Infectious Disease and Foreign Travel Emergencies 155Tuberculosis
testing such as a polymerase chain reaction (PCR) assay for HIV, viral RNA
load test and the p24 antigen, rather than simple antibody testing.9 Otherwise, routine HIV antibody testing in the ED is inappropriate if skilled
counselling and follow-up are not available.
(i) Also relying on a single serum test for HIV antibody to establish
or exclude HIV infection is unwise as:
(a) occasional false positives occur
(b) false negatives occur in those infected due to:
- early infection
- lack of seroconversion in the first 4 months.
MANAGEMENT1 Consider every patient to be potentially infectious and adopt standard infec-
tion control precautions including designated hospital hand hygiene
practice, and the use of personal protective equipment to minimize body
substance exposure.
(i) Precautions must be consistently observed with every patient
in order to prevent any HIV dissemination and consequent
exposure to disease risk.
(ii) Always wash hands before and after contact with a patient.
(iii) Wear gloves when handling blood specimens and body fluids.
(iv) Wear a disposable apron if there is likely to be contamination
of clothing (e.g. from bleeding), and a face mask and goggles if
splashing is even a small possibility.
(v) Take great care handling needles or scalpel blades, particularly on
disposal.
(vi) Clean blood spills immediately with a suitable chlorine-based
disinfectant.
2 Refer the patient to the medical team in the usual way if he or she is acutely
ill.
(i) Otherwise refer the patient to infectious disease, genitourinary
medicine (special clinic), or to the medical outpatient service for
complete and ongoing care.
TUBERCULOSIS
DIAGNOSIS
1 Tuberculosis is an unusual diagnosis in the ED, particularly in developed
countries such as Australia and the UK. However, as tuberculosis is a treat-
able and potentially curable disease its diagnosis should be remembered.