THE 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. CCTipnchcnsivicly revised throughout,include up-to-dacoinformationonviruses suchas COVID-f?,HIV,arboviruses,andEbola FatiKCCM topractical.evidence-bated advice on diuptosi*.clinical features.,andmjrmgeiinM*t Incorporates updatedguidelinesInclude latest WHOguidelinesonHIV,TBandrabies OXFORD HANDBOOK OF Tropical Medicine ii Published and forthcoming Oxford Handbooks Oxford Handbook for the Foundation Oxford Handbook of Integrated Dental Programme 5e Biosciences 2e Oxford Handbook of Acute Medicine 4e Oxford Handbook of Head and Neck Oxford Handbook of Anaesthesia 4e Anatomy Oxford Handbook of Cardiology 2e Oxford Handbook of Humanitarian Medicine Oxford Handbook of Clinical and Healthcare Oxford Handbook of Key Clinical Evidence 2e Research Oxford Handbook of Medical Dermatology 2e Oxford Handbook of Clinical and Laboratory Oxford Handbook of Medical Imaging Investigation 4e Oxford Handbook of Medical Law and Ethics Oxford Handbook of Clinical Dentistry 7e Oxford Handbook of Medical Sciences 3e Oxford Handbook of Clinical Diagnosis 3e Oxford Handbook for Medical School Oxford Handbook of Clinical Examination and Oxford Handbook of Medical Statistics 2e Practical Skills 2e Oxford Handbook of Neonatology 2e Oxford Handbook of Clinical Haematology 4e Oxford Handbook of Nephrology and Oxford Handbook of Clinical Immunology Hypertension 2e and Allergy 4e Oxford Handbook of Neurology 2e Oxford Handbook of Clinical Medicine – Mini Oxford Handbook of Nutrition and Edition 10e Dietetics 3e Oxford Handbook of Clinical Medicine 10e Oxford Handbook of Obstetrics and Oxford Handbook of Clinical Pathology Gynaecology 3e Oxford Handbook of Clinical Pharmacy 3e Oxford Handbook of Occupational Health 2e Oxford Handbook of Clinical Specialties 11e Oxford Handbook of Oncology 3e Oxford Handbook of Clinical Surgery 4e Oxford Handbook of Operative Surgery 3e Oxford Handbook of Complementary Oxford Handbook of Ophthalmology 4e Medicine Oxford Handbook of Oral and Maxillofacial Oxford Handbook of Critical Care 3e Surgery 2e Oxford Handbook of Dental Patient Care Oxford Handbook of Orthopaedics Oxford Handbook of Dialysis 4e and Trauma Oxford Handbook of Emergency Oxford Handbook of Paediatrics 3e Medicine 5e Oxford Handbook of Pain Management Oxford Handbook of Endocrinology and Oxford Handbook of Palliative Care 3e Diabetes 3e Oxford Handbook of Practical Drug Oxford Handbook of ENT and Head and Therapy 2e Neck Surgery 3e Oxford Handbook of Pre- Hospital Care 2e Oxford Handbook of Epidemiology for Oxford Handbook of Psychiatry 4e Clinicians Oxford Handbook of Public Health Practice 4e Oxford Handbook of Expedition and Oxford Handbook of Rehabilitation Wilderness Medicine 2e Medicine 3e Oxford Handbook of Forensic Medicine Oxford Handbook of Reproductive Medicine Oxford Handbook of Gastroenterology & & Family Planning 2e Hepatology 3e Oxford Handbook of Respiratory Medicine 4e Oxford Handbook of General Practice 5e Oxford Handbook of Rheumatology 4e Oxford Handbook of Genetics Oxford Handbook of Sleep Medicine Oxford Handbook of Genitourinary Medicine, Oxford Handbook of Sport and Exercise HIV, and Sexual Health 3e Medicine 2e Oxford Handbook of Geriatric Medicine 3e Handbook of Surgical Consent Oxford Handbook of Infectious Diseases and Oxford Handbook of Tropical Medicine 4e Microbiology 2e Oxford Handbook of Urology 4e 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 Great Clarendon Street, Oxford, OX2 6DP, United Kingdom Oxford University Press is a department of the University of Oxford. It furthers the University’s objective of excellence in research, scholarship, and education by publishing worldwide. Oxford is a registered trade mark of Oxford University Press in the UK and in certain other countries © Oxford University Press 2021 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 All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, without the prior permission in writing of Oxford University Press, or as expressly permitted by law, by licence or under terms agreed with the appropriate reprographics rights organization. Enquiries concerning reproduction outside the scope of the above should be sent to the Rights Department, Oxford University Press, at the address above You must not circulate this work in any other form and you must impose this same condition on any acquirer Published in the United States of America by Oxford University Press 198 Madison Avenue, New York, NY 10016, United States of America British Library Cataloguing in Publication Data Data available Library of Congress Control Number: 2020952937 ISBN 978– 0– 19– 881085– 8 DOI: 10.1093/ med/ 9780198810858.001.0001 Printed and bound in China by C&C Offset Printing Co., Ltd. Oxford University Press makes no representation, express or implied, that the drug dosages in this book are correct. Readers must therefore always check the product information and clinical procedures with the most up-t o- date published product information and data sheets provided by the manufacturers and the most recent codes of conduct and safety regulations. The authors and the publishers do not accept responsibility or legal liability for any errors in the text or for the misuse or misapplication of material in this work. Except where otherwise stated, drug dosages and recommendations are for the non-p regnant adult who is not breast- feeding Links to third party websites are provided by Oxford in good faith and for information only. Oxford disclaims any responsibility for the materials contained in any third party website referenced in this work. 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