Davidson's Principles and Practice of Medicine : Davidson's Principles and Practice of Medicine E-Book

More than two million medical students, doctors and other health professionals around the globe have owned a copy of Davidson's Principles and Practice of Medicine since it was first published. Now in its 23rd Edition, this textbook describes the pathophysiology and clinical features of the most frequently encountered conditions in the major specialties of adult medicine and explains how to recognise, investigate, diagnose and manage them. Taking its origins from Sir Stanley Davidson's much-admired lecture notes, Davidson's has endured because it keeps pace with how modern medicine is taught and provides a wealth of information in an easy-to-read, concise and beautifully illustrated format. This book will serve readers everywhere as a core text that integrates medical science with clinical medicine, conveying key knowledge and practical advice in a highly accessible and readable format. The opening section describes the fundamentals of genetics, immunology, infectious diseases and population health, and discusses the core principles of clinical decision-making and good prescribing. A new second section on emergency and critical care medicine encompasses poisoning, envenomation and environmental medicine, and introduces a new chapter on acute medicine and critical illness. The third section covers the major medical specialties, each thoroughly revised and brought fully up to date. Two new chapters on maternal and adolescent/transition medicine complement the one on ageing and disease. A new chapter on medical ophthalmology has been included. Clinical Examination overviews summarise the main elements for each system and now feature in the biochemistry, nutrition and dermatology chapters. Presenting Problems sections provide a clear pathway for the assessment of and approach to the most common complaints in each specialty. Practice Point summaries detail the practical skills that medical students and junior doctors must acquire. Emergency boxes emphasise the core knowledge needed to manage acutely ill patients. In Old Age, In Pregnancy and In Adolescence boxes highlight differences in the practice of medicine in these patient groups, and illustrate the interfaces between medical, obstetric and paediatric services. The text is extensively illustrated, with over 1000 diagrams, clinical photographs, and radiology and pathology images. The global perspective is enhanced by an International Advisory Board of experts from 17 countries, and by authors from around the world. The new second section on emergency and critical care medicine introduces a significantly expanded and comprehensive account of the approaches to dealing with acute medical and critical illness. Two new chapters on maternal and adolescent/transition medicine complement the one on ageing and disease by addressing problems encountered at key stages of patients' lives. A new chapter on medical ophthalmology has been included as a direct response to readers' requests. The opening chapter has been completely rewritten with a new focus on the important principles of clinical decision-making or clinical reasoning. A new internal text design for this 23rd Edition provides a simpler and clearer presentation of the various categories of text boxes. Front Cover Inside Front Cover Half title page Sir Stanley Davidson (1894–1981) Davidson's Principles and Practice of Medicine Copyright Page Table Of Contents Preface Contributors International Advisory Board Acknowledgements Introduction Clinical examination overviews Presenting problems Boxes General Information Practice Point Emergency In Old Age In Pregnancy In Adolescence Terminology Units of measurement Finding what you are looking for 1 Fundamentals of Medicine 1 Clinical decision-making Introduction The problem of diagnostic error Clinical reasoning: definitions Clinical skills and decision-making Use and interpretation of diagnostic tests Normal values Factors other than disease that influence test results Operating characteristics Sensitivity and specificity Prevalence of disease Dealing with uncertainty Cognitive biases Type 1 and type 2 thinking Common cognitive biases in medicine Human factors Reducing errors in clinical decision-making Cognitive debiasing strategies History and physical examination Problem lists and differential diagnosis Mnemonics and checklists Red flags and ROWS (‘rule out worst case scenario’) Using clinical prediction rules and other decision aids Effective team communication Patient-centred evidence-based medicine and shared decision-making Clinical decision-making: putting it all together Evidence-based history and examination Deciding pre-test