Page 38 - Jan-March 2025

HEALTH FEATURE

There is no such diagnosis as “bacterial infection”.
It usually means an automated cell counter has
found an elevated white count or just an elevated
neutrophil percentage. It can be due to absolutely
anything including stress or exercise. It was the
latest fad diagnosis 5 years ago: I hope it has
already been confined to the dustbin of history. Of
course, many fevers are indeed caused by bacterial
infections, but it isn’t a diagnosis. It has to be
bacterial infection OF something: the diagnosis is
tonsillitis or pneumonia, or intestinal infection, or
minutes. It might tell us what you have, or it might meningitis. Some of those 20 diseases are caused
tell us what you don’t have. I remember when we by bacteria. In some bacterial diseases the white
found a case of trypanosomiasis from Jinja about count is high, in others the diagnostic clue is the
10 years ago. It really did take less than10 minutes white count is low. Automated cell counts are
looking down a microscope, the slide was a absolutely a vitally important diagnostic tool but
crawling with them. Beautiful if you like that sort of requires proper evaluation. Looking at a white
thing. They insisted on medivac and Nairobi took count and saying “bacterial infection” is certainly
2 days to confirm because we had already treated not making a proper diagnosis.
it before they left, so tryps were no longer visible. So, what does this mean for you? The CDC and
Warnings WHO experts do it properly: and so can any doctor
who chooses to. CDC have the facilities to do
“Malaria and typhoid” is extremely unlikely and extremely expensive tests in labs 500 km away to
in 42 years I never saw both cases together. The discover rare or new disease. But they start with
diagnosis was almost always due to a “positive” the 3 pillars. For most of us, fevers in the tropics
blood slide which was probably wrong. Malaria can be diagnosed with enough evidence to initiate
rapid tests are extremely accurate, the CDC effective treatment, by using simple diagnostic
publicly claims they are 100% accurate. A negative tools and a modicum of common sense. There
test, especially if repeated in 24 hours, means it is is no justification for calling every fever malaria,
absolutely not the dangerous species, falciparum typhoid and bacterial infection, nor treating
malaria. The rare species, p. vivax or p. Malariae, everyone with antimalarials and the latest most
can be missed by the rapid, but as they are mild fashionable antibiotic. Good medicine can still be
variants it doesn’t matter if they are missed for 24 practiced in a grass thatch facility 100 km from the
hours, and a urine dip for urobilinogen can arouse nearest tarmac: CDC experts do, and so can we
enough suspicion for a more careful search. But all. A proper diagnosis of a fever in the tropics is
essentially a negative rapid test means it’s not vital and could be life saving. Don’t be taken in by
malaria. Demand to see the test yourself. It’s not poor medical standards just because it’s delivered
rocket science; one line means negative. Typhoid in a shiny environment. If the 3 pillars of good
is suggested clinically by a slow climbing fever, diagnostic practice, history, exam, simple lab tests,
headache, almost always cough and abdominal are not being clearly followed then why not? If you
pain. The modern tests can rule it out, a culture get given a diagnosis that makes you suspicious
is still best to confirm and that takes 2 days. The try google. If you have the choice, try somewhere
old Widal tests are utterly unreliable: they are else.
positive for life in anyone who has had salmonella
food poisoning twice. And that means almost If you’re up country phone: 0752 756 003.
everyone. A diagnosis of typhoid using a Widal is
meaningless. They’re still used so don’t be fooled.

THE SURGERY
42 Naguru Drive, Naguru, Kampala ER
Reception: +256 312 256 008 24/7 | Emergency: +256 752 756 003
Admin: +256 312 256 004
stockley@thesurgeryuganda.org | thesurgeryuganda.org
@TheSurgeryUganda (f)
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