2.4 Infection: Fever in returning traveler Flashcards
Simple tertian fever (72h interval)
p vivax and p ovale malaria
simple qurtan fever (96h interval)
P. malariae malaria
malignant tertian fever
Cerebral malaria (usually P. falciparum)
cyclical (Pel-Ebstein fever)
Hodgkin’s lymphoma
intermittent fever
abscesses
stepladder fever
Typhoid (caused by Salmonella typhi)
infections associated with food and water
Hepatitis A/E, typhoid
infections associated with unpasteurised milk
Listeria, Brucella
infections associated with fresh water
Leptospirosis, schistosomiasis
infection associated with camels
MERS
infection associated with poultry
Avian influenza (H5N1, H7N9)
infections associated with dog/ bat bites
Rabies
infections associated with rats
Murine typhus (R. typhi), leptospirosis
infections associated with unprotected sex
HIV, Hepatitis C, syphilis
short incubation periods (<10 days)
Dengue, influenza, chikungunya, yellow fever, malaria, typhoid, rickettsia, leptospirosis, VHF, MERS, SARS
medium incubation periods (10-21 days)
Malaria, typhoid, leptospirosis, rickettsia, brucella, MERS, SARS, VHF
long incubation periods (>21 days)
Hepatitis, malaria, typhoid
Amoebic abscess, schistosomiasis, filariasis
HIV, TB
Testing: Initial & Diagnostic Tests
INITIAL INVESTIGATIONS:
- Full blood count, renal & liver function tests
- If indicated, C-reactive protein, CXR, urinalysis
- _____________ for malaria (or rapid diagnostic tests)
DIAGNOSTIC TESTS: depending on presentation
- Blood cultures (2 sets ___________)
- Stool cultures, stool for ______________
- PCR or serology for specific pathogens
- Nasopharyngeal swabs or sputum samples
Blood films;
BEFORE antibiotics;
ova/cysts/parasites
[Fever & Rash in a Traveller]
Rash is common part of presentation:
- Mosquito-borne: Dengue, chikungunya, Zika
- Vaccine-preventable: Measles, rubella, varicella
- Meningococcus
Rash is described but less common with:
- Typhoid: _________
- Rickettsial infections including typhus: _______
Rose spots;
Eschar
[Fever & GI Symptoms in a Traveller]
Fever with diarrhea:
- E.coli is the most common cause of bacterial TD
- Other bacteria: ________________
- Viruses (enteroviruses, norovirus, rotavirus)
- Parasites (__________________)
Fever with elevated LFT:
- Amebic liver abscess, cholecystitis
- Typhoid, lepto, malaria, CMV, EBV
- Viral hepatitis (A-E) high AST&ALT usually after fever
Fever with jaundice: ______________ etc
Salmonella (enteritidis & typhi), Shigella, Campylobacter, Yersinia, Vibrio, C.difficile ;
Giardia, Entamoeba, cryptosporidia;
Malaria, leptospirosis
[Fever & Respiratory Symptoms in a Traveller]
The most important factors are:
- Destination – country/city
- Exposure to animals or foods
- Exposure to healthcare facilities or sick contacts
- Vaccines: influenza, pneumococcus, pertussis
Important Exposures to Consider:
- Poultry, SE Asia/China: _________
- Camels, Middle East: ______
- Endemic/sporadic: __________________
Avian flu H5N1/H7N9;
MERS;
Seasonal influenza, Strep pneumoniae, Legionella, pertussis
[Fever & Neuro Symptoms in a Traveller]
Meningitis
- __________ (Africa, Haj, sporadic exposures)
- __________ (unpasteurized milk or cheese)
Encephalitis / Coma:
- Japanese encephalitis
- ___________ (Bangladesh, northeast India)
- HSV, VZV, CMV, opportunistic infections
- Rabies (weeks to months after dog or bat bite)
Meningococcus;
Listeria
Nipah encephalitis
[Fever & Eosinophilia in a Traveller]
Fever & eosinophilia in a traveller:
- Parasitic infections: Helminths, flukes, protozoa. Ascariasis, Fasciola, Hookworm (__________, _______), Schistosomiasis, Strongyloidiasis
- Drug reaction
- Other causes: ____________ etc
Ancylostoma, Necator
Adrenal insufficiency