probability Interpreting test results Treatment threshold Post-test probability Cognitive biases Human factors Reducing cognitive error Person-centred EBM and information given to patient Answers to problems Harvard problem (p. 5) Bat and ball problem (p. 6) Further information Books and journal articles Websites 2 Clinical therapeutics and good prescribing Principles of clinical pharmacology Pharmacodynamics Drug targets and mechanisms of action Dose–response relationships Therapeutic index Desensitisation and withdrawal effects Pharmacokinetics Drug absorption and routes of administration Enteral administration Parenteral administration Other routes of administration Drug distribution Volume of distribution Drug elimination Drug metabolism Drug excretion Elimination kinetics Repeated dose regimens Inter-individual variation in drug responses Adverse outcomes of drug therapy Adverse drug reactions Prevalence of ADRs Classification of ADRs Detecting ADRs – pharmacovigilance Drug interactions Mechanisms of drug interactions Avoiding drug interactions Medication errors Responding when an error is discovered Drug regulation and management Drug development and marketing Licensing new medicines Drug marketing Managing the use of medicines Evaluating evidence Evaluating cost-effectiveness Implementing recommendations Prescribing in practice Decision-making in prescribing Making a diagnosis Establishing the therapeutic goal Choosing the therapeutic approach Choosing a drug Absorption Distribution Metabolism Excretion Efficacy Avoiding adverse effects Features of the disease Severity of disease Coexisting disease Avoiding adverse drug interactions Patient adherence to therapy Cost Genetic factors Choosing a dosage regimen Dose titration Route Frequency Timing Formulation Duration Involving the patient Writing the prescription Monitoring treatment effects Stopping drug therapy Prescribing in special circumstances Prescribing for patients with renal disease Prescribing for patients with hepatic disease Prescribing for elderly patients Prescribing for women who are pregnant or breastfeeding Writing prescriptions Prescribing in hospital Hospital discharge (‘to take out’) medicines Prescribing in primary care Monitoring drug therapy Clinical and surrogate endpoints Plasma drug concentration Timing of samples in relation to doses Interpreting the result Further information Websites 3 Clinical genetics The fundamental principles of genomics The packaging of genes: DNA, chromatin and chromosomes From DNA to protein Transcription: DNA to messenger RNA RNA splicing, editing and degradation Translation and protein production Non-coding RNA Cell division, differentiation and migration Cell death, apoptosis and senescence Genomics, health and disease Classes of genetic variant Nucleotide substitutions Insertions and deletions Simple tandem repeat mutations Copy number variations Consequences of genomic variation Normal genomic variation Polymorphisms and common disease Evolutionary selection Constitutional genetic disease Constructing a family tree Patterns of disease inheritance Autosomal dominant inheritance Autosomal recessive inheritance X-linked inheritance Mitochondrial inheritance Imprinting Somatic genetic disease Interrogating the genome: the changing landscape of genomic technologies Looking at chromosomes Looking at genes Gene amplification: polymerase chain reaction Gene sequencing NGS capture Challenges of NGS technologies Uses of NGS Third-generation sequencing Genomics and clinical practice Genomics and health care Genomics in rare neurodevelopmental disorders Genomics and common disease Genomics and obstetrics Genomics and oncology Genomics in infectious disease Treatment of genetic disease Pharmacogenomics Gene therapy and genome editing Induced pluripotent stem cells and regenerative medicine Pathway medicine Ethics in a genomic age Further information Books and journal articles Websites 4 Clinical immunology Functional anatomy and physiology The innate immune system Physical barriers Phagocytes Neutrophils Monocytes and macrophages Dendritic cells Cytokines Integrins Complement Mast cells and basophils Natural killer cells The adaptive immune system Lymphoid organs The thymus The spleen Lymph nodes Mucosa-associated lymphoid tissue Lymphatics Humoral immunity Immunoglobulins Cellular immunity CD8+ T lymphocytes CD4+ T lymphocytes The inflammatory response Acute inflammation The acute phase response Septic shock Resolution of inflammation Chronic inflammation Laboratory features of inflammation C-reactive protein Erythrocyte sedimentation rate Plasma viscosity Presenting problems in immune disorders Recurrent infections Aetiology Clinical assessment Investigations Management