Out-patient clinic

I'm working in the out-patient clinic at the hospital for tropical diseases at the moment. People come back from trips to places all over the world with various maladies ranging from malaria to strange skin things to general malaise ...

It has been a very interesting couple of weeks working here. The range of things to think about is huge, and the consultants are very good and pro-teaching.

Here are a couple of the photos from the cases I've been seeing


Cutaneous larva migrans : a dog hookworm burrows around in the skin, causing this very itchy "serpiginous" (snake-like) rash.



Pityriasis versicolor. This poor girl had had this for 6 months and had been told by her GP it was "dry skin". It is actually a fungal infection that destroys skin pigment.

That's all the skin stuff I've diagnosed so far. I'll talk about the viral outbreak system soon - that's pretty cool, if a little scary !

answer to mystery Chest x-ray competition

This is the answer to the question of the previous post : have a look at that before reading the answer.

Luca Sarti sent me the right answer last night, I'm very impressed. Here is his email

Very interesting case. Just a quick note to underline that praziquantel is active against the adult stage of Schisto, and nearly uneffective in killing cercariae after introduction in body fluid trought the skin. In other words, there is no chemoprophilaxis agaist schisto with praziquantel or other antihelmintics. A guy with fever reporting to have taken pills after swimming in high risk waters remains at high risk to have katayama fever.
Good luke for your great and exciting work
Luca Sarti, Italy

So the reason that the previous X-ray had strange "lumps" was that parasitic flatworms were migrating through his lungs on the way to his bladder, where they would lay their eggs ... sounds worse than a sci-fi horror movie !

Anyway, very impressed by Luca's knowledge of parasite pharmacology... here is a photo which I'm sure will please him :




Forza Italia !

mystery chest x-ray competition

I'm now settling into my job at HTD (Hospital for Tropical Diseases), though unfortunately I've had to start by going straight into a week of nights. It isn't too bad so far, and there have been some pretty interesting admissions.

I'm currently a bit mystified by one guy who came in today, so I thought I'd make this into a kind of Tropical Quiz question - hopefully someone will read this and e-mail me the diagnosis...

So: 22yr old caucasian man, recently returned from 2 months in Uganda. He suffered with malaria while out there, treated successfully with quinine. Also self-medicated with praziquantel for possible schistosomasis after swimming in high-risk water. No sexual activity whilst in Uganda. On return to UK, he has been having some vague fevers, but otherwise not too bad - not coughing or losing weight. He's normally fit+well.

At HTD, he has been found to have an eosinophilia (0.8) and also this bizarre chest x-ray:


Alternative settings to show bizarre lesions...



So not actually sure what he may have. My top ideas so far are
1. Schistosomiasis - ?Loefflers lungs appearance?
2. some other wormy-type thing eg Paragonamiasis, strongyloides
3. TB
4. ?? Lymph nodes

I hope some clever doctors out there can see these x-rays and make a spot diagnosis... Prize of a special mention on my blog for anyone who seends a sensible suggestion !
I'm just going to wait for all the tests to start giving an idea.