Department of Health
PUBLIC HEALTH ALERT
Please immediately bring to the attention of all doctors

31 December 2004

ADDITIONAL INFORMATION FOR MEDICAL PRACTITIONERS TREATING PEOPLE RETURNING FROM TSUNAMI-AFFECTED AREAS

Brief notes on specific conditions which may be encountered.

Note that not all symptoms will be found in all cases.

Typhoid and Paratyphoid Fever: Incubation: 1 day - 1 month.

• Clinical: Sustained fever, headache, malaise, anorexia, relative bradycardia, splenomegaly, rose spots, constipation or diarrhoea

• Diagnosis: *Blood culture, urine / faeces culture.

Cholera: Incubation: few hours - 5 days

• Clinical: profuse watery diarrhoea, nausea, vomiting, dehydration

• Diagnosis: *#Stool microscopy and culture

Melioidosis: Incubation: 1 - 21 days (acute), may reactivate after months to years

• Clinical: Septicaemia, fever, pneumonia, empyema, osteomyelitis, skin ulcers and abscesses, wound infections. Clinical signs variable, not sensitive to many commonly used antibiotics.

• Diagnosis: *Blood culture, *sputum culture, *wound swabs, throat swabs, serology

Amoebiasis: Incubation: days - months - many years

• Clinical: Dysentery, fever, chills, bloody or mucoid diarrhoea, intermittent constipation, abdominal discomfort, colitis, perianal ulceration, liver abscesses.

• Diagnosis: *Examination of stools, serology for invasive disease

Malaria: Incubation: usually 7 - 30 days

• Clinical: Fever, chills, sweats, cough, diarrhoea, myalgias, headache. Use of chemoprophylaxis does not preclude diagnosis of malaria.

• Diagnosis: *Thick and thin blood films, other tests may be available in some laboratories.

Dengue Fever: Incubation: usually 3 - 14 days

• Clinical: Fever (usually lasting 3-5 days), intense headache, myalgia, arthralgia, retroorbital pain, anorexia, GI disturbances, rash.

• Diagnosis: *Serology

Hepatitis A and E: Incubation period: 15 - 50 days (A) / 15 - 64 days (E)

• Clinical: Fever, malaise, anorexia, nausea, abdominal discomfort, followed by jaundice

• Diagnosis: *Serology

Leptospirosis: Incubation period: 4 - 19 days

• Clinical: Fever, headache, chills, severe myalgia (calves and thighs), conjunctival suffusion, meningitis, rash, haemorrhage into skin and mucous membranes, hepatorenal failure, jaundice, confusion, depression, pulmonary involvement.

• Diagnosis: *Serology, #culture from blood, CSF, urine (in some laboratories).

* Essential tests                     # Alert laboratory - requires special culture media

Dr Jane Raupach - Acting Director, Communicable Disease Control Branch
Contact telephone number: 8226-7177 (24 hours/7 days)