Which infectious diseases require treatment?

Infectious Diseases Requiring Treatment

Infectious diseases that require treatment include malaria, enteric fever (typhoid/paratyphoid), tuberculosis, HIV infection, and specific bacterial infections where antimicrobial therapy is indicated to prevent morbidity, mortality, or further transmission.

Tropical Infections Requiring Urgent Treatment

Malaria

• Malaria must be excluded in all patients with a history of fever returning from tropical regions, especially sub-Saharan Africa, as it is the most important potentially fatal cause of febrile illness in returning travelers 1
• Treatment is mandatory for all cases of malaria, with particular urgency for Plasmodium falciparum infections 1
• Most P. falciparum cases present within 1 month of return, but P. vivax, P. ovale, and P. malariae can present up to a year or longer following return 1

Enteric Fever

• Enteric fever (typhoid and paratyphoid) requires treatment, especially in travelers returning from South and Southeast Asia 1
• If clinically unstable, empiric treatment with ceftriaxone is indicated; if confirmed sensitive, switch to ciprofloxacin; if resistant, use azithromycin as oral follow-on agent 1
• Ciprofloxacin is indicated for treatment of typhoid fever (enteric fever) caused by Salmonella typhi 2

Respiratory Infections Requiring Treatment

Tuberculosis

• All forms of active tuberculosis (TB) require treatment 1
• All HIV-infected persons who have a positive tuberculin skin test (TST) result but have no evidence of active TB should be treated for latent TB infection 1
• HIV-infected persons who are close contacts of persons with infectious TB should be treated for latent TB infection, regardless of their TST results 1

Bacterial Respiratory Infections

• Specific bacterial respiratory infections requiring treatment include:
  • Community-acquired pneumonia due to Streptococcus pneumoniae, Haemophilus influenzae, Mycoplasma pneumoniae, or Chlamydophila pneumoniae 3
  • Acute bacterial sinusitis due to H. influenzae, M. catarrhalis, or S. pneumoniae 3
  • Acute bacterial exacerbations of chronic obstructive pulmonary disease 3

Gastrointestinal Infections Requiring Treatment

Infectious Diarrhea

• Infectious diarrhea requiring antimicrobial therapy includes:
  • Diarrhea caused by Escherichia coli (enterotoxigenic strains), Campylobacter jejuni, Shigella species when antibacterial therapy is indicated 2
  • Amoebic liver abscess requires treatment with tinidazole/metronidazole 1

Sexually Transmitted Infections Requiring Treatment

• Urethritis and cervicitis due to Chlamydia trachomatis or Neisseria gonorrhoeae require treatment 2, 3
• Genital ulcer disease in men due to Haemophilus ducreyi (chancroid) requires treatment 3
• HIV infection requires evaluation for antiretroviral therapy 1

Special Considerations for Treatment

Drug-Resistant Infections

• Infections caused by drug-resistant organisms (especially MDR-TB) should be treated with specialized regimens containing second-line drugs 1
• For patients exposed to isoniazid- or rifampin-resistant TB, decisions about chemoprophylaxis should be made in consultation with public health authorities 1

Infection Prevention

• Treatment of infectious diseases is not only for individual benefit but also to prevent transmission to others 4
• Healthcare facilities must implement appropriate infection control measures when managing highly infectious diseases 5

Factors Influencing Treatment Decisions

• Travel history is crucial in evaluating infectious diseases, as it helps identify potential exposures to endemic pathogens 6, 7
• Risk factors for hospitalization in children with travel-related illnesses include travel to Southern Asia and diagnoses such as typhoid fever, pyogenic abscess, or malaria 8
• Appropriate culture and susceptibility tests should be performed before treatment to determine the causative organism and its susceptibility to antimicrobials 2, 3

Treatment Settings

• Many infections previously requiring hospitalization can now be safely treated in outpatient settings, including cellulitis, pyelonephritis, and certain pneumonias 9
• Patients must be thoroughly assessed for suitability for outpatient treatment, including clinical stability and social circumstances 9

Reporting Requirements

• All providers must report both new and retreatment TB cases and their treatment outcomes to local public health authorities 1
• Notifiable diseases should be reported to local health protection units 6