“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