ER goldbook: Tropical disease

Typhoid fever/paratyphoid (less invasive)

Clinical: most 5-25 yr, flu-like symptoms, N/V, diarrhea (conspitation in adult), hepatosplenomegaly, relative bradycardia, MP rash 2-4 mm at chest/abdomen
Lab: normal-low WBC +/- anemia/thrombocytopenia, mild transaminitis
Diagnosis: clinical + C/S, PCR
Tx: ofloxacin 15-20 mg/kg/d, ciprofloxacin 20-30 mg/kg/d 5-14 d (depend on FQ resistant); ceftriaxone 40 mg/kg/d x 7-14 d, azithromycin 8-10 mg/kg/d x 7 d
**Non-typhoidal samonellosis: spontaneous recovery in 3-7 d; Tx with ATB if old age, immunocompromised host

Melioidosis

Septicemic melioidosis: septic shock, death
Pulmonary meliodosis: fever, cough, pus sputum > 1mo + concurrent UTI (differentiated from pulmonary TB)
Hepatosplenic abscess: abdominal pain, N/V, transaminitis; other localized infection: skin, lymohadenitis, pyomyositits, osteomyelitis, arthritis

Diagnosis: serology Ab IgG/IgM > 1:160
Tx: ceftazidime or carbapenam 10-14 d then cotrimazole + doxycycline or augmentin (higher relapsed rate) x total 20 wks

Rickettsia

Clinical (systemic vasculitis): fever (upto 3 wks), headache, myalgia, eschar, abdominal pain, diarrhea, pneumonitis, AIN, interstitial myocarditis, meningoencephalitis, DIC

Spotted fever group (Thai tick typhus), epidermic typhus (louse), murine typhus (flea), scrub typhus

Lab: mild leukopenia, anemia, thrombocytopenia, hyponatremia, hypoalbuminemia, mild hepatic & renal abnormality
Diagnosis: IFA IgM/IgG > 1:400 or 4 fold rising in 10-14 d (> 1:200)
Treatment: doxy(100) 1x2 for 3 d; azithromycin(alternative in scrub typhus)

Leptospirosis

Clinical: fever, headache, myalgia (esp. back, calf, neck), conjunctival hyperemia
Lab: increaseTB(upto 20), mild transaminitis, renal failure, anemia, leukocytosis, thrombocytopenia, hematuria, hyaline/granular cast in urine
Diagnosis: IFA, MAT (>1:400 or 4-foled rising)
Tx: PGS 1.5-2 mU q 6 h for 7 d; doxy(100) 1x2; cef-3 1 gm IV OD; cefotaxime 1 gm IV q 6 h

Malaria

Parasite

Enterobius: Alben 400 once + repeat 2 weeks later
Trichuris: Alben 400 once
Ascaris: Alben 400 once
Capillaria: Alben 200 BID x 10d
Hookworm: Alben 400 once
Cutaneous larva migrans: Alben 400 BID x 3-5d
Strongyloides: Ivermectin 200 mcg/kg OD x 2d (6mg/tab), if disseminated infection x 5-7d +/- ATB cover gr neg sepsis
Trichinella: Alben 400-800/d until fever subsides + pred 40-60 mg/d
Gnathostoma: Alben 400-800 x 21d Angiostrongylus: No specific Rx, CSF removal to reduce ICP
Opisthorchis: Praziquantel 25mg/kg tid x 1d (600 mg/tab)
Paragonimus: Praziquantel 25mg/kg tid x 3d (600 mg/tab)
Schistosoma: Praziquantel 20 mg/kg tid x 1d
Taeniasis: Praziquantel 10 mg/kg once
Neurocysticercosis (T. solium): Alben 400 bid x 21d, steroid, AED
Giardia: Metro 750 tid x 5d
Entamoeba histolytica: Metro 500-750 tid x 5d
Isospora: Bactrim SS 2x4 x 10d
Cyclospora: Bactrim SS 2x4 x 10d
Cryptosporidium: No effective Rx; ARV
Scabies: 5% Permethrin or 1% Lindane apply to all areas of body from neck down, Wash off after 8 hours

Dengue

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