ABSTRACT
Background: A patient presenting with fever and purpura after a stay in the tropics tempts a physician to make a differential diagnosis mainly focusing on imported diseases. Although the importance of considering a tropical disease is obvious, the fact that cosmopolitan infections account for one third of the cases in a febrile returning traveler must not be overseen. Toxic Shock Syndrome is amongst the most notorious diseases due to the high mortality when inappropriately managed and the association with necrotizing fasciitis. Methods : We present a 60-year old female with fever, shock syndrome and progressive appearance of painful purpura on the lower legs after a 2-week holiday in Zanzibar. Results : The patient was diagnosed with Streptococcal Toxic Shock Syndrome. Treatment focusing on aggressive fluid resuscitation, prompt administration of antibiotics (ceftriaxon, doxycycline and one dose of amikacin) and adjunctive treatment by clindamycin and immunoglobulin was initiated. She was also immediately taken into surgery for a bilateral fasciotomy and surgical exploration of the lower legs. Histology appeared compatible with purpura fulminans, thereby excluding necrotizing fasciitis. No source of infection could be identified. Conclusion: Toxic Shock Syndrome remains a challenging diagnosis and even more in a returning traveler with an extensive differential diagnosis containing both tropical and cosmopolitan diseases. Cornerstones for the treatment of Streptococcal Toxic Shock Syndrome are abrupt administration of antimicrobial therapy comprising beta-lactam antibiotics and clindamycin and surgical exploration to apply source control when indicated.
Subject(s)
Anti-Bacterial Agents/administration & dosage , Fasciitis, Necrotizing , Fluid Therapy/methods , Shock, Septic , Streptococcal Infections , Streptococcus pyogenes/isolation & purification , Anti-Bacterial Agents/classification , Communicable Diseases, Imported/diagnosis , Communicable Diseases, Imported/etiology , Diagnosis, Differential , Fasciitis, Necrotizing/complications , Fasciitis, Necrotizing/diagnosis , Fasciitis, Necrotizing/therapy , Female , Humans , Middle Aged , Patient Care Management/methods , Purpura Fulminans/diagnosis , Purpura Fulminans/therapy , Shock, Septic/diagnosis , Shock, Septic/etiology , Shock, Septic/therapy , Streptococcal Infections/diagnosis , Streptococcal Infections/physiopathology , Streptococcal Infections/therapy , Surgical Procedures, Operative/methods , Travel-Related Illness , Treatment OutcomeABSTRACT
OBJECTIVE: The objective of this study was to develop and evaluate an evidence-based information technology (IT) application that guides clinical decision-making during the reverse-triage selection process in mass casualty incidents. METHODS: Based upon 28 validated critical interventions (CI) relevant for determining whether a patient qualifies for early discharge, we developed the Reverse Triage Tool of Leuven (RTTL). The RTTL is compatible with the health electronic record (HER) of UZ Leuven, a tertiary hospital in Belgium. During a 3-week period in March 2015, we registered data from 2 groups of patients: a random group (no RTTL usage) and a filtered group (RTTL usage). RESULTS: When applying the original 28 CIs, we were able to select almost twice as many patients in the filtered group who qualified for early discharge compared with patients in the random group. The predictive validity was highly satisfactory. CONCLUSIONS: The RTTL saves time in 2 ways. First, it reduces the patient population that needs to be evaluated for potential early discharge to one-third. Second, it doubles the probability of selecting an actual dischargeable patient. Each selected patient, however, still must undergo multidisciplinary reassessment in order to qualify for early discharge. Thus, further research is required to optimize the IT application.(Disaster Med Public Health Preparedness. 2018;12:599-605).
Subject(s)
Decision Support Systems, Clinical/standards , Triage/methods , Triage/standards , Belgium , Decision Support Systems, Clinical/instrumentation , Emergency Medical Services/methods , Emergency Medical Services/standards , Emergency Medical Services/statistics & numerical data , Evidence-Based Practice/methods , Humans , Mass Casualty Incidents , Pilot Projects , Time Factors , Triage/statistics & numerical dataABSTRACT
Isolated perianal lesions in a returned traveller from Togo were observed. Eosinophilia was the lead to schistosomiasis, although no systemic symptoms were reported. This case report of cutaneous schistosomiasis demonstrates the importance of a travel history, especially geographic and exposure features, and treats the differential diagnosis of eosinophilia in a returned traveller with skin lesions.