Host: Michelle Odian (My Health Academy) Guest Speaker: Dr. Clinton Colaco (Infectious Diseases & Consultant Physician) Episode Overview Join us as infectious diseases physician Dr. Clinton Colaco shares clinical pearls and fascinating case studies from his time completing the prestigious Gorgas Course in Clinical Tropical Medicine in Lima, Peru. While these cases originate in South America, their diagnostic lessons are highly relevant for any primary care clinician treating travelers, immigrants, or dealing with local tropical pathogens. From navigating the diagnostic pitfalls of syphilis testing to removing botfly larvae, this episode equips general practitioners (GPs) with the essential skills to spot overlooked tropical diseases and ask the right social and travel questions. High-Yield Chapter Markers [00:00] Introduction & The Gorgas Experience Host Michelle Odian introduces Dr. Clinton Colaco and his background. Dr. Colaco describes his 9-week training at the Alexander von Humboldt Institute in Lima, Peru, and excursions into the Peruvian Amazon. [05:30] Case 1: Syphilis, HIV, & The "Prozone Effect" A 41-year-old male presents with a widespread psoriasiform rash and a negative RPR test. Dr. Colaco explains the prozone effect—how an excess of antigen-antibody complexes can cause false-negative serology in secondary syphilis—and how to overcome it with serum dilution. [09:15] Case 2: Cryptococcal Meningitis & Bedside Eye Ultrasound A 26-year-old law student presents with severe headaches, seizures, and an astronomical lumbar puncture opening pressure of 136 cm H₂O. Learn how point-of-care ultrasound (POCUS) over the eye can detect optic nerve sheath thickening to screen for raised intracranial pressure. [14:40] Case 3: Hydatid Lung Cysts (Echinococcus) A 20-year-old from the Bolivian border presents with hemoptysis and a massive fluid-filled cavity in his lung. Dr. Colaco outlines the Echinococcus lifecycle, its link to livestock and dogs, and the surgical management of hydatid disease. [18:10] Case 4: Myiasis (Botflies in the Skin) A patient presents with painful, non-healing skin nodules. Using real-time bedside ultrasound, the team visualizes moving botfly larvae (Dermatobia hominis) beneath the skin, requiring occlusion with Vaseline to force the maggot to emerge for extraction. [21:25] Cases 5 & 6: Pulmonary Tuberculosis vs. Bilateral Psoas Abscesses Why is Peru a hotbed for TB? Hint: it's all about overcrowded public transit. Dr. Colaco contrasts classic pulmonary tuberculosis with a rare presentation of bilateral psoas abscesses and spinal discitis in a non-compliant HIV patient. [25:50] Case 7: Leprosy (Hansen’s Disease) A sibling pair presenting with severe facial disfigurement and thickened nerves. Dr. Colaco explains how to perform a quick slit skin smear to identify acid-fast bacilli and reviews the three-drug combination therapy. [29:10] Case 8: Cutaneous Leishmaniasis How to approach a non-healing, crater-like ulcer. The key diagnostic takeaway: perform a punch biopsy on the active, raised border of the lesion (not the necrotic center) to successfully find amastigotes. [32:45] Case 9: Leptospirosis Meningoencephalitis A patient with high viral load HIV presents with severe neurological symptoms linked to river exposure and rodent droppings. Discover the two-step diagnostic testing process (screening serology followed by the Microscopic Agglutination Test, or MAT). [35:20] Case 10: Paragonimiasis (Lung Flukes) A school teacher presenting with chronic cough and peripheral nodules after eating ceviche. Learn why coastal, saltwater ceviche is safe, whereas inland freshwater ceviche (made with freshwater crabs or crayfish) carries a major risk for lung flukes. [38:15] Case 11: Fascioliasis (Liver Flukes) & Watercress A patient presenting with epigastric pain and a massive blood eosinophil count of 10. Dr. Colaco details the lifecycle of Fasciola hepatica contracted from contaminated watercress, showing dramatic ERCP footage of living worms being extracted from the common bile duct. [41:30] Case 12: Pelvic Actinomycosis & Lost IUDs A woman presenting with chronic yellow vaginal discharge