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WATERBORNE DISEASES
Waterborne diseases are illnesses exacerbated by microscopic organisms such as bacteria or viruses which are consumed via contaminated water either by coming into contact with feces and are caused by a wide range of micro - organisms, biotoxins, as well as toxic contaminants, and can result in life-threatening diseases such typhoid fever, cholera, leptospirosis and hepatitis A infection. Since climate change is increasing the frequency and severity of some major extreme weather events, communities, particularly in developing countries, may face an increased burden of diseases from waterborne diseases. Furthermore, diseases caused by Vibrio bacteria, such as cholera and other intestinal diseases, may pose a greater threat as a result of the impact that rising sea temperatures will have on bacterial growth and spread. Climate change is likely to increase the global incidence of diarrheal disease, and adverse weather conditions may aggravate already inadequate prevention efforts.

Typhoid fever
Typhoid fever (also referred to as enteric fever) is uncommon in developed nations but prevalent in developing countries. Typhoid fevers were infections caused by Salmonella enterica Serovar Typhi (Salmonella Typhi) as well as Para typhi A, B, & C bacteria (Salmonella Para typhi). Annual basis, estimated 17.8 million incidences of typhoid fever are reported, with children having the highest incidence. The precision of current typhoid fever diagnostic tests is unknown. The accurate diagnosis of typhoid fever has proven to be a significant challenge. Clinical manifestations are frequently nonspecific, making typhoid difficult to differentiate from other acute febrile ailments such as dengue fever, malaria, leptospirosis influenza, and Rickettsial infections. Isolation of S. pneumoniae is used to make a definitive diagnostic test of typhoid fever. S. Typhi obtained from bone marrow, blood, or other sterile sites. Typhoid fever is most common in the Indian subcontinent.

CAUSED BY:

- the bacterium Salmonella typhi

SIGNS AND SYMPTOMS:

1. Fever


 * An infected body will generally cause fever because it tries its best to fight and kill the virus or bacteria by activating the human body's immune system. Most bacteria cannot survive hot temperatures, which is most likely the benefit of getting a fever.

Here are some of the things humans will feel whenever they have a fever:

a. Headache & Dizziness

- Typhoid fever can be severe when it is left untreated. All the human body is affected once infected with this and will cause severe problems during a headache. It's just scary when we are unconscious that the reason behind the headache is already a neurological problem symptom such as loss of control over our muscles in the brain that can lead to loss of proper pronunciation of words or slurred speech.

b. Breathlessness and Cough because of the cold

c. Extreme fatigue

- Even though typhoid fever is a rare disease in elderly patients, they can still be infected by this whenever they eat contaminated food and drink contaminated water and when they directly contact other infected patients.

As humans grow older, the body changes and stops developing at some point. For elderly patients, extreme fatigue may be felt due to their lack of antibodies to fight the infection and their age. Moreover, the loss of appetite might also cause extreme fatigue for any patient. The possibility of being unable to treat the disease or recover from it may lead to death.

d. Poor appetite, Lethargy, and Weight Loss

- These symptoms happen because of cytokines, a chemical that makes us tired, weak, and unable to eat.

e. Vomiting

The reason for this is that our gastrointestinal tract is getting irritated and inflamed, and most of the time, drinking and eating will only lead to further irritating and inflaming of the GI.

2. Stomach pain, Constipation, Diarrhea

- As the bacteria multiply, a trigger of the digestive system will happen and causes stomach pain, diarrhea, and constipation.

3. The possibility of developing rashes

- Having rashes is normal whenever the human body's immune response of fighting infections.

HOW DO YOU GET THE DISEASE:

- When a contaminated food and drink has been intake by someone

HOW IS IT DIAGNOSED:

- Any blood, poo, or pee will be diagnosed by a professional in the clinical laboratory. They will determine which strain of the bacteria you’re infected with

- Although effective treatment is available, accurate diagnosis of typhoid fever is difficult because it can be difficult to differentiate from other infections. One of the most precise and reliable diagnostic tests for typhoid fever is bone marrow culture, but it is invasive and therefore not feasible in many settings. The most sensitive and specific test for typhoid fever is bone marrow culture; moreover, because this test could be invasive, conveys medical complications, and necessitates specialist knowledge and advanced machinery, it is not widely used as a commonly performed diagnostic process in endemic settings. Blood culture is by far the most widely used culture-based procedure for typhoid diagnosis, but results take days to arrive, and several settings require additional support essential for effective culturing techniques. Further to that, it has a low sensitivity (40–75 percent in most cases), which may be exacerbated by prior antibiotic use. New typhoid vaccines, as well as the need for more accurate burden estimates, increase the demand for a deeper understanding of diagnostic performance. Evaluating the diagnostic accuracy of typhoid fever tests is difficult due to the scarcity of head-to-head studies.

