Infectious Diseases – public patients

Suspected / Confirmed Encephalitis with presence of:

• Headache
• Confusion
• Seizures
• Altered movement or sensation
• Diplopia
• Dysarthria / dysphagia
• Petechial Rash 

If requesting advice about body fluid exposure with the last 72 hours requiring post exposure prophylaxis (PEP) 

Pyrexia of unknown origin with presence of:

• Altered conscious level
• Suspicion of meningitis
• Suspicion of endocarditis
• Features of sepsis (hypotension, tachycardia, tachypnoea) 

Proven or suspected travel related and tropical infections with presence of:

• Altered conscious level
• Breathing difficulty 
• Abnormal bruising or bleeding
• Petechial rash
• Persistent vomiting
• Dehydration
• Paralysis
• Jaundice
• Positive tick / thin smears for malaria parasites
• Blood culture positive for salmonella 

Proven or suspected Zoonotic Disease with the following features:

• High fever
• Altered level of consciousness 

A pregnant women with the following features:

• Temperatures greater than 38 degrees celcius
• Associated symptoms such as rigors, sweating, dysuria, rash, diarrhoea, vomiting
• Exposure history e.g. foreign travel, contact with animals, unwell people with rashes

A refugee, migrant or asylum seeker with the following features:

• Altered level of consciousness 
• Breathing difficulty
• Abnormal bruising or bleeding
• Petechial rash 
• Persistent vomiting
• Dehydration
• Paralysis
• Jaundice
• Positive thick / thin smears for malaria parasites 
• Blood cultures positive for salmonella 

Essential information (Referral will be declined without this)

• General Referral Information
• Presence of
  • Evidence of septicaemia or bacteraemia 
  • Septic Arthritis
  • Cellulitis
  • Bone infection with associated valvular heart disease or new heart murmur
  • Suspected mycobacterial, gonococcal infection
• Documented surgical plan of management - e.g. dates of washout, single or two-stage joint replacement
• History of recent surgery (joint replacement or trauma). Include hospital discharge letter if available 
• Location of suspected infection
• Duration and location of symptoms (fever, pain, swelling, inflammation) 
• Treatments trialed to date

Additional referral information (useful for processing the referral)

• Microscopy and culture of any discharge or aspirate collected 
• Blood culture results
• Mycobacterial culture of any specimens 
• Isotope bone scan or Indium-111 labelled while cell scan results
• MRI results if available (may not be possible if ferrous metal prosthesis) 

Other useful information for management (not an exhaustive list)

• No additional information

Categorisation

Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.

Essential information (Referral will be declined without this)

• General Referral Information
• CD4 count (cells/mm3)
• HIV viral load (highly desirable if available) 
• History of condition including date diagnosed. Include last 3 specialist letters if patient has been seen previously by another specialist
• Investigations
  • FBC, ELFTs, lymphocyte subsets
  • HIV viral load
  • HIV 1 and 2 serology 
  • HIV genotype resistance assay (GRA) if viral load detectable
  • Chest x-ray
  • CMV, EBV, Varicella, Toxoplasma
  • Hepatitis A, B and C serology
  • Urine chlamydia and gonorrhoea PCR
  • Serum beta-HCG (for women) 

Additional referral information (useful for processing the referral)

• Previous HIV genotype resistance assay (GRA)
• Tuberculosis exposure history and previous treatment history if applicable

Other useful information for management (not an exhaustive list)

• If requesting advice about body fluid exposure within the last 72 hours requiring post exposure prophylaxis (PEP) please refer to emergency department 
• If referring a patient with a new diagnosis of HIV on antenatal screening mark referral as URGENT and contact ID physician on call to facilitate urgent appointment 
• If referring a patient with a new diagnosis of HIV or known HIV patient not on antiretroviral treatment mark referral as URGENT and contact Infectious Diseases physician on-call for consideration of hospital admission for further management

Categorisation

Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.

