TROPICAL DISEASES Zoonosis Animal to human transfer It is almost impossible to distinguish the three most common zoonoses based

ed on Sx and clinical signs alone. Brucellosis Sx Fever, myalgia arthralgia Leptopirosis Fever, myalgia Abrupt fever, severe headache and myalgia, chills, abdo pain, rash Q fever Coxiella burnetii Fever, myalgia Shivers and sweats 3 syndromes: Acute flu like Chronic (70% endocarditis) Long term sequelae (CFS) Sparese crackles with mild bilateral pneumonitis Systolic murmur MR Acute = Ab to phase 2 Ag -ve Ab in first 10-15 days does not exclude QF +ve result at 3-4 days is probably old PCR increasingly important = AB sensitivity = PCR IF more sensitive than complement fixation Acute QF = Ab to phase 2 Ag Chronic QF = Ab to phase 1 Ag Acute: Doxy 2 wks Not response to penicillins or macrolides Chronic: complex doxy and chloroquine for 18+ months May require valve replacement Source cattle, sheep, goats, roos, ticks Respiratory route breathe in blood vapours Particularly in birth fluids (POC) most infectious Vaccine works well Bug can live in soil for up to 1 year breathe in Infection in pregnancy often has serology similar to chronic QF

Signs

Dx

Adenopathy, arthritis, splenomegaly, spinal tenderness, PID, endocarditis Serology not species specific Culture species specific

Meningism, rash, fever Biphasic infective phase

Serology

Tx

Doxycycline 6 wks Add rifampicin if indicated (not indicated, so no PBS) Can use aminoglycocide for 2 weeks (gentamicin + doxy) Transmission via blood Cuts and abrasions, conjunctiva

Doxy Or IV penicillin

In/Out

Hosts eg pigs, cows, mice Blood - Cuts and abrasions

Other info

Commonly passed on from pigs Epididymo-orchitis

Weils Ds lepto with jaundice Liver and renal failure = 510% die Much damage to foetus

Other names

Undulant fever

Unpasteurised milk Brucellosis Q fever Campylobacter Salmonella EHEC enterohaemorrhagic E Coli haemolytic uraemic syndrome (HUS) TB

Dengue Arbovirus (arthropod borne) Flavivirus yellow fever, Japanese encephalitis, NOT RRF Vector is aedes aegypti mosquito o Day biting, breeds in clean water o Container breeder Sx acute fever, marked myalgia Signs acute high continuous fever 2-7 days Bleeding o Consistently +ve tourniquet test (consistent peticiae at occlusion b/q diastolic and systolic for >5 min) Ds Dengue haemorrhagic fever o 4 serotypes infection confers long lasting homotypic protection Dx IgM usually +ve in a few days

ROSS RIVER/ BARMAH FOREST Transient moderate fever, fine erythematous rash Pain with morning joint stiffness Arbovirus Vector culex annulirostris o Long flight breeder more difficult to contain Incubation av 7-9 days Most infections asymptomatic

JAPANESE ENCEPHALITIS

Lethargy, high fever, headache, GIT Sx Can extend to CNS effects nuchal rigidity, symmetrical gait, patchy CNS deficits, generalised seizures Transmit infection from water birds to animals esp pigs Humans accidentally infected Syndrome in 1/200 infected humans Diarrhoea, rigors, extrapyramidal S/E

Murray Valley encephalitis and Kunjin Endemic in east Kimberley, occasional epidemics in Murray-Darling Seroprevalence up to 45% in endemic areas Fever, diarrhoea, rash, cough , encephalitis

Rickettsial Ds (Rocky mountain spotted fever) Forms as eschar primary lesion forms at the entrance site Queensland tick typhus Vector tick Dx serology Tx doxy Scrub tyhus is related

Ticks Local reactions pain, swelling

Fulminant Melioidosis Dx culture on specific media, serology difficult to interpret Tx abscess drainage, Abs intensive for >2 wks with Transmission environment to person

Cryptococcus C. Neoformins Very uncommon unless immunosuppressed eg HIV

Snake bite envenomation Only 1/10 bites represent true envenomation Sx rhabdomyalisis, paralysis, potentially coagulopathies o Drowsiness, naeusea, vomiting, muscle weakness, headache, pain Signs altered SOC, muscle paralysis, rhabpdomyolysis, ptosis, dysarthria, bleeding, haematuria, myoglobinuria, diplopia Ix FBC, E/lft, coag profile Tx o First aid, Pressure immobilisation bandage, immobilisation, transport to hospital o At hosp = vital signs, ABC o 1 in 10 envenomated o IV access, Venom detection kit prior to Tx o If envenomated give anti-venene (snake specific) o Anaphylaxis and anaphylactoid Rxn drugs o If no signs of envenomation, remove PIB and observe for 12 hours