TREATMENT:

- According to Mayo Clinic (2020), the best or most effective treatment for typhoid fever is antibiotic therapy. The most prescribed antibiotics by health professionals to typhoid patients are the following: Cipro or Ciprofloxacin, Zithromax or, Azithromycin, and Ceftriaxone. Another treatment for typhoid patients is more on drinking fluids to aid dehydration and surgery when the intestine has become torn.

WAYS TO PREVENT AND CONTROL THE INFECTION:

1. Eat healthy meals. Always remember the foods to avoid and ensure that the meals taken are light and easy to digest. Here are some of the foods and drinks to avoid.

Foods / Drinks to take

Semi-solid foods that are easy to digest Dairy Products Soups Vegetables and Fruits Fluids
 * Porridge and soft rice
 * milk and yogurt
 * spinach, vegetable, chicken, carrot, mushroom
 * Bittergourd, carrots, baked potato, radish, squash, banana, grapes, apple, etc.
 * The water must be boiled. Lukewarm water with a pinch of salt is recommended for typhoid patients because it removes germs and cleanses the human body.
 * Fruit juices like lemon juice are also beneficial for typhoid patients because they restore the human body's water content.

Foods to avoid:

Raw foods Spicy and oily foods Garlic and onion Higher fiber foods
 * Typhoid patients must strictly avoid these foods because these raw foods cause diarrhea, constipation, and bloating.
 * Spicy and fatty foods are also hard to digest and might trigger inflammation within the body, especially in the intestine and the whole digestive system.
 * Similar to spicy and oily foods, garlic and onion can cause inflammation
 * raw vegetables, fruits, grains, seeds, and even legumes must be limited for typhoid patients to ease their digestion

Junk foods and sweet foods

1. Always maintain proper hygiene wherever you are.

2. Always have self-discipline, not only for you, for us, but also for everyone.

3. Always maintain cleanliness at home.

4. Do not go outside when you are infected or not feeling well. This is also for keeping the people surrounding you safe.

5. Get a check-up and follow check-ups regularly.

6. Always drink prescribed medicines by your health physician.

7. Know about the disease to know what to do if you acquire it.

8. Be aware of your surroundings. If you know that it is unsafe to touch and eat something within a particular area, don't. Immediately leave the site and observe proper hygiene 9. when you reach home.

10. Vaccination (Vi vaccine- single injection, Ty21a vaccine- 3 capsules to take on alternate days)

CHOLERA
Cholera is a commonly known disease that usually spreads in contaminated food and water. It is a diarrheal illness that targets the intestine by the strains of a certain bacteria. This disease has an estimated 2.9 million cases and approximately 95,000 deaths every year. Cholera rapidly spreads on areas that are identified to have poor sanitation and inadequate water. Identifying cholera is important due to its high potential to cause a widespread outbreak that can lead to increase in death rates if not treated well.

CAUSED BY: - an infection found in the intestine associated with the bacterium called Vibrio Cholerae

SIGN AND SYMPTOMS:
 * Watery Diarrhea - indicates that you have liquid stools or some call a stomach bug. This is caused by the invasion of different germs such as bacteria, viruses, parasites that may or may not require treatment at all. This usually lasts for more than three times in a day due to uncontrolled bowel movement which coincides with other gastrointestinal issues such as nausea, vomiting, cramping, and loss of appetite.
 * Severe abdominal or rectal pain - this refers to the movement of the stool through the rectum and out of the body through the anus. Rectal pain is usually caused by anal fissures and hemorrhoids.

HOW DO YOU GET THE DISEASE?

- This can be acquired through consumption of contaminated food or sipping contaminated water with the unknown presence of the cholera bacteria. An infected person’s feces can become the source of contamination wherein it can most likely spread in areas like sewage and drinking water that have inadequate treatment.

HOW IS IT DIAGNOSED?

- Doctors recommend taking stool samples or a rectal swab to test in the laboratory to look for the presence of cholera bacteria. Thiosulfate Citrate Bile Salts agar is mainly used for the isolation and identification of Vibrio Cholerae. TREATMENT: With immediate replacement of  the fluids and salts, patients can be successfully treated with oral rehydration solution (ORS) that consists of a prepacked salt and sugar mixture which is then mixed with 1 liter of water to be drunk by the patient. In some severe cases, intravenous fluid replacement may be required. However, antibiotics can also contribute to the treatment process but rehydration is much more important.

