prearrangements资料.ppt

Important Problems on Returning from the Tropics Bruno Bernardin MD, FRCP, CSPQ Objectives Learn to recognize this presentation ... Learn to recognize this rash … Learn when and where to hide from patients Learn when to call funeral pre-arrangements Who’s toast, who’s not Objectives What is NOT malaria Why is the epidemiology of infectious diseases changing Recognize the most dangerous illnesses you can come across and prevent a disaster Build a differential diagnosis from syndromic approach (as you may rarely come across these entities) Maybe a few other goodies... Case 1: return of the prodigal son Young man, 27 y.o., returned x 36 hrs from Cameroun where he visited his family x 1 mo Fever, chills, malaise, apetite loss Normal physical exam, To 39o, non toxic Case -2: Asia Presents post trip to Thailand-Vietnam Sore throat, dry cough, headache, myalgias, malaise, fever… Exam non specific, some lymph nodes Case-3 Patient returns from Middle East (or new immigrant) Cough, wheezing, SOB New onset asthma, in crisis Better with B-agonists CBC: eosinophilia Syndromes Fever: Hemorragic manifestations : Transmissible: Ebola, Marburg, Lassa, Congo-Crimean Non transmissible: yellow fever, HD Respiratory manifestations Neurological manifestations Symptoms non specific: dengue, typhoid, malaria With eosinophilia Diarrhea Hematuria Cutaneous manifestations Fever in a traveler 3% of travelers Focus on life threatening, treatable, or transmissible Incubation period may allow to eliminate certain pathologies: 21 days = NOT dengue, viral hemorragic, ricketsioses... Small exercise: Typical picture : fever, malaise myalgias, headache chills, anorexia nausea, vomiting +/- diarrhea DIAGNOSIS?? Tropical fever : initial approach Hemorragic Fevers Initial approach : isolate, isolate, isolate… Differential diagnosis : meningococcemia gram negative sepsis viral (not in the sense: “it’s just a virus, it’ll pass”) Hemorragic Fevers 18 viruses identified 4