Infectious Disease and Foreign Travel Emergencies 147Hepatitis
(i) Urgent empirical i.v. therapy with broad-spectrum antimicrobials
is universal, although the optimal regimen will depend on local
bacteriological susceptibilities and preference. Give:
(a) piperacillin 4 g with tazobactam 0.5 g i.v. 8-hourly, plus
gentamicin 5 mg/kg i.v. once daily when no source is apparent
(b) ceftazidime 2 g i.v., t.d.s. if penicillin-sensitive, plus
gentamicin 5 mg/kg i.v. once daily
(c) add vancomycin 1.5 g i.v. 12-hourly for possible line sepsis,
MRSA or if the patient is shocked.2 Admit the patient under the medical team, even if the patient looks well with
only a fever, as rapid deterioration may occur.
(i) Refer haemodynamically unstable patients to the intensive care
unit (ICU).
HEPATITIS
DIAGNOSIS
1 Causes of hepatitis include:
(i) Viruses such as enterically transmitted hepatitis A or E, or
parenterally spread hepatitis B, C, D or G, and infectious
mononucleosis, cytomegalovirus (CMV) or herpes simplex virus
(HSV).
(ii) Bacteria such as leptospirosis, or amoebae.
(iii) Toxins and drugs such as alcohol, Amanita mushrooms,
methyldopa, statins, chlorpromazine, isoniazid and paracetamol
(remember the possibility of acute poisoning).
2 Hepatitis presents with anorexia, malaise, nausea, vomiting, abdominal
pain and joint pain.
3 Look for a raised temperature, jaundice, tender hepatomegaly and spleno-
megaly. Assess for confusion or an altered conscious level.
4 Send blood for serology for hepatitis A, B or C, plus FBC, coagulation profile,
ELFTs and lipase.
5 Test the urine for bilirubin and urobilinogen.
MANAGEMENT1 Refer unwell patients to the medical team.
(i) This should include those with persistent vomiting, dehydration,
encephalopathy or a bleeding tendency with a prolonged
prothrombin time.