“Infectious disease manifests across all clinical specialties”

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“Infectious disease manifests across all clinical specialties” Professor Steve Green Sheffield Teaching Hospitals University of Sheffield Sheffield Hallam University

Transcript of “Infectious disease manifests across all clinical specialties”

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“Infectious disease manifests across all clinical specialties”

Professor Steve GreenSheffield Teaching Hospitals

University of SheffieldSheffield Hallam University

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“There is nothing

permanent except change.”

Heraclitus (535 BC – 475 BC)

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Infectious Diseases is pretty

well the only specialty that has

new diseases, and new versions

of old ones, turning up from time to time…

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Historically, Infectious diseases were everything

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Infectious diseases killed the poor

The Plague, or the Black Death, in the 14th century reduced the European population by a third.

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And in doing so changed history…..

The Black Death led to the decline of feudalism and serfdom in Europe

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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…….

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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

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Nothing stays the same

Lady Mary Wortley Montagu Dr Edward Jenner

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Infection never really went away

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1970s

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1980s

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1994

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The effects of infection on the NHS are massive

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HIV/AIDS

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The sting in the tail of infection -Antimicrobial resistanceAntimycobacterial

AntifungalsAntivirals Antiprotozoals

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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

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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

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But surely there isn’t that much to worry about now?

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What bout travel?

• Important diseases include…

• Malaria

• Typhoid

• Viral hepatitis

• Legionellosis

• Dengue

• Helminths etc

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Importance of

Zoonoses

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Hobbies e.g. spelunking

birds

Don’t forget the link between histoplasmosis and the dropping from bats and birds

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2014

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You don’t need to travel all that

far to get problems….

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What people do to each other

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Most people think of

worms as someone

else’s problem !

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Worms can even present to respiratory

physicians!

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• 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

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Politics and healthcare don’t mix well

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Transverse myelitis

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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!

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Medical Tourism

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Thank you