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Tropical diseases in the ICU: A syndromic approach to diagnosis and treatment.
J Crit Care. 2018 08; 46:119-126.JC

Abstract

Tropical infections form 20-30% of ICU admissions in tropical countries. Diarrheal diseases, malaria, dengue, typhoid, rickettsial diseases and leptospirosis are common causes of critical illness. Overlapping clinical features makes initial diagnosis challenging. A systematic approach involving (1) history of specific continent or country of travel, (2) exposure to specific environments (forests or farms, water sports, consumption of exotic foods), (3) incubation period, and (4) pattern of organ involvement and subtle differences in manifestations help in differential diagnosis and choice of initial empiric therapy. Fever, rash, hypotension, thrombocytopenia and mild derangement of liver function tests is seen in a majority of patients. Organ failure may lead to shock, respiratory distress, renal failure, hepatitis, coma, seizures, cardiac arrhythmias or hemorrhage. Diagnosis in some conditions is made by peripheral blood smear examination, antigen detection or detection of microbial nucleic acid by PCR. Tests that detect specific IgM antibody become positive only in the second week of illness. Initial therapy is often empiric; a combination of intravenous artesunate, ceftriaxone and either doxycycline or azithromycin would cover a majority of the treatable syndromes. Additional antiviral or antiprotozoal medications are required for some specific syndromes. Involving a physician specializing in tropical or travel medicine is helpful.

Authors+Show Affiliations

Jupiter Hospital, Thane, India.Division of Critical Care, Charlotte Maxeke Hospital and Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa.Department of Neurology and Neurosurgery, Universidade Federal de São Paulo and Programa Integrado de Neurologia and Instituto de Ensino e Pesquisa, Hospital Israelita Albert Einstein, São Paulo, Brazil.Bombay Hospital Institute of Medical Sciences, Mumbai, India. Electronic address: pamin@vsnl.com.No affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

29625787

Citation

Karnad, Dilip R., et al. "Tropical Diseases in the ICU: a Syndromic Approach to Diagnosis and Treatment." Journal of Critical Care, vol. 46, 2018, pp. 119-126.
Karnad DR, Richards GA, Silva GS, et al. Tropical diseases in the ICU: A syndromic approach to diagnosis and treatment. J Crit Care. 2018;46:119-126.
Karnad, D. R., Richards, G. A., Silva, G. S., & Amin, P. (2018). Tropical diseases in the ICU: A syndromic approach to diagnosis and treatment. Journal of Critical Care, 46, 119-126. https://doi.org/10.1016/j.jcrc.2018.03.025
Karnad DR, et al. Tropical Diseases in the ICU: a Syndromic Approach to Diagnosis and Treatment. J Crit Care. 2018;46:119-126. PubMed PMID: 29625787.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Tropical diseases in the ICU: A syndromic approach to diagnosis and treatment. AU - Karnad,Dilip R, AU - Richards,Guy A, AU - Silva,Gisele Sampaio, AU - Amin,Pravin, AU - ,, Y1 - 2018/03/27/ PY - 2018/01/15/received PY - 2018/03/21/revised PY - 2018/03/23/accepted PY - 2018/4/8/pubmed PY - 2019/7/23/medline PY - 2018/4/8/entrez KW - Critical care KW - Dengue KW - Leptospirosis KW - Malaria KW - Multiple organ system failure KW - Rickettsial infections SP - 119 EP - 126 JF - Journal of critical care JO - J Crit Care VL - 46 N2 - Tropical infections form 20-30% of ICU admissions in tropical countries. Diarrheal diseases, malaria, dengue, typhoid, rickettsial diseases and leptospirosis are common causes of critical illness. Overlapping clinical features makes initial diagnosis challenging. A systematic approach involving (1) history of specific continent or country of travel, (2) exposure to specific environments (forests or farms, water sports, consumption of exotic foods), (3) incubation period, and (4) pattern of organ involvement and subtle differences in manifestations help in differential diagnosis and choice of initial empiric therapy. Fever, rash, hypotension, thrombocytopenia and mild derangement of liver function tests is seen in a majority of patients. Organ failure may lead to shock, respiratory distress, renal failure, hepatitis, coma, seizures, cardiac arrhythmias or hemorrhage. Diagnosis in some conditions is made by peripheral blood smear examination, antigen detection or detection of microbial nucleic acid by PCR. Tests that detect specific IgM antibody become positive only in the second week of illness. Initial therapy is often empiric; a combination of intravenous artesunate, ceftriaxone and either doxycycline or azithromycin would cover a majority of the treatable syndromes. Additional antiviral or antiprotozoal medications are required for some specific syndromes. Involving a physician specializing in tropical or travel medicine is helpful. SN - 1557-8615 UR - https://www.unboundmedicine.com/medline/citation/29625787/Tropical_diseases_in_the_ICU:_A_syndromic_approach_to_diagnosis_and_treatment_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0883-9441(18)30073-X DB - PRIME DP - Unbound Medicine ER -