By Rusul Anwar

Presenting Problems
In Infectious Diseases

1. Fever:
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 of sweating
 Normal ESR & CRP
 Evidence of self – injection or self – harm. (pyogenic)

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
1. Really = rubella
2. Sick = scarlet fever
3. People = pox
4. Must = measles
5. Take = Typhus
6. No = non-specific infection
7. Exercise = enteric fever (typhoid +paratyphoid)

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:
 sepsis, abscesses
 Tuberculosis
 Endocarditis
 Enteric fever
 Brucellosis
 HIV
 Toxoplasmosis
 fungal infection

B. Malignancies
 Lymphoma
 Hodgkin s disease
 Myeloma
 Hypernephroma

 Leukemia
C. Connective tissue disorders:
 Vasculitis
 SLE
 Polyarteritis nodosa

 Still s disease
D. Miscellaneous
 inflammatory bowel disease
 drug fever
 sarcoidosis
 FMF
 Atrial myxoma
 No diagnosis or resolves spontaneously

 Investigations & Management

 Re take history
 Repeat the examination
 Review results of investigations and repeat if indicated
 consider farther investigations; serological, CT, MRI, tissue
biopsies,…
 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.

All The Best