Intermittent fever Aetiology Clinical assessment Investigations Management Anaphylaxis Aetiology Clinical assessment Investigations Management Immune deficiency Primary phagocyte deficiencies Chronic granulomatous disease Leucocyte adhesion deficiencies Defects in cytokines and cytokine receptors Complement pathway deficiencies Clinical features Investigations Management Primary antibody deficiencies X-linked agammaglobulinaemia Selective IgA deficiency Common variable immune deficiency Functional IgG antibody deficiency Investigations Management Primary T-lymphocyte deficiencies DiGeorge syndrome Bare lymphocyte syndromes Severe combined immune deficiency Investigations Management Autoimmune lymphoproliferative syndrome Secondary immune deficiencies Periodic fever syndromes Familial Mediterranean fever Mevalonic aciduria (mevalonate kinase deficiency) TNF receptor-associated periodic syndrome Amyloidosis Pathophysiology Clinical features Investigations Management Autoimmune disease Pathophysiology Clinical features Investigations Autoantibodies Complement Cryoglobulins Management Allergy Pathophysiology Clinical features Insect venom allergy Peanut allergy Birch oral allergy syndrome Diagnosis Investigations Skin-prick tests Specific IgE tests Supervised exposure to allergen Mast cell tryptase Serum total IgE Eosinophilia Management Avoidance of the allergen Antihistamines Glucocorticoids Sodium cromoglicate Antigen-specific immunotherapy Omalizumab Adrenaline (epinephrine) Angioedema Pathophysiology Clinical features Investigations Management Hereditary angioedema Clinical features Investigations Management Acquired C1 inhibitor deficiency Transplantation and graft rejection Transplant rejection Investigations Pre-transplantation testing Post-transplant biopsy: C4d staining Complications of transplant immunosuppression Organ donation Tumour immunology Further information 5 Population health and epidemiology Global burden of disease and underlying risk factors Life expectancy Global causes of death and disability Risk factors underlying disease Social determinants of health The hierarchy of systems – from molecules to ecologies The life course Preventive medicine Alcohol Smoking Obesity Poverty and affluence Atmospheric pollution Climate change and global warming Principles of screening Epidemiology Understanding causes and effect Health data/informatics Further information Books and journal articles Websites 6 Principles of infectious disease Infectious agents Viruses Prokaryotes: bacteria (including mycobacteria and actinomycetes) Eukaryotes: fungi, protozoa and helminths Prions Normal microbial flora Host–pathogen interactions Characteristics of successful pathogens The host response Pathogenesis of infectious disease The febrile response Investigation of infection Direct detection of pathogens Detection of whole organisms Detection of components of organisms Nucleic acid amplification tests Culture Blood culture Indirect detection of pathogens Antibody detection Enzyme-linked immunosorbent assay Immunoblot (Western blot) Immunofluorescence assays Complement fixation test Agglutination tests Other tests Antibody-independent specific immunological tests Antimicrobial susceptibility testing Epidemiology of infection Geographical and temporal patterns of infection Endemic disease Emerging and re-emerging disease Reservoirs of infection Human reservoirs Animal reservoirs Environmental reservoirs Transmission of infection Deliberate release Infection prevention and control Health care-associated infection Outbreaks of infection Immunisation Vaccination Types of vaccine Use of vaccines Antimicrobial stewardship Treatment of infectious diseases Principles of antimicrobial therapy Antimicrobial action and spectrum Empiric versus targeted therapy Combination therapy Antimicrobial resistance Duration of therapy Pharmacokinetics and pharmacodynamics Therapeutic drug monitoring Antimicrobial prophylaxis Antibacterial agents Beta-lactam antibiotics Pharmacokinetics Adverse effects Drug interactions Penicillins Cephalosporins and cephamycins Monobactams Carbapenems Macrolide and lincosamide antibiotics Pharmacokinetics Macrolides Lincosamides (e.g. clindamycin) Adverse effects Aminoglycosides and spectinomycin Pharmacokinetics Gentamicin dosing Adverse effects Spectinomycin Quinolones and fluoroquinolones Pharmacokinetics Adverse effects Glycopeptides Pharmacokinetics Vancomycin Teicoplanin Adverse effects Lipopeptides Polymyxins Folate antagonists Pharmacokinetics Adverse effects Tetracyclines and glycylcyclines Tetracyclines Pharmacokinetics Adverse effects Glycylcyclines (tigecycline) Nitroimidazoles Pharmacokinetics Adverse effects Phenicols Oxazolidinones Other antibacterial agents