Table Of ContentTHE ESSENTIAL MEDICAL GUIDE FOR THE TROPICS
-
DON'T LEAVE HOME WITHOUT IT!
OXFORD HANDBOOK OF
TROPICAL
MEDICINE
EDITED Robert Davidson Andrew Ensue
Anna Seale Lucille Blumbore.
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COVID-f?,HIV,arboviruses,andEbola
FatiKCCM topractical.evidence-bated advice
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Incorporates updatedguidelinesInclude latest
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OXFORD HANDBOOK OF
Tropical Medicine
ii
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OXFORD HANDBOOK OF
Tropical
Medicine
FIFTH EDITION
edited by
Robert Davidson
Department of Infectious Diseases and Tropical Medicine
Northwick Park Hospital, Harrow, UK
Andrew Brent
Nuffield Department of Clinical Laboratory Sciences
University of Oxford, UK
Anna Seale
Faculty of Epidemiology and Population Health,
London School of Hygiene & Tropical Medicine,
London, UK
Lucille Blumberg
National Institute for Communicable Diseases
Johannesburg, South Africa
1
iv
1
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The moral rights of the authors have been asserted
First Edition published in 1999
Second Edition published in 2005
Third Edition published in 2008
Fourth Edition published in 2014
Fifth Edition published in 2021
Impression: 1
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v
Contents
Foreword vii
Preface xi
Symbols and abbreviations xiii
Contributors to the fifth edition xxi
Contributors to the fourth edition xxvii
Previous contributors xxxi
1 M anagement of the sick child 1
2 Malaria 35
3 HIV medicine 69
4 Tuberculosis 143
5 Chest medicine 167
6 Gastroenterology 223
7 Cardiovascular medicine 315
8 Renal medicine 353
9 Neurology 383
10 Haematology 445
11 Endocrine disorders 483
12 Ophthalmology 515
13 Dermatology 537
14 B one, joint, and soft tissue infections 587
15 S exually transmitted infections 603
16 Nutrition 629
17 M ultisystem diseases and infections 673
18 Mental health 767
19 Trauma 795
20 P oisoning and envenoming 813
vi CONTENTS
839 21 Immunization
861 22 H ealth emergencies in humanitarian crises
881 23 Obstetric emergencies
893 24 Healthcare- associated infection,
antimicrobial prescribing, and antimicrobial
resistance
Index 903
vii
Foreword
What has changed in Tropical Medicine
since OHTM4e?
Epidemic infectious diseases have dominated the Tropical Medicine
scene since 2014, when the last edition of OHTM was published. Outbreaks
of familiar diseases have rumbled on, such as yellow fever, especially in
Angola, DR Congo, Nigeria and SE Brazil; together with Chikungunya;
seasonal influenza; dengue (2019– 20 in the Asia Pacific region and Latin
America; plague (2014– 17 in Madagascar); Japanese encephalitis (India
2017); measles (e.g., in DR Congo 2019–2 0); and pandemic antibiotic
resistance.
Ebola, Zika and COVID- 19: against this background, there have been
some terrible new challenges in the tropical world and globally. Ebola haem-
orrhagic fever, a disease discovered by Dr Jean-J acques Muyembe in a mis-
sion hospital in Yambuku, DR Congo back in 1976, has been resurgent.
A new, widespread epidemic of this highly fatal filovirus was concentrated
in three West African countries in 2013– 16, exacting more than 11,300
deaths, but stimulating development of some effective vaccines and treat-
ments. Ebola recurred in DR Congo and Uganda in 2018–2 0 with a new
outbreak in Guinea in March 2021. Zika virus caused more than 84,000
infections globally in 2015– 16, mostly in Latin America and SE Asia, with
an estimated 1,000 deaths, mainly among about 4,000 children born with
microcephaly and other birth defects. Completely overshadowing these
challenges to human health has been the global pandemic of COVID-1 9
which has affected 2 billion and killed 3 million people so far, leaving the
debilitating symptoms of long COVID, including types 1 and 2 diabetes mel-
litus, in survivors.
Other challenges: the magnitude and novelty of these epidemics alone
would justify a new edition of OHTM, as would the continuing problem
of HIV/ AIDS and tuberculosis, but, the speciality of Tropical Medicine
comprises far more than infectious diseases. Non- communicable dis-
eases continue to cause a massive burden of human suffering and deserve
the attention devoted to them in OHTM5e. It is reassuring to see strong
coverage of important topics, such as inherited, endocrine, nutritional and
psychiatric diseases, trauma and obstetrics.
viii FOREWORD
Publication of this new edition should
provoke both celebration and reflection
Celebration: we celebrate the presence of OHTM, discovered on
otherwise- empty bookshelves in district hospitals from Kenya’s Swahili
Coast to Karnataka, and from Australia’s Northern Territory to PNG’s
Marshall Lagoon; and in the otherwise- empty pockets of health assistants,
dispensers, nurses, paramedics, community health worker, and doctors, es-
pecially in rural areas of LMICs.
Reflection: what is the future of a hard copy book, whose average ges-
tation period is 9 months from proof to printing, in the face of dynamic
changes in acquisition of new knowledge essential for the optimal treat-
ment of disease? This problem is exemplified by the surge in important
new knowledge about all aspects of SARS CoV-2 virus variants. The answer
would seem to be electronic publication with continual updating. However,
despite the increasing reach of the world wide web, and proliferation and
penetration of mobile phone connectivity, this remains impossible or in-
convenient for many medical staff in search of immediate up-t o- date clin-
ical guidance. Using modern technology, might medical publishers speed up
this process and deliver hard copy in weeks or a few months, as has been
achieved for other non- fictional hot topics?
Editors and contributors
OTM4’s editorial team of Andrew Brent, Anna Seale, and Robert Davidson
is strengthened by the addition of Lucille Blumberg from the National
Institute for Communicable Diseases Johannesburg, South Africa. There
are some 59 listed contributors to the new edition, 30 of whom, to the edi-
tors’ great credit, are new (it’s far less effort to get existing authors to up-
date, than to identify and recruit newcomers!). Although 34 of the current
contributors are based in Western countries, most have evident overseas
links, while 21 authors write from African countries (11 from South Africa,
reflecting the footprints of two of the editors), and 4 from Asia. All have in-
stilled valuable experiences and insights. However, in OHTM, authorship of
and responsibility for a chapter must acknowledge a lineage of writers who
have enhanced and updated that chapter over the 5 editions since Michael
Eddleston and Stephen Pierini chipped OHTM1ed out of the bedrock.
FOREWORD ix
Learning Tropical Medicine
The best way to discover Tropical Medicine and to understand its appeal
and rewards is not by reading books, however good they may be, but by
living and working in a tropical country, learning from your patients and ex-
perienced local doctors, and following up investigations to confirm the diag-
nosis. However, there are many important facts; clinical features, complex
life- cycles, drug doses, vaccine regimens, and so on; that you may need—
more than can reliably be memorised. Searching OHTM can reveal this vital
information immediately. That is its great strength.
Congratulations!
I applaud all those, past and present, who have been involved in the OHTM
project. I congratulate them for establishing its high reputation and for
securing its promise of further, future, achievements. This small book, com-
prising barely 540 cm3 of printed pages, remains uniquely accessible, au-
thoritative, affordable, attractive, and appropriate for use in ‘All places that
the eye of heaven visits’, especially tropical countries, and anywhere travel
and immigrant medicine are practised.
David A. Warrell
Oxford March 2021
