Introduction

Infections have plagued doctors for centuries, in both the diagnosis of the specific diseases and the identification and subsequent management of the causative agents. There is a constant need for information as new organisms emerge, existing ones develop resistance to current drugs or vaccines, and changes in epidemiology and prevalence occur. In the 21st century, obtaining this information has never been more important. Population migration and the relatively low cost of flying means that unfamiliar infectious diseases may be brought into industrialized countries. An example of this was an outbreak of severe acute respiratory syndrome (SARS), which was first recognized in 2003. Despite modern technology and a huge input of money, it took months for the agent to be identified, a diagnostic test to be produced, and a strategy for disease reporting and isolation to be established. There is no doubt that other new and fascinating diseases will continue to emerge.

For the forensic physician, dealing with infections presents two main problems. The first problem is managing detainees or police personnel who have contracted a disease and may be infectious or unwell. The second problem is handling assault victims, including police officers, who have potentially been exposed to an infectious disease. The latter can be distressing for those involved, compounded, in part, from an inconsistency of management guidelines, if indeed they exist.

From: Clinical Forensic Medicine: A Physician's Guide, 2nd Edition Edited by: M. M. Stark © Humana Press Inc., Totowa, NJ

With the advent of human rights legislation, increasing pressure is being placed on doctors regarding consent and confidentiality of the detainee. Therefore, it is prudent to preempt such situations before the consultation begins by obtaining either written or verbal consent from the detainee to allow certain pieces of information to be disclosed. If the detainee does not agree, then the doctor must decide whether withholding relevant details will endanger the lives or health of those working within custody or others with whom they may have had close contact (whether or not deliberate). Consent and confidentiality issues are discussed in detail in Chapter 2.

Adopting a universal approach with all detainees will decrease the risk to staff of acquiring such diseases and will help to stop unnecessary overreac-tion and unjustified disclosure of sensitive information. For violent or sexual assault victims, a more open-minded approach is needed (see also Chapter 3). If the assailant is known, then it may be possible to make an informed assessment of the risk of certain diseases by ascertaining his or her lifestyle. However, if the assailant is unknown, then it is wise to assume the worst. This chapter highlights the most common infections encountered by the forensic physician. It dispels "urban myths" and provides a sensible approach for achieving effective management.

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