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Geelong Hospital INFECTIOUS DISEASES REFERRAL GUIDELINES Contents page Infectious Diseases Skin and soft tissue infections Genital discharge Fever/pyrexia of unknown origin Diarrhoea o Chronic diarrhoea Jaundice Upper Respiratory Tract Infection Lower Respiratory Tract Infection Fever and a rash Travel Medicine Travel advice Fever in returned travellers HIV medicine New diagnosis HIV Established HIV Hepatitis C HIV co infection Hepatitis mono infection Post splenectomy hyposplenism asplenism Acknowledgement to The Alfred Hospital Referral Guidelines DIAGNOSIS EVALUATION Skin and soft tissue infections Genital discharge STI history INVESTIGATION REFERRAL GUIDELINES Swab of purulent discharge FBE U&Es LFTs PCR for M. ulcerans if suspicious Refer to Infectious Diseases Clinic Fax referral to 03 4215 1383 M,C & S swab of discharge Serology of syphilis, HIV Urine for Chlamydia, gonococcal PCR Refer to Sexual Health Clinic. This is a walk in clinic that patients can attend without a referral return to contents page Or referring doctor can Fax referral to 03 4215 1383 return to contents page Fever, pyrexia of unknown origin Travel, contact, animal history FBE, LFTs, CRP Urine for MSU Blood cultures CXR If rigors present, refer IMMEDIATELY by contacting ID Registrar via Geelong Hospital switchboard ph. 03 4215 000 return to contents page Faeces for M&C Faeces for ova, cysts and parasites Cryptosporidium stain Faecal fats Thyroid function Diarrhoea (chronic) Jaundice History of : Travel Gallstone pain medications Exposure to hepatitis Upper GIT USS LFTs FBE, Haemolytic screen Serology for Hep BsAg, Hep A IgM, IgG, Hep C antibody Refer to Infectious Diseases Clinic Fax referral to 03 4215 1383 return to contents page Contact Infectious Diseases registrar via Geelong Hospital switchboard ph. 03 4215 0000 return to contents page Acknowledgement to The Alfred Hospital Outpatients Referral Guidelines DIAGNOSIS EVALUATION Upper Respiratory Tract symptoms INVESTIGATION REFERRAL GUIDELINES Throat swab for PCR for respiratory viruses Nasopharyngeal aspirate PCR Serology for EBV, influenza, pertussis If concerned, refer to Infectious Diseases Clinic registrar via Geelong Hospital switchboard ph. 03 4215 0000 return to contents page Lower Respiratory Tract symptoms Fever and a rash Advice for travellers Sputum for M& C CXR Legionella and pneumococcal Urinary antigens Consider any TB contacts, then sputum for AFB, M & C Serology Legionella, Mycoplasma and Chlamydia History of travel, animal contacts Seek history of medication and bites FBE, LFTs, U+E,Cr Blood cultures If vesicular rash, swab for herpes virus PCR IMMEDIATE referral if rigors, breathless on room air or oxygen desaturation: contact Infectious Diseases registrar via Geelong Hospital switchboard ph. 03 4215 0000 return to contents page Consider meningococcal infection and IMMEDIATE referral. Contact ID Registrar via Geelong Hospital switchboard ph. 03 4215 0000 return to contents page For travel advice by GP referral only 1. GPs (only) can also get travel advice from Dr Daniel O’Brien ph. 03 4215 2376 Clinical history Record of previous vaccinations Medications Travel plans www.smartraveller.gov.au The following clinics offer a travel vaccination service Myers Street Family Medical Practice and Kensington Hill Medical Clinic at Leopold offer a travel vaccination service return to contents page Fever in returned travellers Blood cultures (typhoid) FBE, LFTs, U+E, Cr Thick and thin film and ICT for malaria CXR Urine M&C Faeces M&C Serology: Dengue, Hepatitis A IMMEDIATE referral recommended by contacting Infectious Diseases registrar at Geelong Hospital via switchboard ph. 03 4215 0000 return to contents page Acknowledgement to The Alfred Hospital Outpatients Referral Guidelines HIV medicine DIAGNOSIS EVALUATION New diagnosis HIV Symptomatic illness i.e. constitutional symptoms or organ specific symptoms Established HIV Reason for referral e.g. complications History of AIDSdefining illness Treatment history including Antiretroviral Rx Current therapy Hepatitis C/ HIV coinfection Hepatitis mono infection HIV treatment history REFERRAL GUIDELINES Copy of HIV Antibody test result and Western blot Also, if available: CD4 count Viral load Sexually transmitted infection testing Hepatitis screen Refer on confirmation of diagnosis. Newly diagnosed patients will be seen as soon as possible. If acutely unwell, phone ID registrar Geelong Hospital via switchboard ph. 03 4215 0000 return to contents page Baseline testing: HIV Antibody test result and Western blot Referral for review Also, if available: If acutely unwell, phone ID registrar Geelong Hospital via switchboard ph. 03 4215 0000 General pathology – FBE, U&Es, LFTs CD4 counts HIV Viral loads HIV Genotype HLA B57 Sexually transmitted infection testing Hepatitis screen Include LFTs, liver biopsy result if performed If not an emergency, fax referral to Refer to Infectious Diseases Clinic Fax number 03 4215 1383 return to contents page Refer on confirmation of diagnosis. If acutely unwell, phone ID registrar Geelong Hospital via switchboard ph. 03 4215 0000 History of active Hepatitis B/C infection Past and current treatment of viral hepatitis Refer to Infectious Diseases Clinic Fax number 03 4215 1383 return to contents page HCV: viral load, genotype, abdominal ultrasound HBV: viral load, hepatitis B e antigen, abdominal ultrasound. For both: HIV serology Refer on confirmation of diagnosis. If acutely unwell, phone ID registrar Geelong Hospital via switchboard ph. 03 4215 0000 Refer to Infectious Diseases Clinic Fax number 03 4215 1383 return to contents page Splenectomised and hyposplenic DIAGNOSIS Post splenectomy Hyposplenism Asplenism EVALUATION Reason for splenectomy Reason for hyposplenism e.g. extensive spleen damage, splenic hypoembolisation Date of splenectomy Vaccination history Prophylactic history History of sepsis/thrombosis Referral if travel advice given FBE and film required Howell – Jolly bodies IgM memory B cell (patient needs to be referred to Pathcare Collection Centre 235 Ryrie Street prior to 0930hrs Mon - Thu) REFERRAL GUIDELINES If signs of bacterial infection refer immediately to Geelong Hospital Emergency Department phone ID registrar Geelong Hospital via switchboard ph. 03 4215 0000 Fax referrals to 03 4215 1383 Victorian Spleen registry form https://spleen.org.au/VSR/Files/Spleen_Registry _Registration_Form.pdf return to contents page Acknowledgement to The Alfred Hospital Outpatients Referral Guidelines
