Travel related and tropical infections

Red flags

Consider urgent referral for patients with the following:

  • Altered conscious level
  • Breathing difficulty
  • Abnormal bruising or bleeding
  • Petechial rash
  • Persistent vomiting
  • Dehydration
  • Paralysis
  • Jaundice

Travel related and tropical infections include:

  • Malaria
  • Dengue fever
  • Chickungunya
  • Typhoid
  • Cholera
  • Schistosomiasis/bilharzia
  • Ebola (very rare)
  • Lyme disease

Most tropical diseases will present with an acute illness and may require urgent transfer through Emergency. However, others present with  early, low grade symptoms that may provide an opportunity to investigate and initially manage within a primary care setting.

Other important information for referring practitioners

Medical management

An extensive review of tropical disease is outside the scope of these ID guidelines but the following may help in logical diagnosis and management based on main symptoms.

Diarrhoea

  • Most commonly caused by E.coli as traveller’s diarrhoea. Most cases resolve spontaneously. However, if:
    • Frequent bowel action, vomiting, fever or blood in stool, may benefit from antibiotic treatment
      • Use ciprofloxacin 500mg bd or norfloxacin 400mg bd for 3-5 days
  • If persistent investigate with:
    • Stool microscopy and culture and PCR
    • If diarrhoea is chronic, consider stool for lactose intolerance testing
    • Consider abdomen U/S and or endoscopy (upper and/or lower)

Respiratory disease

Commonly caused by:

  • Influenza
  • Bacterial pneumonia
  • Rarely TB, Pandemic respiratory illness
  • Investigate with:
    • Sputum Micro C&S
    • CXR

Lymphadenopathy

  • Consider Dengue, rickettsial infection, HIV, brucellosis, leishmaniasis, lymphogranuloma venereum, plague

Skin rash

  • Can be non-specific or heat related
  • If petechial consider meningococcal disease, yellow fever, rickettsial infection of viral haemorrhagic fevers
  • Generalised rash can be seen in dengue fever, measles, rubella

Jaundice

  • Consider viral hepatitis, cholangitis, liver abscess, typhoid fever, leptospirosis, yellow fever, dengue fever and haemoglobinopathies. Rarely malaria.

Hepatosplenomegaly

  • Consider viral hepatitis, malaria, brucellosis, typhoid fever, leishmaniasis, schistosomiasis and toxoplasmosis

Gross Splenomegly

  • Consider malaria, visceral leishmaniasis, trypanosomiasis, typhoid, brucellosis, typhus and dengue fever

Anaemia

  • Consider hookworm, malaria and visceral leishmanisis

Referral requirements

A referral may be rejected without the following information.

  • Presence of any red flags
  • History of symptoms and signs
    • Nature, onset, duration
    • Include a description of any transient rashes (despite resolution)
    • Describe nature of fever symptoms if periodic or diurnal
    • Weight loss, loss of appetite
  • Examination
    • Temperature
    • Lymphadenopathy
    • Hydration level
    • Heart rate
    • Rash
  • Travel history
    • Departure and return dates
    • Destinations (include type of terrain visited)
    • Risk activities undertaken
      • Fresh water swimming
      • Degree of contact with local population
      • Disease contacts if known
      • Insect or animal bites or scratches
      • Unprotected intercourse
      • Diet while travelling (esp local water ingested)
      • Injuries or illnesses while travelling
  • Vaccination history
  • Prophylactic medications taken and compliance
  • Investigations (these can be performed if the patient is not seriously unwell, however, they are not necessary if any red flags)
    • Choice of investigations are governed by history and examination but may include:
      • FBC, E/LFT
      • Malarial thick and thin film
      • MSU
      • Viral serology as suggested by history
      • HIV serology
      • Stool micro C&S and PCR
      • Blood cultures

Out of catchment

Metro North Health is responsible for providing public health services to the people who reside within its boundaries. Special consideration is made for patients requiring tertiary care or services that are not provided by their local Hospital and Health Service. If your patient lives outside the Metro North Health area and you wish to refer them to one of our services, inclusion of information regarding their particular medical and social factors will assist with the triaging of your referral.

  • Impact on employment
  • Impact on education
  • Impact on home
  • Impact on activities of daily living
  • Impact on ability to care for others
  • Impact on personal frailty or safety
  • Identifies as Aboriginal and/or Torres Strait Islander
  • To establish a diagnosis
  • For treatment or intervention
  • For advice and management
  • For specialist to take over management
  • Reassurance for GP/second opinion
  • For a specified test/investigation the GP can’t order, or the patient can’t afford or access
  • Reassurance for the patient/family
  • For other reason (e.g. rapidly accelerating disease progression)
  • Clinical judgement indicates a referral for specialist review is necessary
  • Presenting symptoms (evolution and duration)
  • Physical findings
  • Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
  • Body mass index (BMI)
  • Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes), noting these must be stable and controlled prior to referral
  • Current medications and dosages
  • Drug allergies
  • Alcohol, tobacco and other drugs use
  • Full name (including aliases)
  • Date of birth
  • Residential and postal address
  • Telephone contact number/s – home, mobile and alternative
  • Medicare number (where eligible)
  • Name of the parent or caregiver (if appropriate)
  • Preferred language and interpreter requirements
  • Identifies as Aboriginal and/or Torres Strait Islander
  • Full name
  • Full address
  • Contact details – telephone, fax, email
  • Provider number
  • Date of referral
  • Signature
  • Willingness to have surgery (where surgery is a likely intervention)
  • Choice to be treated as a public or private patient
  • Compensable status (e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.)

Send referral

Hotline: 1300 364 938

Fax: 1300 364 952

Electronic: eReferral system templates
Medical Objects ID: MQ40290004P
HealthLink EDI: qldmnhhs

Mail: Metro North Central Patient Intake
Aspley Community Centre
776  Zillmere Road
ASPLEY QLD 4034

Health pathways

Access to Health Pathways is free for clinicians in Metro North Brisbane.

For login details email:
healthpathways@brisbanenorthphn.org.au

Login to Brisbane North Health Pathways:
brisbanenorth.healthpathwayscommunity.org