Page 33 - Oct-Dec 2024 Edition

HEALTH FEATURE

investigations in the affected district included they might suggest that Borelia, Rickettsia,
testing blood samples for pretty much everything leptospirosis, Coxiella, or other common but
and again found evidence of past infection with missed febrile diseases are likely. The good news
the 20 odd different diseases that we know are is they all respond very nicely to doxycycline.
common causes of fever in Uganda, but just not A properly followed-up therapeutic trial of
diagnosed. So, when they fail to get better with doxycycline is often the most sensible option.
malaria treatment or if the rapid test is negative
the next default diagnosis is typhoid. Again, The key to quick diagnosis is common sense. We
most cases diagnosed as typhoid it isn’t typhoid all want to avoid massively expensive and time-
and the treatment given wouldn’t be effective if consuming investigations, or avoid the trauma of
it was. But Borelia is sensitive to most groups unnecessary or painful treatment and injections.
of antibiotics so would be quickly eliminated by If you’re a long way from sensible and competent
drugs given for typhoid. Or just antibiotics given medical care, my advice is to always carry
on suspicion: so, they get better without it being malaria rapid test kits, travel with doxycycline,
diagnosed or recorded. All species of Borelia and if you get a fever look up old articles on
respond very well to doxycycline. So, our policy The Eye website or The Surgery website. DIY
was if it looked like Borelia and quacked like diagnosis and treatment are never recommended
Borelia we would diagnose it on suspicion, give but is often unavoidable: if you have to do it, be
doxy and see if they’re better in a couple of days. prepared and use your common sense. I also
A lot easier than sending samples off for pcr-for- know if you email The Surgery one of the tropical
everything costing thousands of dollars and taking specialists there will guide you. If you’re told your
a week. fever is “clinical malaria” but you know you have a
negative rapid test, (ask to see the strip, it’s your
Rickettsia are also difficult to diagnose for right) or typhoid (how would you get typhoid? Is
certain. Most people think of typhus and the other your personal hygiene that bad?) or “bacterial
Rickettsiae as the “spotted fevers”, but not every infection” which is not a diagnosis at all, then ask
case has a rash. Like Borelia they can be just a questions: modern medical training encourages
fever with non-specific symptoms. A suggestive us to listen to our patients and encourage them
diagnostic sign is the Eschar: a red area which to voice their concerns. Use Google. If it doesn’t
scabs over with a black crust where the bite was. sound like common sense, look like common
Borelia bites can also cause a red lump for 3 days sense or quacks like common sense then it
but a true Eschar strongly points to rickettsia. All probably isn’t.
tropical fever diagnosis depends on the classic
diagnostic process of history, examination and In summary. Tick fever is not a diagnosis, there
simple lab tests. “Who, when, where”. Where has are 2 common causes which are usually fairly
he been, central Kampala or a swamp in west mild and many rare tick-borne diseases which
Nile? Is he an accountant or a vet? How long can be severe. Though difficult to diagnose with
after swimming in Jinja or camping in Karamoja or certainty, different tick-borne fevers and a lot of
walking in Murchison did the fever begin? Simple other causes of non-specific fevers respond to
tests like a urine dip stick, a simple blood count doxycycline Diagnosis of fever in the tropics is
and the easy rapid tests will point in the right not straight forward but history, examination and
direction. History, examination and simple tests simple lab tests will usually get there. Common
will narrow it down to not malaria, not bilharzia, sense can avoid disaster. If in doubt use Google
not dengue or one of the other arboviruses, and and don’t be afraid to email a tropical disease
not a common focal bacterial infection. Instead specialist.
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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