“Infectious disease manifests across all clinical specialties”
Transcript of “Infectious disease manifests across all clinical specialties”
“Infectious disease manifests across all clinical specialties”
Professor Steve GreenSheffield Teaching Hospitals
University of SheffieldSheffield Hallam University
“There is nothing
permanent except change.”
Heraclitus (535 BC – 475 BC)
Infectious Diseases is pretty
well the only specialty that has
new diseases, and new versions
of old ones, turning up from time to time…
Historically, Infectious diseases were everything
Infectious diseases killed the poor
The Plague, or the Black Death, in the 14th century reduced the European population by a third.
And in doing so changed history…..
The Black Death led to the decline of feudalism and serfdom in Europe
Infectious Diseases also killed the great
• What about smallpox?
• Several monarchs and other leaders have died of smallpox
• They include
– Queen Mary II of England (“William and Mary”)
– Tsar Peter II of Russia
– Emperor Joseph I of Austria
– King Luis I of Spain
– Queen Ulrike Eleonora of Sweden
– And…….
And in doing so changed history…..
• King Louis the 15th of France (1710 –1774) died from smallpox in 1774
• His son, the Grand Dauphin Louis, had already died of “consumption” in 1765
• The Dauphin’s eldest surviving son, Louis-Auguste, Duc de Berry, became the new Dauphin, and ascended the throne as King Louis the 16th in May 1774.
• He was a weak person and a weak King, and succumbed to bad advice
• “Let them eat cake” – Marie Antoinette
• The French Revolution shook France between 1787 and 1799, and changed the world
Nothing stays the same
Lady Mary Wortley Montagu Dr Edward Jenner
Infection never really went away
1970s
1980s
1994
The effects of infection on the NHS are massive
HIV/AIDS
The sting in the tail of infection -Antimicrobial resistanceAntimycobacterial
AntifungalsAntivirals Antiprotozoals
Whatever you do, please always think of infection
• Systems• Fever, high CRP, neutrophilia etc
– Chest– Throat– Ears– Sinuses– Bowel– Liver and biliary tree– Urinary tract– Cardiac, including valves– Skin– Brain and meninges– Joints and bone– Gynaecological– Dental
• A lot of things need to be considered– Behaviours and environment– Genitourinary – sexual activity– Menstruation and contraception– Pets – may be exotic, maybe
straightforward– Job eg sewage worker, police man– Hobbies eg swimming, spelunking
Remember infection is a great mimic, and is it itself often mimicked
• Infections can look like something else
• Creutzfeldt-Jakob disease can resemble dementia
• Amoebic dysentery can look like ulcerative colitis
• Pericarditis can resemble an MI
• Cellulitis of the leg can look like a DVT
• Neurocysticercosis can resemble a brain tumour
• Non-infectious conditions can look like infections
• Sarcoidosis can look like TB• Henoch Schonlein purpura
can resemble meningococcal septicamia
• SLE can resemble infective encephalitis
• Renal carcinoma can cause PUO
• Hodgkin’s Disease can resemble cervical TB
But surely there isn’t that much to worry about now?
What bout travel?
• Important diseases include…
• Malaria
• Typhoid
• Viral hepatitis
• Legionellosis
• Dengue
• Helminths etc
Importance of
Zoonoses
Hobbies e.g. spelunking
birds
Don’t forget the link between histoplasmosis and the dropping from bats and birds
2014
You don’t need to travel all that
far to get problems….
What people do to each other
Most people think of
worms as someone
else’s problem !
55
Worms can even present to respiratory
physicians!
60
• Paragonimuswestermani:
• The Chinese lung fluke.
• More than 20 million cases world-wide. Adult is one cm long.
• Looks like TB or tumour
• Eggs are found in sputum
•
Politics and healthcare don’t mix well
Transverse myelitis
Vaccines
• Wonderful things
• But they only work if people are given them!– Eg. Levels of influenza vaccination among staff at
STH
– Eg Post BMT vaccination of patients in primary care
• Not all vaccines work in everyone
• Not all vaccines are safe in everyone
• They cost money!
Medical Tourism
Thank you