İn Di̇sease Hi̇story

To obtain a history in
infectious diseases
Dr Elif Nur Özbay Haliloğlu
İnfectious Disease and Clinical Microbiology
• Endemic: a disease of low morbidity, constantly present in a certain region,
or among a particular group, characteristic to it, showing no or little change
by time, e.g., sleeping sickness in an African country
• Epidemic: a significant increase in an infection in a certain region or a
population at the same time than is previously common at that time
• Pandemic: an epidemic distributed over wide geographical areas (worldwide),
e.g., COVID-19
Current symptoms
Allergies
• The first step in the Social/family history

examination of a
newly arrived refugee Medications
is to obtain a detailed
Mental health assessment
history, including
Occupational history
Past medical problems

Current symptoms
• Common manifestations of infections diseases

• Fever (onset time, course, level) High fever /Hypothermia may be a
presenting feature of severe infections
• Loss of weight HIV disease, tuberculosis, infective endocarditis, visceral
leishmaniasis, chronic brucellosis
• Headache, nausea, weakness, loss of appetite, joint and muscle pain
• Complaints about urination (color, smell, amount of urine, dysuria, feeling
of urgency, frequency)
Bloody diarrhoea · Bacterial infections: shigellosis,
Campylobacter jejuni, enteroinvasive and
enteroinvasive E coli, Clostridium
perfringens, Yersinia, Clostridium
difficile (pseudomembranous colitis)
· Parasitic infections: amoebiasis
Watery diarrhoea · Bacterial infections: cholera, salmonella species,
campylobacter jejuni, Escherichia coli
(enterotoxigenic, enteropathogenic and
enteroadherent), Yersinia enterocolitica
· Viral infections: rotavirus, HIV enteropathy and
other enteric viruses
· Protozoal infections: Giardia lamblia,
Cryptosporidium parvum
Traveler's diarrhoea · · Frequently caused by enterotoxigenic E coli
Occurs on visits to developing countries with bad (salads, fruits and other undercooked or uncooked
sanitation systems, and different climates foods)
· Diarrhoea is likely to develop within 2-10 days of · Other causes: shigella, Campylobacter jejuni,
arrival salmonella, giardiasis
· Affects adults and children
Splenomegaly/hepatospl Sole hepatomegaly Jaundice
enomegaly
Malaria, typhoid fever, Hepatitis (all types), Viral hepatitis (all types),
brucellosis, relapsing fever amoebic liver abscess, severe falciparum malaria,
(louse and tick-borne), pyogenic liver abscess, leptospirosis (Weil’s
visceral leishmaniasis, hydatid cyst disease disease), severe
trypanosomiasis, (Echinococcus granulosus), pneumococcal pneumonia,
schistosomiasis (portal kwashiorkor (protein relapsing fever, yellow fever
hypertension), HIV disease deficiency malnutrition, (and other viral
causes fatty liver haemorrhagic fevers),
ascending cholangitis,
septicaemia,
cytomegalovirus
Skin rash
Maculopapular rash Vesicular rash Haemorrhagic rash
measles, rubella, dengue, chickenpox, herpes zoster, meningococcaemia, viral
rickettsia spotted fevers, disseminated herpes simplex haemorrhagic fevers,
primary HIV disease NB. Herpes labialis are small, disseminated intravascular
grouped vesicles on an coagulation
erythematous base on the
lips; causes include fevers,
AIDS, mycoplasma, Weil's disease
•January 2018, Journal of Dr Behcet Uz Children s Hospital,DOI:10.5222/buchd.2018.08941

• Fever (this is sometimes the only sign of an • Unusual vaginal discharge or irritation.
infection).
• Increased urination.
• Chills and sweats.
• Change in cough or a new cough. • Redness, soreness, or swelling in any area,
including surgical wounds and ports.
• Sore throat or new mouth sore.
• Diarrhea.
• Shortness of breath.
• Nasal congestion. • Vomiting.
• Stiff neck. • Pain in the abdomen or rectum.
• Burning or pain with urination. • New onset of pain.
Past medical problems
• Prior hospitalizations
• Episodes of severe illness
• Chronic conditions
• Previous injuries
• Surgeries (including dental procedures)
• Childhood, adult infections
• Splenectomized patient: Encapsulated bacteria
• Neutropenic patient: GNB and fungal infection
• Patient diagnosed with lymphoma: Intracellular mo, Opportunistic infections
• Patient using steroids: Intracellular mo, Opportunistic infections
• HIV infected patient: Opportunistic infections
Patient's family history
• Diseases present in the family: Information about major diseases, such as

diabetes, sickle-cell anemia and hypertension
• Diseases in the family
• Operation in the family
• Current drug use in the family
Congenital infections
• İnfections acquired in utero or during delivery

