Infectious Diseases and Epidemiology
Infectious Diseases and Epidemiology tests tuberculosis, brucellosis, hepatitis, outbreak investigation, notification, and antimicrobial stewardship. Mongolia has a high tuberculosis burden and zoonotic exposure is common in rural areas.
Core rules
- Tuberculosis: sputum smear, GeneXpert, and culture; standard treatment uses four drugs in the intensive phase. Never add a single drug to a failing regimen.
- Brucellosis: undulant fever, sweats, arthralgia, sacroiliitis, and livestock exposure; confirm serologically and treat with doxycycline plus rifampicin or an aminoglycoside for at least 6 weeks.
- Outbreak investigation: define a case, calculate attack rates, identify source, isolate or notify as required, and monitor contacts.
- Antimicrobial stewardship: choose narrow-spectrum therapy when possible, obtain cultures, and review duration.
Worked example
A herder has two weeks of fever, night sweats, knee pain, and low back pain after assisting with lambing. Brucella agglutination is positive. Treat with doxycycline and rifampicin for 6 weeks, and assess for spondylitis. Reasoning: livestock exposure plus undulant fever and sacroiliitis fits brucellosis; combination therapy reduces relapse.
Traps
- Treating tuberculosis with monotherapy.
- Missing meningococcal contacts who need prophylaxis.
- Using rifampicin alone for brucellosis.
- Ignoring notification requirements for tuberculosis and brucellosis.