WAYS TO PREVENT OR CONTROL THE INFECTION

- Be aware of the areas or places you wish to visit if recent cholera cases have occurred.

- It is advised to drink more often on bottled distilled water when visiting areas that have limited sources of water. Boiling the available water can also be an option in order to disinfect the water.

- Clean hands often with soap and water before and after eating the prepared foods.

- Use chemically treated water in brushing your teeth, making ice as well as washing the dishes.

- If soap and water are not readily available, use hand sanitizer that contains at least 60% alcohol.

- Be sanitary and responsible in disposing of feces to avoid exposing the source of infection to the environment.

- A single dose of Vaxchora® (lyophilized CVD 103-HgR), an FDA approved oral vaccine for adults ages 18-64  years old that are travelling  in areas that have active cases of cholera can help prevent the transmission of Vibrio Cholerae.

Leptospirosis
Leptospirosis, with its other name as Weil disease, is a significant endemic especially prevalent among developing countries with thousands of reported cases annually. Leptospirosis is a bacterial infection that has the ability to affect both humans and animals. Bacteria of the genus Leptospira are the main agents for this disease and it is most often spread through exposure, either direct or indirect, to water or soil contaminated with animal urine. It can cause a wide range of symptoms within humans, some of which may be mistaken for other diseases which makes early diagnosis very difficult for clinicians.

CAUSED BY:

- the spirochete bacterium Leptospira

SIGN AND SYMPTOMS:
 * Leptospirosis can produce a variety of symptoms in people, including:
 * Fever is really high.
 * Headache
 * Having chills
 * Muscle pain
 * Vomiting
 * Jaundice
 * Eyes appear to be reddish
 * Pain in the abdomen
 * Diarrhea
 * Rash

Leptospirosis has a wide range of symptoms, and some people may not show any signs or symptoms at all. Some people may develop mild to severe flu-like symptoms. If the condition is not addressed, some people may have very significant problems.

The condition usually manifests itself in two stages. Headache, pain behind the eyeball, anorexia, severe muscle aches, chills, sweating, nausea, vomiting, and fever are all symptoms of the septocemic phase. Constipation, diarrhea, cold symptoms, coughing, chest pain, a stiff neck, and difficulty breathing are all possible side effects. This phase lasts four to nine days, with repeated chills and a fever that peaks at over 39 degrees Celsius (102 degrees Fahrenheit) before subsiding.

The immune or the second phase of leptospirosis begins on the 6th to 12th day of sickness. Antibodies can be found in blood serum, fever and other early symptoms may return, as well as symptoms of inflamed membranes lining the brain (meninges). After the seventh day, at least 50% of patients have a higher-than-normal amount of cells in their cerebral fluid (pleocytosis). Iridocyclitis or the inflammation of the iris and ciliary body behind the iris, optic neuritis or the inflammation of the optic nerve, and peripheral nerve illness (neuropathy) may rarely occur.

HOW DO YOU GET THE DISEASE?:

- Persons can become infected by coming into contact with or being exposed to the urine of infected animals (or other body fluids, except saliva). The bacteria may have entered the body through the skin or mucous membranes (eyes, nose, and mouth), especially if the skin was breached by a cut or scratch. Drinking contaminated water might also spread infection. In most cases, leptospirosis outbreaks are caused by contact with contaminated water, such as floods.

HOW IS IT DIAGNOSED?:

- Serological tests are done to detect antibodies through either microscopic agglutination test (MAT) for serovar-specific antibodies or through a solid-phase assay for Immunoglobulin M (IgM) antibodies.

TREATMENT:

- Antibiotic treatment such as with penicillin or doxycycline. For patients with more severe symptoms, intravenous antibiotics may be necessary.

WAYS TO PREVENT OR CONTROL THE INFECTION:

- Avoid contact with animal urine or body fluids especially if there are open wounds, cuts, or other abrasions and possible wound entries in the skin.

- Wear protective clothing such as boots and gloves when working with or when near soil and water that may possibly be contaminated with animal urine.

- Avoid swimming and wading on potentially contaminated water such as floodwaters, muddy ponds, or streams near farms and stagnant water.

- Maintain cleanliness and control rats and mice around the household on a regular basis.

