Mosquitoes can transmit many infectious diseases that are caused by a variety of microorganisms to people, but these diseases are mostly confined to certain geographical areas. In the Philippines, the mosquito-borne diseases include dengue, Chikungunya, Japanese encephalitis, malaria, and filariasis. Dengue, chikungunya, and Japanese encephalitis are caused by viruses while malaria and filariasis are caused by parasites.

Dengue and Chikungunya

Dengue and chikungunya have things in common. They are both caused by RNA viruses, albeit from different families. Also, they are transmitted by the same mosquitoes, Aedes aegypti and Aedes albopictus. Furthermore, their signs and symptoms, which appear three to seven days after a bite from an infected mosquito, are similar—high grade fever, joint pain, joint swelling, rash, headache, muscle pain, nausea, vomiting, and fatigue.  The two diseases differ, however, in that Chikungunya is generally more benign than dengue (serious complications and fatalities occur rarely), although the joint pains that it produces are often more severe and incapacitating.

Japanese Encephalitis

Japanese encephalitis (JE) is caused by the Japanese encephalitis virus (JEV) whose most important vectors are the mosquitoes Culex tritaeniorhynchus and Culex vishnui.

The vast majority of JEV infections are asymptomatic. Symptoms, if they occur, appear five to 15 days after the bite of an infected mosquito. They are flu-like and include headaches, fever, and fatigue and in children, nausea, vomiting, and abdominal pain. Although generally benign, one in 250 patients infected by JEV develop encephalitis (inflammation of the brain), which can be fatal, especially in children. Lifelong neurological defects such as deafness, emotionalliability, and hemi paresis may occur in those who survive the encephalitis.

Malaria

Malaria is a serious disease that is still a major public health problem in the Philippines, although the number of reported cases has been decreasing since 1990 because of the anti-malarial program of the government.

Malaria is caused by a parasite, a protozoon (i.e., a single-celled organism) that belongs to the genus plasmodium. There are four known species of this genus that cause disease in man—Plasmodium falciparum, P.vivax, P.ovale, and P. malariae—all are present in the Philippines.The parasites are transmitted to people through the bites of infected female Anopheles mosquitoes.

Malaria is present or endemic in all provinces of our country, except Cebu, Leyte, and Catanduanes, but most cases occur in rural areas, especially in forested, swampy, hilly, and mountainous regions—the preferred habitat of the mosquito vector.

The typical presentation of malaria is high grade fever that periodically recurs every after two to three days. The fever is preceded by several hours of chills and, as the fever subsides, the patient experiences marked sweating.

Malaria patients sooner or later develop anemia, but the more dreadful and sometimes fatal complications of the disease are kidney and liver failure, and cerebral malaria.

Filariasis

The causative agent of filarias is in the Philippines are two microscopic, thread-like roundworms: Wuchereriabancrofti (the more prevalent one) and Brugiamalayi. The former is transmitted by several species of Aedes, Culex, and Anopheles mosquitoes while the latter by at least two species of the Mansonia mosquito.

Repeated mosquito bites over several months to years are needed to get filariasis. Most people with filaria worms stay asymptomatic, but a small percentage will develop a condition called elepanthiasis, in which the limbs, genital organs, and the breasts swell to monstrous proportions.

According to our Department of Health (DOH), filariasis is endemic in 44 provinces in the Philippines but most cases occur in the rural areas of Bicol, Quezon, Mindoro, Masbate, Mindanao, Palawan, Agusan, and the Mountain Province. Also, seven provinces have reached elimination level already, namely: Southern Leyte, Sorsogon, Biliran, Bukidnon, Romblon, Agusandel Sur, and Dinagat Island.

It’s been exactly a year since I experienced the most excruciating pain ever. I felt like an elephant was weighing down on me. The pain radiated from my abdomen all the way to my spine and upper back. It intensified whenever I breathed! So I endured the pain as I took breaths of precious air.

My pain threshold is high. I was in denial for three months all the while getting severe abdominal pain attacks. One was after I had a slice of pizza, then another after I attended a dinner party, and another one when I had half a cup of soda! I told myself perhaps my digestive system is more sensitive since I am no long used to eating high fat foods and drinking cabonated beverages for a decade now.

At the back of my mind, however, I knew that there was something wrong. I suspected gallstones but as I said I was in denial until that fateful day when I excreted clay-colored stools and tea-colored urine. Ominous signs that told me I had an obstruction in my common bile duct and that I was terribly sick. I broke down, accepted my fate, and prayed for healing. So off I went to have my blood exam and urinalysis done further confirming that my liver enzymes were deranged and I had infection. To make matters worse, I was starting to turn yellowish!

A team of seven doctors (endocrinologist, hepatologist, gastroenterologist, laparoscopic surgeon, urologist, and anesthesiologists) was formed, thus diagnosing me with ascending cholangitis. A medical emergency brought about by infection of the common bile duct due to an obstruction by gallstones and in my case also biliary sludge—particulates that precipitated from bile, a fluid produced by the liver, stored in the gallbladder, and released into the small intestine to digest lipids including fat, cholesterol, and fat soluble vitamins A,D,E, and K.

What causes gallstones to form? Well one of the things you don’t wish to inherit is this. Unfortunately for me, I did! A gallbladder that does not empty properly, obesity, type of diet, liver disease, medical conditions such as diabetes and hypothyroidism that could affect your lipids (triglycerides and cholesterol levels), and drastic weight loss can all lead to gallstone formation. There are two types of stones: cholesterol and pigment stones. Stones inside the gallbladder may not lead to an emergency situation but when the stones fall off and get into the common bile duct, then you’re in deep trouble just like I was.

 What to expect during the recovery phase

After undergoing two procedures, endoscopic retrograde cholangiopancreatography (ERCP) to put a stent in my common bile duct and laparoscopic cholecystectomy to remove my non-functioning gallbladder, not to mention a blood transfusion post surgery, I thought I was fine. Little did I know that I would experience more abdominal pain so severe that I was afraid I would have to undergo surgery again.

If you have gallstones and have opted to have your gallbladder removed, expect the following symptoms characteristic of postcholecystectomy syndrome during your recovery phase:

Abdominal pain

Uncontrollable and frequent flatulence

Bloating, indigestion

Diarrhea, especially after eating food that contains fat

What to do when you experience postcholecystectomy syndrome?

Consult your doctor for proper management and prescription

Eat small, frequent meals instead of few large ones

Chew your food properly, avoid hard to digest foods like meats

Eat fruits like banana and apple to help form stool

Hydrate throughout the day

Eat soup dishes with vegetables and lean protein like fish or chicken to boost immune system and enhance wound healing process

Avoid saturated fats from processed foods, pastries, and fastfood

Avoid gas forming foods like beans, onion, garlic, and cruciferous vegetables (cabbage, broccoli, cauliflower)

Consume probiotic food or supplement under the supervision of your dietitian

Gradually introduce healthy fats from fatty fishes, nuts, seeds, and oils into your diet

Symptoms may be temporary or persistent. Consult your doctor and dietitian for proper management and prevention of complications.