• TORCH, toxoplasmosis, rubella, cytomegalovirus, syphilis, HIV
disease, coxsackie virus...
• Vaccination history
• Recent contact with an infected patient, e.g., COVID-19, hepatitis A
• Previous exposures
• Prophylaxis, e.g., malaria prophylaxis
• History of bites and stings: mosquitos, ticks (typhus, relapsing fever)
Recent travel history
• List of countries visited (vectors specific to visited places, and the status of their
sanitary and hygiene conditions)
• Some diseases that are endemic in our country or foreign countries examples
• East-Southeast Anatolia (malaria, kala-azar, schistosomiasis,salmonellosis, cholera, hepatitis
A, leprosy, trachoma)
• Black Sea (lyme, STD)
• Southeast Asia (cholera, hepatitis A, meningitis, yellow fever, STDs,malaria)
• Africa (meningitis, yellow fever, AIDS, parasitic diseases)
Tropical diseases:
• Previous geographic • Malaria
exposure to infections • Leishmaniasis
and/or diseases
• Schistosomiasis
• The type and quality of
health care available to
• Trypanosomiasis
the patient prior to • İntestinal parasites
immigration • Lymphatic filariasis
Drug history
Medications
• Traditional and/or herbal remedies and therapies
• Antibiotics, antiparasitic drugs
• Drug-drug interactions!!
Allergies
• Sexual history: contact with STD cases
• Keeping pets at home: dogs (rabies, toxocara canis), birds (bird flu,
psittacosis), cats (rabies, cat scratch disease)
• Blood transfusion: hepatitis B and C, HIV disease, malaria
Dietary history:
• Dietary deficiencies
• Undercooked meats (tapeworms, salmonellosis, toxoplasmosis)
• Intake of unwashed fruits and vegetables (typhoid fever, cholera,
shigellosis, amoebiasis, hepatitis A and E)
• Unpasteurized milk (brucellosis, E coli, campylobacteriosis)
• Safety of drinking water (Tularemia)
Occupational history
• Occupational history is also important to discuss, as this will help to
determine past environmental and chemical exposure
Butcher, veterinarian, animal breeder Brucellosis
Q fever
Anthrax
Orf
Fisherman, butcher, veterinarian Erysipeloid
Hunter Tularemia
Rabies
Chicken breeder, bird seller Psittacosis
Sewage worker A hepatitis
Leptospirosis
Forest worker Lyme
Sporotrichosis
Sex workers STDs and AIDS
Laboratory facilities AIDS
Hepatitis
Brucellosis
Salmonellosis
Tularemia
Tuberculosis
• Use of alcohol, tobacco, and illicit drugs
• Recent contact with an infected patient, e.g., COVID-19, hepatitis A
Routes of transmission of infections
• Orofaecal route
• Food or water become contaminated by people not washing their hands before
preparing or serving food
• Or untreated sewage system water being released into the drinking water supply
Include cholera, giardiasis, rotaviruses, hepatitis A, Entamoeba histolytica, E coli,
tapeworms, ascariasis, giardiasis
• Direct contact: some diseases that are transmissible by direct contact with nfected
persons, e.g. impetigo
•
• Sexual transmission: sexually transmitted disease e.g., gonorhoea, syphilis
• Vertical transmission: directly from the mother to an embryo, fetus or baby
during pregnancy, or childbirth: HIV, hepatitis B, cytomegalovirus
• Air-borne transmission: pathogens remain in air for a long period; TB, measles,
chickenpox, influenza
• Droplet contact:
• Respiratory route through coughing or sneezing, talking to other close persons (one
metre)
• Contact with surfaces, including hands or body parts, that contain the droplets
• Respiratory droplets are large enough to fall to the ground rapidly after being
produced, as opposed to the smaller particles that carry airborne pathogens
Examples: common cold, COVID 19
• Vector-borne transmission:
• Transmitted by a vector, which is an
animal that does not cause disease
itself, but conveys pathogens from
one host to another (mosquitos,
flies…. etc)
• Mosquitos include: Anopheles
(malaria), Culex (elephantiasis, Japanes
encephalitis), Aedes (yellow fever,
dengue fever, Chikungunya fever)
• Skin penetration or contact: schistosomiasis, hookworms, Strongyloides
stercoralis, rabies, broken skin (HIV disease, hepatitis B, C)
• Zoonoses are animal diseases that spread to humans, e.g., rabies,
brucellosis
Disease diagnosis
• Physical examination
• Temperature measurement
• Heart rate
+ All systems
• Respiratory rate
• Blood pressure
• Skin examination
• Lymph nodes

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To obtain a history in

• The first step in the Social/family history

Past medical problems

• Common manifestations of infections diseases

•January 2018, Journal of Dr Behcet Uz Children s Hospital,DOI:10.5222/buchd.2018.08941

• Diseases present in the family: Information about major diseases, such as

• İnfections acquired in utero or during delivery

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