The Febrile Patient Clinical Essentials in Global Health: David Roesel MD, MPH, DTM&H

Top Ten Causes of Death in Low Income Countries WHO, Global Burden of Disease 2004 Update

Burden of Disease in Low Income Countries WHO, Global Burden of Disease 2004 Update 2004 Update

Adult Mortality by Region WHO, Global Burden of Disease 2004 Update

Child Mortality by Region: WHO, Global Burden of Disease 2004 Update

General Principles: Fever is one of the most common reasons for seeking medical care in developing countries-- you must become comfortable evaluating and treating it .

Fever is one of the most common reasons for seeking medical care in developing countries-- you must become comfortable evaluating and treating it .

Fevers in the tropics are often due to illnesses with which North American health-workers are not familiar.

Fevers in the tropics are often due to illnesses with which North American health-workers are not familiar.

The febrile patient may represent an infectious disease threat to others- including you.

The febrile patient may represent an infectious disease threat to others- including you.

Fever can represent a life-threatening emergency or a self-limiting viral illness: triage is essential .

Fever can represent a life-threatening emergency or a self-limiting viral illness: triage is essential .

Do you . . . ? Get a head CT. Draw blood cultures. Perform a lumbar puncture. Get a chest X-ray. Send a blood smear for malaria. Start empiric treatment.

Get a head CT.

Draw blood cultures.

Perform a lumbar puncture.

Get a chest X-ray.

Send a blood smear for malaria.

Start empiric treatment.

Integrated Management of Childhood Illness: IMCI A set of clinical guidelines developed by WHO and UNICEF for low-resource settings. “ Reduce death, illness and disability, and promote improved growth and development among children under five years of age.”

A set of clinical guidelines developed by WHO and UNICEF for low-resource settings.

“ Reduce death, illness and disability, and promote improved growth and development among children under five years of age.”

Respiratory Illness Diarrhea Febrile Illness Ear Infection Malnutrition Anemia HIV infection Integrated Management of Childhood Illness: IMCI

Respiratory Illness

Diarrhea

Febrile Illness

Ear Infection

Malnutrition

Anemia

HIV infection

Main Causes of Child Mortality: Other Infectious & Parasitic Diseases 9% Non-communicable diseases 4% Measles 4% HIV/AIDS 2% Malaria 7% Diarrheal diseases 16% Acute Respiratory Infections 17% Injuries 4% Neonatal deaths 36% Malnutrition 35% WHO, Global Burden of Disease 2004 Update

Prioritize Based on Danger Signs: Persistent vomiting Inability to drink/breastfeed Convulsions Decreased level of consciousness

Persistent vomiting

Inability to drink/breastfeed

Convulsions

Decreased level of consciousness

Important Causes of Fever in Children Respiratory illness Malaria Tuberculosis Typhoid Meningitis Measles

Respiratory illness

Malaria

Tuberculosis

Typhoid

Meningitis

Measles

IMCI Management of Fever: Give Tylenol as antipyretic. Refer if fever > 7 days Danger Signs/ Stiff Neck Broad Spectrum Antibiotics + Quinine + Glucose No Danger Signs Oral Malaria Treatment (ACT) Rash, Coryza Treat for Measles None of the above Supportive care

Malaria Kills

How should this child be managed?

✓ ✓ ✓ ✓ ✓

General Principles: Explore the history, esp. exposure risks and duration of illness.

Explore the history, esp. exposure risks and duration of illness.

Know the local epidemiology.

Know the local epidemiology.

Do a thorough physical exam.

Do a thorough physical exam.

Use wisely whatever diagnostic tests you have available.

Use wisely whatever diagnostic tests you have available.

Be able to read X-rays.

Be able to read X-rays.

Learn to do ultrasounds.

Learn to do ultrasounds.

Tuberculosis is a common cause of persistent fevers.

Tuberculosis is a common cause of persistent fevers.

Hospital-acquired infections are common.

Hospital-acquired infections are common.

Know how to use a few key medications.

Know how to use a few key medications.

Essential Drugs: Amoxicillin Ampicillin Co-Artem (Artemether + lumefantrine) Benzylpenicillin Chloramphenicol Cloxacillin Co-trimoxazole Doxycycline Erythromycin Gentamycin Metronidazole Praziquantel Quinine

Amoxicillin

Ampicillin

Co-Artem (Artemether + lumefantrine)

Benzylpenicillin

Chloramphenicol

Cloxacillin

Co-trimoxazole

Doxycycline

Erythromycin

Gentamycin

Metronidazole

Praziquantel

Quinine

Show respect, compassion, humility, and patience.

Show respect, compassion, humility, and patience.

Why do millions die from treatable diseases every year? A. Because they’re poor. B. Who cares? C. Ignorance. D. It is written.