Presenting problems in infectious diseases
and most constant presentation
it is the most common
:
1. Fever
A.
Fever in tropical resident
:
❖ Geography and exposure
❖ Mosquito bite ……Malaria
❖ Sand fly bite ……..Leishmaniasis
❖ Infected person contact……Hemorrhagic fever, hepatitis, HIV
❖ Animal contact …..Brucellosis, anthrax
❖ Fresh water swimming… Schistosomiasis
B. Fever in old age :
❖ Oral temperature are unreliable
❖ Frequently associated with confusion
❖ Commonly caused by pneumonia, UTI, soft tissue infection & gateroenteritis
C. Factitious fever:
❖ mainly in female patients with medical or nursing background
❖ The patients looks well with bizarre temperature chart , absence of diurnal variation
and changes in pulse rate
❖ Absence f sweating
❖ Normal ESR & CRP
❖ Evidence of self – injection or self – harm.
D. Fever in neutropenic patient:
❖ caused by gram +ve organisms most commonly.
❖ broad spectrum antibiotic should be started.
❖ The most common regimen is pipracillin + gentamicin i.v with the addition of
antifungal if the fever not resolved within 48 hours
2. SKIN RASHES
A. Patterns of rash associated with infection
1. Macular: Measeles, Rubella, Typhoid fever, Secondary Syphilis.
2. Haemorrhagic: Meningococcal infection, haemrrhaghaemrrhagic fever, Leptospirosis,
Septicaemia with DIC
3. Vesicular: Chickenpox, Poxvirus, herpes simplex, Shingles
4. Erythematous: Scarlet fever, Toxic shock syndrome, human erythrovirus 19, Drug
rash.
5. Urticarial; Schistosomiasis, Strongyloidosis
6. Nodular: Erythema nodosum ( primary TB, Leprosy, streptococcal infection,
mycoplasma)
7. Chancres (( ulcerating nodules )): Primary Syphilis, anthrax, Trypanosomiasis
B. Onseat of rash
❖ Really
❖ Sick
❖ People
❖ Must
❖ Take
❖ No
❖ Exercise
3. SPLENOMEGALY ( TROPICAL )
❖ Mild: Malaria, toxoplasmosis, Hepatitis, HIV, Typhoid, Brucellosis, Leptospirosis,
❖ Moderate: SBE, portal hypertension due to schistosomiasis.
❖ Massive: Visceral Leishmaniasis, tropical splenomegaly syndrome.
4. EOSINOPHILIA
❖ It is associated with parasite infections and any patients with eosinophil count more
than 400 cell/ml. should be investigated for possible parasitic infection which include:
❖ Strongyloidosis, Hook warm, Ascariasis, Schistosomiasis, Cysticercosis, hydatid
disease,……
5. Bacteraemia & Septicaemia:
❖
Bacteraemia is the presence of living organism in the blood and it can occur in healthy
people without symptoms but when it cause a disease it is called as septicaemia.
❖
The organism may originate from any area of the body
❖
Septicaemia can be complicated by metastatic septic lesions in organs or tissues e.g
heart valves, liver, brain, bone, joint,….
Circulatory failure ( septic shock syndrome ) is the most dangerous complication of
septicaemia with possible organ failure
(( heart failure, renal failure, bone marrow failure, respiratory failure,….)
❖
Blood cultures are the most important
❖
Treatment: Antibiotics according to the result of blood culture and sensitivity.
6. Pyrexia Of Unknown Origin (( PUO )):
◼
It is consistently elevated body temperature more than 37.8 c persisting for more than 2
weeks with no diagnosis after initial investigations.
Aetiology of PUO:
A. Infection:
1. sepsis, abscesses
2. Tuberculosis
3. Endocarditis
4. Enteric fever
5. Brucellosis
6. HIV
7. Toxoplasmosis
8. fungal infection
B. Malignancies
1. Lymphoma
2. Hodgkin s disease
3. Myeloma
4. Hypernephroma
5. Leukemia
C. Connective tissue disorders:
1. Vasculitis
2. SLE
3. Polyarteritis nodosa
4. Still s disease
D. Miscellaneous:
1. inflammatory bowel disease
2. drug fever
3. sarcoidosis
4. FMF
5. Atrial myxoma
E. No diagnosis or resolves spontaneously
Investigations & Management
A. Re take history
B. Repeat the examination
C. Review results of investigations and repeat if indicated
D. consider farther investigations; serological, CT, MRI, tissue biopsies,…
E. Consider therapeutic trial e.g antimalaria
Acute Diarrhoea
◼ It is the predominant symptom of acute infective gasteroenteritis
◼ Infectious causes of acute diarrhea:
A. Toxin mediated: Bacillus cereus, Clostridial enterotoxin, staphylococcal enterotoxin.
B. infective food poisoning: caused by Rota virus, Shigella, cholera, E.Coli, Salmonella,….
C. Protozoal; Giardiasis, Amoebiasis,…
D. Systemic illness: sepsis, pneumonia, Malaria, Meningococcal sepsis.
8. Chronic Diarrhoea:
It is defined as Diarrhoea persisting for more than 14 days and its infectious causes include:
a. Giardiasis
b. Strongyloidiasis
c. HIV enteropathy
d. Tropical sprue
e. Enteropathic E. Coli
usually the diarrhoea with pale bulky stools,abdominal symptoms with distension and
flatulence, nutritional deficiencies and general ill health.