone), and the urethral and vaginal openings. Female Genital Mutilation is often called Female Circumcision. This implies that it is similar to male circumcision, but the degree of cutting is much more extensive and it often impairs a woman's sexual and reproductive functions.

Most girls undergo Female Genital Mutilation between the ages of 7 and 10. Female Genital Mutilation seems to be occurring at earlier ages in several countries because parents want to reduce the trauma to the children. Parents also want to avoid government interface and/or resistance of the children as they get older and form their own opinions. Some women undergo Female Genital Mutilation during early adulthood when they marry into a community that practices Female Genital Mutilation or just before or after the birth of their first child. This is common in Mali and Nigeria.

Female Genital Mutilation is practiced in at least 26 of the 43 African countries. Female Genital Mutilation is also found among ethnic groups in Oman, the United Arab Emirates and Yemen. It is also found in parts of India, Indonesia and Malaysia. Female Genital Mutilation has become an important issue in Australia, Canada, England, France and the United States due to continuation of the practice by immigrants from countries where Female Genital Mutilation is common.

TYPE I This is the most common form of Female Genital Mutilation. The clitoris is held between the thumb and index finger and then pulled out and amputated with one stroke of a sharp object. The bleeding is stopped by packing the wound with gauze. A pressure bandage is then applied. Modern trained practitioners may insert one or two stitches around the clitoral artery to stop bleeding.

TYPE II The degree of severity varies a lot in this type. The clitoris is amputated as in Type I. The Labia Minora are partially or totally removed, often with the same stroke. The bleeding is stopped with packing and bandages or by circular stitches that may or may not cover the urethra and part of the vaginal opening. Types I and II account for 85% of all Female Genital Mutilation.

TYPE III An extensive amount of tissue is removed. This is the most extreme form. It involves a complete removal of the clitoris and labia minor along with the inner surface of the labia majora. The raw edges of the labia majora are brought together to fuse. Thorns, poultices or stitching are used to hold them together for two to six weeks. The healed scar creates a hood of skin that covers the urethra and part or most of the vagina. This acts as a physical barrier to intercourse. A small opening is left at the back to allow the flow of urine and menstrual blood. The opening is surrounded by skin and scar tissue. It is usually 2 to 3cm in diameter and may be as small as the head of a matchstick.

TYPE IV This type is unclassified and deals with a variety of procedures. (1) Pricking, piercing, stretching or an incision of the clitoris and/or the labia. (2) Cauterization by burning the clitoris and surrounding tissues. (3) An incision is made to the vaginal wall. (4) Scraping or cutting of the the vagina. (5) An introduction of corrosive substances or herbs into the vagina. Some of these procedures often result in vesicovaginal fistulae and damage to the anal sphincter.


Female Genital Mutilation does irreparable harm. It can result in death through severe bleeding leading to hemorrhagic shock, neurogenic shock as a result of pain and trauma and severe, overwhelming infection and septicemia. Female Genital Mutilation is routinely traumatic. Many girls enter a state of shock that is induced by severe pain, psychological trauma and exhaustion from screaming.

Other harmful physical effects include failure to heal, abscess formation, cysts, excessive growth of scar tissue, urinary tract infection, painful sexual intercourse, increased susceptibility to HIV/AIDS, hepatitis and other blood-borne diseases, reproductive tract infection, pelvic inflammatory disease, infertility, painful menstruation, chronic urinary tract obstruction, bladder stones, urinary incontinence, obstructed labor, increased risk of bleeding and infection during child birth.


Female Genital Mutilation is practiced for several reasons. (1) To control or reduce female sexuality. (2) An initiation for girls into woman-hood, social integration and for the maintenance of social cohesion. (3) Hygiene and aesthetic reasons because it is believed that the female genitalia is dirty and unsightly. (4) It is believed that it enhances fertility and child survival. (5) It is believed that Female Genital Mutilation is a religious requirement.

Since 1998, 16 states have instituted criminal sanctions against the practice of Female Genital Mutilation in the United States. The states include California, Colorado, Delaware, Illinois, Maryland, Minnesota, Missouri, Nevada, New York, North Dakota, Oregon, Rhode Island, Tennessee, Texas, West Virginia and Wisconsin.

A federal law criminalizing the practice was passed in 1996 and became effective in April, 1997. Female Genital Mutilation that is performed on a person under the age of 18 is a federal crime, unless the procedure is necessary to protect the health of a young person or for medical purposes that are connected with labor or birth. The penalty is a fine or imprisonment for up to five years or both. The law specifically exempts cultural beliefs or practices as a defense for conducting Female Genital Mutilation.

It is estimated that 130 million girls and women have undergone Female Genital Mutilation. Approximately 2 million are subjected to this practice worldwide each year worldwide. Female Genital Mutilation is a violation of the rights of girls. It is discrimination and it violates the rights to equal opportunities, health, freedom from violence, abuse, torture, cruel or inhuman and degrading treatment, protection from harmful traditional practices and to make decisions concerning reproduction. These are all rights that are protected in international law.