Fusidic acid Nitrofurantoin Fidaxomicin Fosfomycin Antimycobacterial agents Isoniazid Rifampicin Pyrazinamide Ethambutol Streptomycin Other antituberculous agents Clofazimine Antifungal agents Azole antifungals Imidazoles Triazoles Echinocandins Polyenes Lipid formulations of amphotericin B Other antifungal agents Flucytosine Griseofulvin Terbinafine Antiviral agents Antiretroviral agents Anti-herpesvirus agents Aciclovir, valaciclovir, penciclovir and famciclovir Ganciclovir Cidofovir Foscarnet Anti-influenza agents Zanamivir and oseltamivir Amantadine and rimantadine Other agents used to treat viruses Ribavirin Antiparasitic agents Antimalarial agents Artemisinin (qinghaosu) derivatives Atovaquone Folate synthesis inhibitors (proguanil, pyrimethamine–sulfadoxine) Quinoline-containing compounds Lumefantrine Drugs used in trypanosomiasis Benznidazole Eflornithine Melarsoprol Nifurtimox Pentamidine isetionate Suramin Other antiprotozoal agents Pentavalent antimonials Diloxanide furoate Iodoquinol (di-iodohydroxyquinoline) Nitazoxanide Paromomycin Drugs used against helminths Benzimidazoles (albendazole, mebendazole) Bithionol Diethylcarbamazine Ivermectin Niclosamide Piperazine Praziquantel Pyrantel pamoate Thiabendazole Further information Websites 2 Emergency and Critical Care Medicine 7 Poisoning Comprehensive evaluation of the poisoned patient General approach to the poisoned patient Triage and resuscitation Clinical assessment and investigations Psychiatric assessment General management Gastrointestinal decontamination Activated charcoal Gastric aspiration and lavage Whole bowel irrigation Urinary alkalinisation Haemodialysis and haemoperfusion Lipid emulsion therapy Supportive care Antidotes Poisoning by specific pharmaceutical agents Analgesics Paracetamol Management Salicylates (aspirin) Clinical features Management Non-steroidal anti-inflammatory drugs Clinical features Management Antidepressants Tricyclic antidepressants Clinical features Management Selective serotonin and noradrenaline re-uptake inhibitors Clinical features and management Lithium Clinical features Management Cardiovascular medications Beta-blockers Management Calcium channel blockers Clinical features Management Digoxin and oleander Clinical features Management Iron Clinical features Management Antipsychotic drugs Clinical features Management Antidiabetic agents Clinical features Management Pharmaceutical agents less commonly taken in poisoning Drugs of misuse Depressants Benzodiazepines Opioids Gamma hydroxybutyrate Stimulants and entactogens Cocaine Amphetamines and cathinones Hallucinogens Cannabis Synthetic cannabinoid receptor agonists Tryptamines d-Lysergic acid diethylamide Dissociative drugs Volatile substances Body packers and body stuffers Chemicals and pesticides Carbon monoxide Clinical features Management Organophosphorus insecticides and nerve agents Mechanism of toxicity Clinical features and management Acute cholinergic syndrome Management Intermediate syndrome Organophosphate-induced delayed polyneuropathy Carbamate insecticides Paraquat Methanol and ethylene glycol Clinical features Management Corrosive substances Aluminium and zinc phosphide Copper sulphate Chemicals less commonly taken in poisoning Chemical warfare agents Environmental poisoning Arsenism Fluorosis Food-related poisoning Paralytic shellfish poisoning Ciguatera poisoning Scombrotoxic fish poisoning Plant poisoning Further information Books and journal articles Websites 8 Envenomation Comprehensive evaluation of the envenomed patient Geographical distribution of venomous snakes Bedside tests in the envenomed patient Overview of envenomation Venom Venomous animals Clinical effects Local effects General systemic effects Specific systemic effects General approach to the envenomed patient First aid Transporting patients Assessment and management in hospital Assessment and management of life-threatening problems Assessment for evidence of envenoming Laboratory investigations Treatment Antivenom Non-antivenom treatments Follow-up Envenomation by specific animals Venomous snakes Clinical features and management Scorpions Clinical features and management Spiders Clinical features and management Paralysis ticks Venomous insects Venomous lepidopterans Venomous hymenopterans Marine venomous and poisonous animals Further information Books and journal articles Websites 9 Environmental medicine Radiation exposure Types of ionising radiation Dosage and exposure Effects of radiation exposure Deterministic effects Stochastic effects Management of radiation exposure Extremes of temperature Thermoregulation Hypothermia Clinical features Investigations Management Mild hypothermia Severe hypothermia Cold injury Freezing cold injury (frostbite) Non-freezing cold injury (trench or immersion foot) Chilblains Heat-related illness Heat cramps Heat syncope Heat exhaustion Heat stroke High altitude Physiological effects of high altitude Illnesses at high altitude Acute mountain sickness High-altitude cerebral oedema High-altitude pulmonary oedema Chronic mountain sickness (Monge’s disease) High-altitude retinal haemorrhage Venous thrombosis Refractory cough Air travel Advice for patients with respiratory disease Advice for other patients Deep venous thrombosis Under water Drowning and near-drowning Clinical features Management Diving-related illness Clinical features Decompression illness Barotrauma Management Humanitarian crisis Recognition Emergency response Consolidation phase Handover and withdrawal Health-care priorities Further information Websites Telephone numbers 10 Acute medicine and critical illness Clinical examination in critical care Monitoring Acute medicine The decision to admit to hospital Ambulatory care Presenting problems in acute medicine Chest pain Presentation Site and radiation Characteristics Onset Associated features Clinical assessment Initial investigations Acute breathlessness Presentation Clinical assessment Initial investigations Syncope/presyncope Presentation Clinical assessment Initial investigations Delirium Presentation Clinical assessment Investigations and management Headache Presentation Clinical assessment Initial investigations Unilateral leg swelling Presentation Clinical assessment Initial investigations Identification and assessment of deterioration Early warning scores and the role of the medical emergency team Immediate assessment of the deteriorating patient C – Control of obvious problem A and B – Airway and breathing C – Circulation D – Disability E – Exposure and evidence Selecting the appropriate location for ongoing management Common presentations of deterioration Tachypnoea Pathophysiology Assessment and management Hypoxaemia Pathophysiology Assessment and management Tachycardia Pathophysiology Assessment and management Hypotension Pathophysiology Assessment and management Shock Hypertension Pathophysiology Assessment and management Decreased conscious level Assessment Management Decreased urine output/deteriorating renal function Assessment Diagnosis and management Abdominal compartment syndrome Rhabdomyolysis Disorders causing critical illness Sepsis and the systemic inflammatory response Aetiology and pathogenesis Initiation of the inflammatory response Propagation of the inflammatory response Activation of the coagulation system Organ damage from sepsis Lactate physiology The anti-inflammatory cascade Management Resuscitation in sepsis Early source control Noradrenaline (norepinephrine) for refractory hypotension Other therapies for refractory hypotension Septic cardiomyopathy Review of the underlying pathology Acute respiratory distress syndrome Aetiology and pathogenesis Diagnosis and management Acute circulatory failure (cardiogenic shock) Definition and aetiology Myocardial infarction Acute massive pulmonary embolism Acute valvular pathology, aortic dissection and cardiac tamponade Post cardiac arrest Acute management Prognosis Other causes of multi-organ failure Critical care medicine Decisions around intensive care admission Stabilisation and institution of organ support Respiratory support Non-invasive respiratory support High-flow nasal cannulae Continuous positive pressure ventilation Non-invasive ventilation or bi-level ventilation Intubation and intermittent positive pressure ventilation Ventilator modes Ventilator-induced lung injury Advanced respiratory support Airway pressure release ventilation Prone positioning Extracorporeal respiratory support Venous–venous extracorporeal membrane oxygenation Extracorporeal carbon dioxide removal Cardiovascular support Initial resuscitation Fluid and vasopressor use Advanced haemodynamic monitoring Mechanical cardiovascular support Intra-aortic balloon pump Venous–arterial extracorporeal membrane oxygenation Renal support Neurological support Daily clinical management in intensive care Clinical review Sedation and analgesia Delirium in intensive care Weaning from respiratory support Spontaneous breathing trials Progressive reduction in pressure support ventilation Extubation Tracheostomy Nutrition Other essential components of intensive care Thromboprophylaxis Glucose control Blood transfusion Peptic ulcer prophylaxis Complications and outcomes of critical illness Adverse neurological outcomes Brain injury ICU-acquired weakness Critical illness polyneuropathy Critical illness myopathy Other long-term problems The older patient Withdrawal of active treatment and death in intensive care Futility Death Organ donation