Yesterday and today we held a clinic in the village of Wakisi directly on the banks of the magnificent Nile river. Over the past two days we have seen the sickest group of people so far. Malaria is extremely prevalent here and many children under five years of age were infected. We were able to treat most of the kids we saw, but there were a few that were too young and needed to receive intravenous treatment. We didn’t have the medicine to administer to extremely young children (<1), and we always take caution and usually opt not to put in a line when the patients live in an environment where risk for secondary infection is high.
 |
| Cutest baby all trip- Be forewarned Adam, I may have an extra suit case coming home ;-) |
Yesterday we saw a one year old boy with what we originally thought was monkey pox, but upon further investigation and receiving a more in-depth history we were able to determine that the little boy most likely had a reaction to a small pox vaccination (mother said he recently received the vaccination against) and developed what is known as progressive vaccinia. The child was too immuno suppressed at the time of vaccination and had a defined cell-mediated immune (CMI) defect (T-cell deficiency), thus developing progressive vaccinia. This is one of the most severe complications of smallpox vaccination. It is almost always life threatening. It is strange that the child was even given a vaccination against it in the first place due to his age and it isn’t given much at all now, if ever. It is hard to say with 100 percent confidence that the child definitely had progressive vaccinia due to variance in story and history, but based on the information and physical signs presented, our closest fitting diagnosis was either progressive vaccinia or monkey pox.
 |
| Suspected Monkey Pox or Progressive Vaccinia |
We saw an abundance of STD’s including quite a bit of syphilis, chlamydia, herpes, etc. There were quite a few fungal infections including chronic tinea capitis and tinea corporis. We also saw a man with madura foot. This is a chronic subcutaneous infection caused by actinomycetes. Mycetoma is most common in adult male agricultural workers. The organism typically enters by a penetrating injury such as a thorn prick. In some cases the sinus tracts communicating with the skin and on occasion, the bone, may cause osteomyelitis.
 |
| Secondary Syphilis |
 |
| Madura Foot |
Today was awesome as I have really found my groove and my confidence in diagnosis is increasing. Together between the three of us were were able to treat 300+ people. Tomorrow we will try and see 100 people in the same village and then we will treat fifty children at the orphanage.
Hope all is well! Look forward to being back in the great US of A in a few days!
Cheers,
Lauren
No comments:
Post a Comment