Recognizing and Managing Emerging Infectious Diseases in the Emergency Department -
Publication Date: May 2018 (Volume 20, Number 5)
CME: This issue includes 4 AMA PRA Category 1 Credits™; 4 ACEP Category I credits; 4 AAFP Prescribed credits; and 4 AOA Category 2 A or 2B CME credits. Included as part of the 4 credits, this CME activity is eligible for 4 Infection Control CME credits, subject to your state and institutional approval.
Ramón Millán, MD, MPH, FACEP
Global Health Division, Emergency Department, Mount Sinai St. Luke’s/Mount Sinai West, New York, NY
Deepti Thomas-Paulose, MD, MPH
Fellowship Director, Global Health Division, Emergency Department, Mount Sinai St. Luke’s/Mount Sinai West, New York, NY
Daniel Egan, MD
Associate Professor, Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai; Program Director, EM Residency, Mount Sinai St. Luke’s/Mount Sinai West, New York, NY
Christopher Baugh, MD, MBA
Medical Director, Department of Emergency Medicine, Brigham and Women’s Hospital; Assistant Professor, Harvard Medical School, Boston, MAY
Roland C. Merchant, MD, MPH, ScD
Department of Emergency Medicine, Brigham and Women’s Hospital; Harvard Medical School, Boston, MA
With population shifts, increased travel, and climate change, the spread of emerging and re-emerging infections is increasing. Although encountering a patient with an emerging infection on any given emergency department shift is unlikely, missing a diagnosis could have profound consequences for the patient, healthcare workers, and the patient’s close contacts. This review provides a framework to evaluate, diagnose, and treat a returning traveler with suspected Middle East respiratory syndrome, chikungunya virus, or Zika virus—3 recently emerged infections. All may present with nonspecific viral-like symptoms and are easily missed if an appropriate travel history is not obtained. A high level of vigilance and proper disposition will enable the emergency clinician to effectively diagnose, manage, and contain these diseases.
Excerpt From This Issue
A 60-year-old man presents to the ED complaining of a fever. The triage note reports that the patient has had 2 days of cough, fever, and mild diarrhea, and he feels short of breath. His temperature is 39.1°C (102.4°F); blood pressure, 138/72 mm Hg; pulse, 104 beats/min; respiratory rate, 18 breaths/min; and oxygen saturation, 98% on room air. On physical examination, you hear scattered rhonchi in both of the patient’s lungs. On further questioning, he tells you that he was in Saudi Arabia for a business trip last week. You remember hearing about an illness in that region that causes fever, and you wonder what you should do next...
A 42-year-old nursing colleague of yours presents to the ED with fever, headaches, and severe joint pain. She has a history of diabetes, hypertension, and early arthritis. She frequently visits the Dominican Republic for work and returned 5 days ago from a trip there. She is convinced that she has dengue fever because she had heard there was an outbreak of this disease while she was there. On physical examination, she looks uncomfortable. She has pain and swelling over her fingers, wrists, and ankles. You consider whether isolation and testing are called for...
Kelly King, MD - 09/10/2018 Interesting review on Novel infectious agents. Concepts of supportive care are always good to review as well as travel hx reviews to help with D/Dx
C. L., MD - 09/07/2018 This improved my teaching.
R. . B, MD - 09/03/2018 I will be sure to ask more about travel history and keep my differential broad
Geraldo Bandel, MD - 07/27/2018 This was a very good article. I will be on the lookout for these re-emerging diseases in people with hx of a recent travel.
D. S., MD - 07/26/2018 I now know what to think of and evaluate for patients with fever and rash who have traveled recently.
P. N., MD - 07/25/2018 I now have an increased understanding of MERS.
Joshua Keegan, MD - 07/23/2018 I'll have broader consideration of emerging infectious diseases in patients with an appropriate travel history as well as consideration of local exposure to such agents in those who have not traveled recently.
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