Donation after brain death Donation after cardiac death Postmortem examination or autopsy Discharge from intensive care Critical care scoring systems Further information Websites 3 Clinical Medicine 11 Infectious disease Clinical examination of patients with infectious disease Presenting problems in infectious diseases Fever Clinical assessment Investigations Management Fever with localising symptoms or signs Pyrexia of unknown origin Clinical assessment Investigations Prognosis Fever in the injection drug-user Clinical assessment Investigations Management Fever in the immunocompromised host Clinical assessment Investigations Neutropenic fever Post-transplantation fever Positive blood culture Clinical assessment Investigations Management Central venous catheter infections Investigations and management Sepsis Severe skin and soft tissue infections Necrotising fasciitis Gas gangrene Other SSTIs Acute diarrhoea and vomiting Clinical assessment Investigations Management Fluid replacement Antimicrobial agents Antidiarrhoeal, antimotility and antisecretory agents Non-infectious causes of food poisoning Antimicrobial-associated diarrhoea Infections acquired in the tropics Fever acquired in the tropics Clinical assessment Investigations and management Diarrhoea acquired in the tropics Eosinophilia acquired in the tropics Clinical assessment Investigations Management Skin conditions acquired in the tropics Infections in adolescence Infections in pregnancy Viral infections Systemic viral infections with exanthem Measles Clinical features Management and prevention Rubella (German measles) Clinical features Diagnosis Prevention Parvovirus B19 Clinical features Diagnosis Management Human herpesvirus 6 and 7 Clinical features Diagnosis and management Chickenpox (varicella) Clinical features Diagnosis Management and prevention Shingles (herpes zoster) Clinical features Management Enteroviral exanthems Systemic viral infections without exanthem Mumps Clinical features Diagnosis Management and prevention Influenza Clinical features Diagnosis Management and prevention Avian influenza Swine influenza Infectious mononucleosis and Epstein–Barr virus Clinical features Long-term complications of EBV infection Investigations Management Cytomegalovirus Clinical features Investigations Management Dengue Clinical features Diagnosis Management and prevention Yellow fever Clinical features Diagnosis Management and prevention Viral haemorrhagic fevers Clinical features Investigations and management Prevention Ebola virus disease (EVD) Clinical features Investigations Management Prevention Zika virus Clinical features Investigations Prevention Viral infections of the skin Herpes simplex virus 1 and 2 Clinical features Recurrence Complications Diagnosis Management Human herpesvirus 8 Enterovirus infections Hand, foot and mouth disease Herpangina Poxviruses Smallpox (variola) Monkeypox Cowpox Vaccinia virus Other poxviruses: orf and molluscum contagiosum Gastrointestinal viral infections Norovirus (Norwalk agent) Astrovirus Rotavirus Hepatitis viruses (A–E) Other viruses Respiratory viral infections Middle East respiratory syndrome coronavirus (MERS-CoV) Clinical features Diagnosis and management Viral infections with neurological involvement Japanese B encephalitis Clinical features Investigations, management and prevention West Nile virus Clinical features Diagnosis and management Enterovirus 71 Nipah virus encephalitis Human T-cell lymphotropic virus type I Viral infections with rheumatological involvement Chikungunya virus Prion diseases Bacterial infections Bacterial infections of the skin, soft tissues and bones Staphylococcal infections Skin infections Wound infections Cannula-related infection Meticillin-resistant Staph. aureus Staphylococcal toxic shock syndrome Management Streptococcal infections Streptococcal scarlet fever Streptococcal toxic shock syndrome Treponematoses Syphilis Endemic treponematoses Yaws Pinta and bejel Tropical ulcer Buruli ulcer Systemic bacterial infections Brucellosis Clinical features Diagnosis Management Borrelia infections Lyme disease Clinical features Diagnosis Management Prevention Louse-borne relapsing fever Clinical features Investigations and management Tick-borne relapsing fever Leptospirosis Microbiology and epidemiology Clinical features Bacteraemic leptospirosis Aseptic meningitis Icteric leptospirosis (Weil’s disease) Pulmonary syndrome Diagnosis Management and prevention Plague Clinical features Bubonic plague Septicaemic plague Pneumonic plague Investigations Management Prevention and infection control Listeriosis Investigations and management Typhoid and paratyphoid (enteric) fevers Clinical features Typhoid fever Paratyphoid fever Complications Investigations