Undifferentiated febrile illnesses in South Sudan: a case series from Operation TRENTON from June to August 2017

Abstract

Undifferentiated febrile illnesses present diagnostic and treatment challenges in the Firm Base, let alone in the deployed austere environment. We report a series of 14 cases from Operation TRENTON in South Sudan in 2017 that coincided with the rainy season, increased insect numbers and a Relief in Place. The majority of patients had headaches, myalgia, arthralgia and back pain, as well as leucopenia and thrombocytopenia. No diagnoses could be made in theatre, despite a sophisticated deployed laboratory being available, and further testing in the UK, including next-generation sequencing, was unable to establish an aetiology. Such illnesses are very likely to present in tropical environments, where increasing numbers of military personnel are being deployed, and clinicians must be aware of the non-specific presentation and treatment, as well as the availability of Military Infection Reachback services to assist in the management of these cases.

Optimising remote health care delivery in Antarctica: a review of the current capabilities utilised in the British Antarctic Territory

“…With increasing technological advances, the provision of remote support has gradually evolved into telemedical support allowing for the deployed personnel to “reach-back” to the UK for advice through a variety of means [ 9 ]. This concept has been influenced by methods utilised by the UK Armed Forces and deployed medical assets from various campaigns and operations over the preceding decades [ 10–13 ]. Key lessons for BASMU when considering operational impact have been rapid access to specialist opinion as was used for infectious diseases in Op TRENTON and the sending of digital radiographs as was initially developed during the Bosnia conflict [ 10 , 12 ].…”

“…This concept has been influenced by methods utilised by the UK Armed Forces and deployed medical assets from various campaigns and operations over the preceding decades [ 10–13 ]. Key lessons for BASMU when considering operational impact have been rapid access to specialist opinion as was used for infectious diseases in Op TRENTON and the sending of digital radiographs as was initially developed during the Bosnia conflict [ 10 , 12 ].…”

“…Although reach-back has provided early communication with respect to patients requiring evacuation, it has also been utilised to keep patients on station by providing bespoke telemedicine support [ 10 , 17 ]. Table 1 contains examples of recent utilisation.…”

“…The inspiration for a number of the change and optimisation programmes as part of the multi-year BASMU projects have been driven by lessons learnt from the UK Armed Forces [ 10 , 11 , 19 , 20 ]27 . Certainly, from a medical perspective, there has also been active engagement between the civilian Emergency Physicians of BASMU and the Emergency Physicians of the Tri-Service Emergency Medicine Cadre with a proportion of established posts within BASMU occupied by Military Physicians [ 17 ].…”

Clinical activity at the UK military level 2 hospital near Bentiu, South Sudan during Op TRENTON from June 2017 to October 2018

“…Throughout this deployment, the number of cases due to "disease" remained high (79% to 71%) despite reductions in the proportion of cases due to AGE (from 36% to 6%) and undiagnosed non-malarial undifferentiated febrile illness (UNMUFI) 3 (from 13% to 6%). Further analysis shows that the decrease in AGE cases was most marked after the first roulement-in-place of UK troops had been completed and that it decreased again after a new water borehole and plumbing system were brought online.…”