Module 7 – 3 Infectious disease

3 Infectious disease

Tuberculosis

Due to a breakdown of functioning health systems in the countries of origin and a change to less hygienic living, in areas of conflict the prevalence of tuberculosis is elevated. Especially young children are more susceptible for infection with tuberculosis and other severe diseases and should therefore be screened for it.

In Austria, at the initial examination, for reason of practicability only children and youths above six years have a chest-x-ray. For those younger than six years it is not recommended routinely because of radiation exposure.

To screen for latent tuberculosis, a tuberculin skin test is recommended in subsequent medical care. If tuberculin (PPD RT-23 SSI) is not sufficiently available, Interferon-y-Release Assays can be used. For both tests it is not possible to differentiate between latent or active tuberculosis.

Tuberculin skin test is regarded to be positive in persons with a history of contact to a TB patient, if the cross-section dimension of the induration measures at least 10 mm; the redness or the thickness is not to be assessed. For children a dimension of induration of minimum 5 mm is considered as positive.  The time frame from infection to immunologic reaction for both tests is up to 10 weeks and leads to conversion.

If the immunologic test is positive, or symptoms like persisting cough, weight loss or lymphadenopathy are evident, or family members or close contacts are diagnosed with tuberculosis, the child or adolescent should be sent to a specialized medical centre for further examination (BMG, 2016).

Scabies (Ages, 2016)

Itch mites (Sarcoptes scabiei var. Hominis) can be transmitted by direct body-contact or indirectly by shared use of bedding, clothes and soft toys. First symptoms appear two to five weeks after infection; three clinical criteria are necessary for diagnosis.

  1. Small red papules and blisters, pustules, sometimes burrow tracks of the mites can be seen, also scratch marks and crustifications
  2. Specific zones of the body are affected: interdigital, axilla, genital area and mammillae
  3. Itching can be quite severe, especially at night

Bacterial super infection with pyogenic Streptococci or Staphylococci can occur.

The primary treatment is topical with 5 percent Permethrin cream, but due to communication difficulties and limited access to sanitary facilities this treatment is sometimes not practicable. Especially for outbreaks, systemic therapy with Ivermectin orally is recommended.

  • Topical treatment with Permethrin:
  • Adults: 5 percent
  • New-born, infants, young children, pregnant and lactating women: diluted to 2,5 percent
  • Application on whole body, excluding only the periorbital and perioral region (periorbital and perioral only if suspect lesions are visible) do not apply on mucous membranes!
  • Preferably over night for eight hours, removal by washing with soap
  • Change of bedding and underwear, wash at 60°C
  • Repetition of treatment after seven days recommended
  • Side effects: pruritus, reddening of the skin, burning sensations
  • Treatment of contact persons with close body-contact like infected persons

Pictures provided by Günther Rainer, Department of Dermatology, Donauspital, Vienna

Hepatitis B, C, and HIV

Screening of immigrants should be performed depending on the seroprevalence of the country of origin (Pottie et al., 2011).

Virus Screening parameters Countries with intermediate to high prevalence
Hepatitis B Surface antigen,
Hep. B core antibody, Hep. B surface antibody		 Asia, Pacific Islands, Africa, Alaska, Peru, Brazil, Amazon basin, Middle East, Mediterranean basin, Eastern Europe
Hepatitis C Hep. C antibody All other than Western Europe, North America, Central and South America, South Asia
HIV HIV-1 and HIV-2 antibody Sub-Saharan Africa, parts of the Caribbean, Thailand

Intestinal Parasites

Abdominal Parasitic infections may endure in infested persons for many years and can lead to severe illness or death. Depending on the country of origin the likelihood of being infested with intestinal parasites is different. It is recommended to screen newly arriving refugees from Southeast Asia, Africa and Afghanistan with stool-analysis (Grois et al., 2016).

Further information about infectious diseases that are uncommon in Europe is available on the website of Robert Koch-Institut.

[http://www.rki.de/DE/Content/Infekt/EpidBull/Archiv/2015/Ausgaben/38_15_Artikel_Asylsuchende.htm]

Malaria

If history of the migrant provides evidence of living or travelling in malaria-endemic areas in the last three months and fever is evident, rapid diagnostic testing or blood smears must be done immediately.