Download Presenting problems in infectious diseases

Presenting problems in
infectious diseases;
1. Fever:

it is the most common and most constant
presentation
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. Onset 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.
 2.
 3.
 4.
 5.

Lymphoma
Hodgkin s disease
Myeloma
Hypernephroma
Leukemia
C. Connective tissue disorders:
1.
 2.
 3.
 4.

Vasculitis
SLE
Polyarteritis nodosa
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

7. 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.
9. Lymphadenopathy.