and a cervical mass. The culprit? A copper intrauterine device (IUD) left in situ for 30 years, resulting in a tumor-mimicking actinomycosis infection showing the classic Splendore-Hoeppli phenomenon on pathology. [44:55] Case 13: Neurocysticercosis (Brain Tapeworm) A young fisherman presenting with seizures. Dr. Colaco discusses the diverse presentations of tapeworm cysts in the brain and why treatment with albendazole or praziquantel must be highly customized depending on the location of the scolex. [48:20] Q&A: Practical Advice for Travel Consults Dr. Colaco answers critical questions regarding:Overcoming "vaccine fatigue" and the high cost of pre-travel vaccines (e.g., Yellow Fever, Japanese Encephalitis).The highly cost-effective strategy of getting rabies vaccinations overseas ($100/shot in Peru vs. $500/shot in Australia) and the updated 2-dose recommendation.The role of doxycycline as post-exposure prophylaxis (PEP) for leptospirosis after fresh-water swimming.Pitfalls of the Interferon-Gamma Release Assay (IGRA/QuantiFERON-Gold) and how fish tank exposures (Mycobacterium marinum) can trigger a false-positive tuberculosis test. 5 Quick Clinical Pearls for Your Practice Test Syphilis Thoroughly: If you strongly suspect secondary syphilis but the RPR is negative, request the laboratory to perform serial dilutions to bypass the prozone effect.Biopsy the Border: When performing a punch biopsy for suspected Cutaneous Leishmaniasis, always biopsy the active, raised border of the ulcer rather than the central necrotic tissue to maximize amastigote yield.Ask About Watercress: An unexplained, sky-high eosinophil count paired with right upper quadrant pain should prompt you to ask about raw watercress consumption (suspect Fasciola hepatica).Mind the Fish Tank: A positive QuantiFERON-Gold test in a patient with low TB risk could be a false positive triggered by Mycobacterium marinum (often contracted from cleaning domestic aquariums).Check Old IUDs: Long-term retention of copper IUDs (e.g., decades-long use) can lead to pelvic actinomycosis, which clinically and radiologically mimics advanced pelvic malignancies. Continuing Professional Development (CPD): Australian general practitioners can obtain CPD points for listening to this episode from our education partner, My Health Academy. Myhealth Academy Link: https://lms-academy.myhealth.net.au/login/index.php?tenant=MHAC01 Enjoyed Today's Clinical Sessions Podcast? Your favourite conferences are now in podcast form too! Stay clinically up to date without travelling to conferences or sacrificing weekends with your family. You've just experienced how easy it is to learn through the Clinical Sessions Podcast. Now imagine having access to hundreds of conferences whenever and wherever you want. Listen while driving to work, walking the dog or exercising. Watch with slides while on your treadmill. Get the education you need without sacrificing the moments that matter. Turn your commute into a masterclass, your gym session into a symposium and cooking dinner into a GP update. Learn more https://www.armchairmedical.tv/podcasts ------------------------------------------------------------------------------- If you are a General Practitioner who gets invited to dozens of webinars a month. The General Practice Clinical Sessions Podcast is designed for you. Instead of giving up an evening with your family for a live webinar or your weekend for a conference, you can listen to it here whenever it's convenient, in half the time and while you are commuting, exercising or even walking the dog. It's the same education, without interrupting your life. GPs can also earn CPD hours. Earn Educational Activity (EA) CPD without sacrificing time with your family. Listen to your Clinical Sessions Podcasts on your commute or while you exercise. Then each week, calculate the amount of time you invest listening and count that as self claimed Educational Activities (EA). Earn Reviewing Performance (RP) CPD without sacrificing time with your family. After each podcast, pause for a few minutes and identify and summarise 3 key points relevant to your scope of practice. Identify the key...
