Survey
* Your assessment is very important for improving the work of artificial intelligence, which forms the content of this project
Download Fever in the Tropics
Document related concepts
no text concepts found
Transcript
Fever in the Tropics Tom D. Thacher, MD Department of Family Medicine Mayo Clinic, Rochester, Minnesota [email protected] Fever as a Symptom 1. 2. 3. 4. Malaria Hypertension Dyspepsia Pulmonary tuberculosis 5. Medical examination 6. Upper respiratory infection 7. Urinary tract infection 8. HIV infection 9. Diabetes mellitus 10.PID 1/3 of all presentations in primary care Disease Burden by Region 100% 80% 60% Injuries Non-communicable Communicable 40% 20% 0% Africa SE Asia Americas Learning Objectives 1. Syndromic Approach 2. 8 Febrile Syndromes Context of Fever • Age • Geography • Season • Duration of fever • Malnutrition • Immune status • Exposures Syndromic Approach Empiric treatment 1. Fever alone 2. Neurologic 3. Abdominal Common 4. Pulmonary Fever Syndromes 5. Rash 6. Hemorrhage 7. Bone and joint 8. Gynecologic 8 Which of these is NOT in the top five causes of death in children in tropical countries? A. Measles B. Pneumonia C. Typhoid D. HIV E. Malaria 38% 22% 19% 14% 6% A. B. C. D. E. Causes of Death in Children Under Age 5 Years in Africa Other 18% Malaria 21% 2/3 of all child deaths Perinatal 15% Pneumonia 17% Measles 8% HIV 9% Diarrhea 12% 1. Fever Alone • Malaria • Typhoid fever • HIV • Dengue • Leptospirosis • Rickettsia • Relapsing fever • Other viral illnesses Malaria Okie S. N Engl J Med 2008;358:2425-2428 Plasmodium falciparum Symptoms of malaria • Headache • Pallor • Severe hemolytic anemia • Heart failure • Cerebral malaria – impaired mental status, convulsions, coma • Labored breathing • acidosis, heart failure • Splenomegaly Typhoid Fever Typhoid • Sustained high fever, headache • Apathy, psychosis • Constipation, abdominal pain • Splenomegaly • Positive blood culture www.worldortho.med.usyd.edu.au Dengue • Asia, So. America • Marked myalgia, eye pain • Rash • ↓ WBC, ↓ platelets Leptospirosis • Rash • Aseptic meningitis • Clue: conjunctival injection Rickettsia • Fever, headache, and myalgia • Clue: tick exposure, painless eschar • African tick-bite fever, scrub typhus Relapsing Fever 1. Fever alone 2. Neurologic 3. Abdominal Common 4. Pulmonary Fever Syndromes 5. Rash 6. Hemorrhage 7. Bone and joint 8. Gynecologic 8 2. Neurologic Syndromes Fever, headache, altered mental status, convulsions, coma • Cerebral malaria • Meningitis • Encephalitis • HIV African Meningitis Belt Encephalitis • Rabies • Japanese encephalitis • West Nile encephalitis • Trypanosomiasis (sleeping sickness) HIV • Chronic Meningitis: TB, cryptococcal • Toxoplasmosis • HIV dementia 1. Fever alone 2. Neurologic 3. Abdominal Common 4. Pulmonary Fever Syndromes 5. Rash 6. Hemorrhage 7. Bone and joint 8. Gynecologic 8 3. Abdominal Syndromes Fever, abdominal pain • Typhoid • Infectious colitis: shigella, E. coli, salmonella, campylobacter, ameba • Amebic liver abscess • Abdominal TB • Appendicitis, pyelonephritis • HIV 1. Fever alone 2. Neurologic 3. Abdominal Common 4. Pulmonary Fever Syndromes 5. Rash 6. Hemorrhage 7. Bone and joint 8. Gynecologic 8 4. Pulmonary Syndromes Fever, cough, dyspnea • Pneumonia • Tuberculosis • HIV Causes of Death in Children Under Age 5 Years in Africa Other 18% Malaria 21% Perinatal 15% Pneumonia 17% Measles 8% HIV 9% Diarrhea 12% IMCI Integrated Management of Childhood Illness • Increased respiratory rate • ≥60 if age < 2 mos. • ≥50 if age 2-12 mos. • ≥40 if age 12 mos. to 5 years • Lower chest retractions 1. Fever alone 2. Neurologic 3. Abdominal Common 4. Pulmonary Fever Syndromes 5. Rash 6. Hemorrhage 7. Bone and joint 8. Gynecologic 8 5. Rash Syndromes Fever and skin rash • Measles • HIV • Dengue • Other viruses 1. Fever alone 2. Neurologic 3. Abdominal Common 4. Pulmonary Fever Syndromes 5. Rash 6. Hemorrhage 7. Bone and joint 8. Gynecologic 8 6. Hemorrhagic Syndromes Hematemesis, melena, epistaxis, petechiae, purpura, puncture site bleeding • Ebola, Lassa, Marburg • Yellow fever • Dengue • Relapsing fever 1. Fever alone 2. Neurologic 3. Abdominal Common 4. Pulmonary Fever Syndromes 5. Rash 6. Hemorrhage 7. Bone and joint 8. Gynecologic 8 7. Musculoskeletal Syndromes Fever with joint or bone pain • Sickle cell disease • Septic arthritis • Osteomyelitis • Pyomyositis • Rheumatic fever 1. Fever alone 2. Neurologic 3. Abdominal Common 4. Pulmonary Fever Syndromes 5. Rash 6. Hemorrhage 7. Bone and joint 8. Gynecologic 8 8. Gynecologic Syndromes Fever, pelvic pain, vaginal discharge • PID • Tubo-ovarian abscess • Postpartum endometritis • Septic abortion Treatment Limiting Factors • Self treatment with OTC antibiotics • Limited spectrum of antibiotics • No health insurance • Counterfeit drugs and adulteration What is the deadliest animal in Africa? no-pest.com no-pest.com 20,000 deaths per year news.nationalgeographic.com 800,000 deaths per year
Related documents