Management Prevention Tularaemia Investigations and management Melioidosis Clinical features Investigations and management Actinomycete infections Nocardiosis Actinomyces spp. Gastrointestinal bacterial infections Staphylococcal food poisoning Bacillus cereus food poisoning Clostridium perfringens food poisoning Campylobacter jejuni infection Salmonella spp. infection Escherichia coli infection Enterotoxigenic E. coli Entero-invasive E. coli Enteropathogenic E. coli Entero-aggregative E. coli Enterohaemorrhagic E. coli Clostridium difficile infection Clinical features Investigations Management Yersinia enterocolitica infection Cholera Clinical features Diagnosis and management Prevention Vibrio parahaemolyticus infection Bacillary dysentery (shigellosis) Clinical features Management and prevention Respiratory bacterial infections Diphtheria Clinical features Management Prevention Pneumococcal infection Anthrax Clinical features Cutaneous anthrax Gastrointestinal anthrax Inhalational anthrax Management Bacterial infections with neurological involvement Mycobacterial infections Tuberculosis Leprosy Epidemiology and transmission Pathogenesis Clinical features Leprosy reactions Borderline cases Investigations Management Patient education Prognosis Prevention and control Rickettsial and related intracellular bacterial infections Rickettsial fevers Pathogenesis Spotted fever group Rocky Mountain spotted fever Other spotted fevers Typhus group Scrub typhus fever Epidemic (louse-borne) typhus Endemic (flea-borne) typhus Investigation of rickettsial infection Management of rickettsial fevers Q fever Clinical features Investigations and management Bartonellosis Investigations and management Chlamydial infections Trachoma Pathology and clinical features Investigations and management Prevention Protozoal infections Systemic protozoal infections Malaria Pathogenesis Life cycle of the malarial parasite Pathology Clinical features P. falciparum infection P. vivax and P. ovale infection P. malariae and P. knowlesi infection Investigations Management Mild P. falciparum malaria Complicated P. falciparum malaria Non-falciparum malaria Prevention Malaria control in endemic areas Babesiosis African trypanosomiasis (sleeping sickness) Clinical features Rhodesiense infections Gambiense infections Investigations Management Prevention American trypanosomiasis (Chagas’ disease) Pathology Clinical features Acute phase Chronic phase Investigations Management and prevention Toxoplasmosis Clinical features Congenital toxoplasmosis Investigations Management Leishmaniasis Epidemiology and transmission Visceral leishmaniasis (kala-azar) Clinical features Investigations Differential diagnosis Management Pentavalent antimonials Amphotericin B Other drugs Response to treatment HIV–visceral leishmaniasis co-infection Post-kala-azar dermal leishmaniasis Clinical features Investigations and management Prevention and control Cutaneous and mucosal leishmaniasis Cutaneous leishmaniasis Pathogenesis Clinical features Mucosal leishmaniasis Investigations in CL and ML Management of CL and ML Prevention of CL and ML Gastrointestinal protozoal infections Amoebiasis Pathology Clinical features Intestinal amoebiasis – amoebic dysentery Amoebic liver abscess Investigations Management Prevention Giardiasis Clinical features and investigations Management Cryptosporidiosis Cyclosporiasis Infections caused by helminths Intestinal human nematodes Ancylostomiasis (hookworm) Clinical features Investigations Management Strongyloidiasis (threadworm) Clinical features Investigations Management Ascaris lumbricoides (roundworm) Clinical features Investigations Management Prevention Enterobius vermicularis (threadworm) Clinical features Investigations Management Trichuris trichiura (whipworm) Tissue-dwelling human nematodes Lymphatic filariasis Pathology Clinical features Investigations Management Chronic lymphatic pathology Prevention Loiasis Clinical features Investigations Management Prevention Onchocerciasis (river blindness) Pathology Clinical features Investigations Management Prevention Dracunculiasis (Guinea worm) Management and prevention Other filariases Mansonella perstans Dirofilaria immitis Zoonotic nematodes Trichinosis (trichinellosis) Clinical features Investigations Management Anisakiasis (herring worm) Cutaneous larva migrans Angiostrongylus cantonensis Gnathostomiasis Trematodes (flukes) Schistosomiasis Pathology Clinical features Schistosoma haematobium Schistosoma mansoni Schistosoma japonicum, S. mekongi and S. intercalatum Investigations Management Prevention Liver flukes Cestodes (tapeworms) Intestinal tapeworm Taenia solium Taenia saginata Taenia asiatica Cysticercosis Clinical features Investigations Managemen