What follows is the post, Infectious Disease History, from Mediwikis, “A Leading Community For Medical Students”. Mediwikis is sponsored by The Royal College of Physicians.
Infectious Diseases History
This history is often a presence on OSCEs [“The Objective Structured Clinical Examination tests a medical students abilities to perform procedures, histories and examinations against objective check lists. The OSCE page has links to 67 different OSCE pages. Although designed for medical student testing, the individual OSCEs can be a useful review for physicians.]
Contents
History of Presenting Complaint
Has the patient encountered:
- Fever: if so, for how long, has the fever had any pattern (i.e. relapsing-remitting as in malaria)?
- Fatigue: how long? Long term fatigue can be caused by EBV and CMV
- Nausea & vomiting: duration, severity, any blood?
- Diarrhoea: explore as any GI inquiry, duration, frequency, colour, mucus etc
- Respiratory symptoms: as with a respiratory history, look for signs of atypical pneumonia, i.e. systemic illness
- Other: jaundice, haematuria (with schistosomiasis), abdominal pain, neurological signs (meningitis)
NB: Remember HIV as a differential in any non-specific infectious presentation!
Past Medical History
Many chronic medical conditions, such as diabetes and inflammatory bowel disease, can lead to increased susceptibility to infection. Remember to identify whether the patient has had any previous infections, particularly HIV.
Social History
This is perhaps the most important part of an infection history, and certainly where most of the marks for an OSCE station are found. Remember to include:
- Is the patient a returning traveller? Where did they go?
- If yes to the above, what did they do when abroad? Did they drink the water, eat local food? Were they in contact with any unhygienic environments? Did they undertake any freshwater-based activities?
- Has the patient been in contact with anyone else who has been unwell recently?
- Have they been in contact with any animals?
- Have they had any sexual contact recently that is unusual for them?
- General social history such as occupational history may be useful here for a differential.
Drug history
- Regular medication?
- Did the patient take any malaria prophylaxis whilst abroad?
- Is the patient on any antibiotics?
- Allergies
- Vaccinations
General tips
The history of presenting complaint for this station can be very broad, as infections can affect multiple systems. However, due to this, your examiner will give you specific instructions on which areas of history to focus on. Be as succinct as possible with HPC, and rule out any red flags where appropriate, before focusing on social/contact history: this is where the majority of marks lie.
Patient actors have been known to be difficult historians in this station. This is perhaps done on purpose, in order to help encourage an empathic style from students, and to challenge you to approach sometimes awkward questions on sexual history with an appropriate and professional manner. For this reason, ensure that plenty of obvious ICE is used, as patients will often have concerns about serious infectious symptoms.