Essential information (Referral will be declined without this)

• General referral information
• Gestation of pregnancy, LNMP and estimated date of delivery (EDD)
• Concerning symptoms
• Investigations
  • Antenatal screening results e.g. HIV, rubella, syphilis, varicella
  • FBC, ELFTs 
  • Antenatal imaging 

Additional referral information (useful for processing the referral)

• No additional information

Other useful information for management (not an exhaustive list)

• No additional information

Categorisation

Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.

Essential information (Referral will be declined without this)

• General referral information
• Language and interpreter requirement
• History of signs and symptoms
  • nature, onset, duration
  • Fever or rashes
  • Weight loss, loss of appetite
• Travel history
  • estimated date of arrival in Australia
  • Countries travelled to enroute to Australia 
• Vaccination History 
• Exposure history e.g. TB exposures, unwell contacts
• Investigations
  • FBC, ELFTs 
  • Malarial Thich and thin film
  • Mid-stream urine 
  • Viral serology as determined by history 
  • HIV serology
  • Stool microscopy, culture and sensitivities (MCS) and PCR
  • Hepatitis A, B, C serology 
  • Schistosoma and strongyloidiasis serology 
  • Chest x-ray

Additional referral information (useful for processing the referral)

• No additional information

Other useful information for management (not an exhaustive list)

• No additional information

Categorisation

Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.

Essential information (Referral will be declined without this)

• General referral information
• Timeline of symptoms
  • Duration and evolution of symptoms
  • Fever history 
  • Ocular symptoms e.g. redness, pain, purulent discharge, visual compromise
  • Associated symptoms e.g. rigors, sweating, dysuria, rash, diarrhoea, vomiting
• Exposure history (foreign travel, contact with animals, unwell contacts 
• Drug history including non-prescription and recreational 
• Ophthalmological Signs
  • description of ophthalmological findings 
  • description of ophthalmological differential diagnoses based on above
  • Treatments initiated 
  • Results of investigations performed 

Additional referral information (useful for processing the referral)

• No additional information

Other useful information for management (not an exhaustive list)

• ALL patients with suspected eye infections need to be seen by an Ophthalmologist or the Mater Ophthalmology Department prior to referral to the Infectious Diseases team

Categorisation

Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.

Essential information (Referral will be declined without this)

• General Referral Information
• Presence of:
  • Active tuberculosis (TB) bacilli in sputum (public health risk) 
  • Significant shortness of breath
  • Abnormal chest x-ray with new changes
  • Pleural effusion
  • Cavitation on chest x-ray
  • Immunosuppression (drug related or due to another disease e.g. HIV) 
  • Spreading ulcer
• Timeline and duration of symptoms
• Presence of immunosuppression and cause
• Investigations
• Chest x-ray
• CT chest if abnormal chest x-ray
• Sputum microscopy and culture, including mycobacterial culture and Ziehl-Neelsen (ZN) staining
• FBC, ELFTs, ESR, CRP
• HIV serology

Additional referral information (useful for processing the referral)

• If previously seen by another specialist 2-3 most recent letters
• Previous treatment history if available 

Other useful information for management (not an exhaustive list)

• If sputum AFB positive and HIV positive, please mark referral as URGENT and contact Infectious Diseases physician on-call to arrange for admission and initiation of management 
• If sputum AFB positive, please mark referral as URGENT

Categorisation

Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.

Essential information (Referral will be declined without this)

• General Referral Information
• Signs and symptoms
• Duration of infection and symptoms
• Travel history 
• Blood tests including eosinophilia
• Microscopy or PCR evidence of infection
• In case of extensive scabies, microscopy, culture and sensitivities (MCS) of secondary infection site

Additional referral information (useful for processing the referral)

• Liver Ultrasound if hepatic cysts present

Other useful information for management (not an exhaustive list)

• No additional information

Categorisation

Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.

