Expansion
Occupation, travel, animals, hobbies and contacts
Expansion
Occupational
- Asbestos: shipbuilding, construction, plumbing, lagging. Latency of 20 to 40 years
- Silica and coal: mining, quarrying, stonemasonry
- Organic dusts: farming (farmer’s lung), birds (bird fancier’s lung), causing hypersensitivity pneumonitis
- Isocyanates: spray painting, causing occupational asthma. Ask whether symptoms improve at weekends and on holiday
- Bladder carcinogens: dye, rubber and leather industries
- Noise, vibration, radiation, chemicals
Travel
- Destination, rural or urban, timing relative to symptoms, prophylaxis and adherence, vaccinations
- Malaria must be excluded in any fever after travel to an endemic area
- Incubation periods narrow the differential: under 10 days suggests dengue or typhoid; weeks suggests malaria or hepatitis; months suggests tuberculosis or leishmaniasis
- Freshwater exposure (schistosomiasis, leptospirosis), sexual contacts, healthcare abroad (resistant organisms)
Animals and hobbies: birds (psittacosis), cats (toxoplasmosis, cat scratch), rodents, sheep at lambing (Q fever), gardening, hot tubs.
Contacts: ill contacts, tuberculosis exposure, and childhood illnesses.