- Seek immediate health care when symptoms suggestive of leptospirosis manifests and antibiotic prophylaxis may be prescribed by your physician if confirmed with possible exposure.

HEPA A INFECTION
Hepatitis A infection is a highly contagious liver infection usually caused by the hepatitis A virus. The virus is one of the numerous types of hepatitis viruses that cause inflammation and impair the ability of your liver to function. People are most likely to develop hepatitis A from contaminated food or water or intimate contact with an infected person or object. Mild hepatitis A instances do not necessitate treatment. Most infected persons recover completely with no long-term liver damage (Mayo Clinic, 2020).

CAUSED BY:

- The term hepatitis refers to liver inflammation. Hepatitis can be caused by excessive alcohol consumption, toxins, certain medications, and certain medical conditions, but it is most typically caused by a virus. Hepatitis A is a highly contagious, short-term liver infection caused by the hepatitis A virus (CDC, 2020).

SIGN AND SYMPTOMS:

Not everyone infected with hepatitis A exhibits symptoms. Adults are more prone than children to experience symptoms. Symptoms usually develop two to seven weeks after infection that include the following: - Symptoms typically last less than two months, while some people may be sick for up to six months (CDC, 2020).
 * Fever
 * Tiredness
 * Appetite loss
 * Nausea
 * Abdominal pain
 * Vomiting
 * Joint pain
 * Clay-colored stools or dark urine
 * Jaundice

HOW DO YOU GET THE DISEASE?

- The hepatitis A virus is usually present in infected people's stool and blood. The hepatitis A virus spreads when someone ingests the virus, which is usually through person-to-person contact. Close, physical contact with an infected individual, such as having sex, caring infected person, or taking drugs with others, can spread Hepatitis A. Hepatitis A is highly contagious, and people can spread the infection even before they become sick.

Aside from that, the Hepatitis A virus can be passed from person to person by putting something in the mouth that has been contaminated with a hepatitis A virus-infected person's stool (feces, poop). This type of transmission is referred to as "fecal-oral." This can happen in a variety of ways, such as when an infected person who prepares or handles food does not thoroughly wash his or her hands after using the restroom and subsequently touches other people's food.

A person can also potentially become infected by drinking water contaminated with the hepatitis A virus or through drinking beverages chilled with virus-contaminated ice. As a result, the virus spread quickly in regions where sanitation is poor or where proper personal hygiene is not practiced (CDC, 2020).

HOW IT IS DIAGNOSED?

- A doctor can tell if you have hepatitis A by discussing your symptoms and performing a blood test to see if you've recently been infected with the virus that causes hepatitis A. (CDC, 2020).

- In addition, the detection of HAV-specific immunoglobulin G (IgM) antibodies in the blood allows for a specific diagnosis. Additional tests, such as reverse transcriptase-polymerase chain reaction (RT-PCR) to detect hepatitis A virus RNA, may be needed and may necessitate the use of specialized laboratory facilities (WHO, 2021).

TREATMENT:

- Hepatitis A has no specific treatment. Recovery from infection-related symptoms might be slow and take several weeks or months. It is critical to avoid using medications that are not necessary. Avoid taking acetaminophen, paracetamol, and anti-vomiting medication.

- In the absence of acute liver failure, hospitalization is not necessary. The treatment aims to maintain comfort or rest and an adequate nutritional balance, including restoring fluids lost due to vomiting or diarrhea (WHO, 2021).

WAYS TO PREVENT OR CONTROL THE INFECTION

- Hepatitis A is best prevented through vaccination with the hepatitis A vaccine. More than one dose is required to receive the full benefit of the hepatitis A vaccine. The number and timing of these doses are determined by the type of vaccine administered (CDC, 2020).

Hepatitis A spread can also be avoided and controlled by:


 * Sufficient supplies of safe drinking water;
 * Proper sewage disposal within communities; and
 * Practicing proper hand hygiene, such as washing hands thoroughly after using the restroom, changing diapers, and before preparing or eating food (WHO, 2021).

REFERENCES:

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Arora, P., Thorlund, K., Brenner, D. R., & Andrews, J. R. (2019). Comparative accuracy of typhoid diagnostic tools: A bayesian latent-class network analysis. PLOS Neglected Tropical Diseases, 13(5). https://doi.org/10.1371/journal.pntd.0007303.

Budihal, S. V., & Perwez, K. (2014). Leptospirosis Diagnosis: Competancy of Various Laboratory Tests. Journal of Clinical and Diagnostic Research. https://doi.org/10.7860/jcdr/2014/6593.3950

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