Essential information (Referral will be declined without this)

• General Referral Information
• Timeline of symptoms
• Maximum recorded temperature and frequency of temperatures above 30 degrees Celsius
• Associated symptoms (riros, sweating, dysuria, rash, diarrhoea, vomiting) 
• Associated weight loss
• Relevant examination findings e.g. lymphadenopathy, rash, heart murmur
• Investigations
  • FBC, ELFTs, CRP, ESR
  • Sputum culture
  • MSU microscopy, culture and sensitivities (MCS) 
  • HIV serology
  • Chest x-ray
  • Blood cultures (at least 2 sets taken from separate sites) 

Additional referral information (useful for processing the referral)

• Auto antibody screen 
• Relevant serology e.g. Epstein-Barr virus (EBV), toxoplasmosis, cytomegalovirus (CMV), pertussis, Hepatitis B and C
• Skinn biopsy results of any rash
• Echocardiogram if heart murmur present

Other useful information for management (not an exhaustive list)

• No additional information

Categorisation

Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.

Essential information (Referral will be declined without this)

• General Referral Information
• Presence of
  • Spreading cellulitis
  • Large abscess of carbuncle
  • Extensive superficial infection
  • Vascular insufficiency, dependent oedema, lymphoedema
• Timeline of symptoms including duration and site of infection
• Treatments trialled to date, duration of treatment and reasons for failure 
• FBC, ELFTs
• Microscopy, culture and sensitivities (MCS) of infected area 

Additional referral information (useful for processing the referral)

• Skin scraping 
• Fungal culture results
• Skin biopsy results

Other useful information for management (not an exhaustive list)

• No additional information

Categorisation

Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.

Essential information (Referral will be declined without this)

• General Referral Information
• Presence of:
  • Confusion
  • Neurological impairment
  • Jarisch-Herxheimer reaction after initiating treatment
• Timeline of symptoms 
• Previous treatment history 
• Relevant features e.g. primary lesion, features suggesting secondary stage
• FBC, ELFTs
• Syphilis serology 
• HIV serology
• beta-HCG (for females)

Additional referral information (useful for processing the referral)

• ECG if late latent syphilis suspected 
• CT brain if late latent syphilis suspected 
• Urine chlamydia and gonorrhoea PCR

Other useful information for management (not an exhaustive list)

• If syphilis serology positive in the setting of pregnancy please mark referral as URGENT and contact the Infectious Diseases physican on-call to facilitate urgent review 

Categorisation

Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.

Essential information (Referral will be declined without this)

• General referral information
• History of signs and symptoms:
  • nature, onset, duration
  • Fever
  • Weight loss, loss of appetite 
• Examination:
  • Lymphadenopathy
  • Rash
• Travel History:
  • Departure and return dates 
  • Destinations
• Vaccination History 
• Prophylactic medications taken and compliance 
• Investigations
  • FBC, ELFT
  • Malarial thick and thin film
  • Stool microscopy, culture and sensitivities (MCS) and PCR
  • Mid-stream urine MCS
  • Blood cultures

Additional referral information (useful for processing the referral)

• No additional information

Other useful information for management (not an exhaustive list)

• No additional information

Categorisation

Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.

Essential information (Referral will be declined without this)

• General referral information
• Timeline of symptoms including key symptoms and any relevant rash descriptions
• Exposure risk factors (occupational exposure, pets, animal husbandry, foreign travel, sewerage worker, feral pig hunting) 
• Treatments trialed 
• Suspected diagnosis
• Relevant immunisation history e.g. Q Fever

Additional referral information (useful for processing the referral)

• No additional information

Other useful information for management (not an exhaustive list)

• No additional information

Categorisation

Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.

Essential information (Referral will be declined without this)

• General referral information
• Relevant condition information
• Relevant pathology and imaging reports

Categorisation

Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.

• Diagnosis or review of Chronic Fatigue Syndrome