2.4 Infection: Fever in returning traveler

Question 1

Simple tertian fever (72h interval)

Answer 1

p vivax and p ovale malaria

Question 2

simple qurtan fever (96h interval)

Answer 2

P. malariae malaria

Question 3

malignant tertian fever

Answer 3

Cerebral malaria (usually P. falciparum)

Question 4

cyclical (Pel-Ebstein fever)

Answer 4

Hodgkin’s lymphoma

Question 5

intermittent fever

Answer 5

abscesses

Question 6

stepladder fever

Answer 6

Typhoid (caused by Salmonella typhi)

Question 7

infections associated with food and water

Answer 7

Hepatitis A/E, typhoid

Question 8

infections associated with unpasteurised milk

Answer 8

Listeria, Brucella

Question 9

infections associated with fresh water

Answer 9

Leptospirosis, schistosomiasis

Question 10

infection associated with camels

Answer 10

MERS

Question 11

infection associated with poultry

Answer 11

Avian influenza (H5N1, H7N9)

Question 12

infections associated with dog/ bat bites

Answer 12

Rabies

Question 13

infections associated with rats

Answer 13

Murine typhus (R. typhi), leptospirosis

Question 14

infections associated with unprotected sex

Answer 14

HIV, Hepatitis C, syphilis

Question 15

short incubation periods (<10 days)

Answer 15

Dengue, influenza, chikungunya, yellow fever, malaria, typhoid, rickettsia, leptospirosis, VHF, MERS, SARS

Question 16

medium incubation periods (10-21 days)

Answer 16

Malaria, typhoid, leptospirosis, rickettsia, brucella, MERS, SARS, VHF

Question 17

long incubation periods (>21 days)

Answer 17

Hepatitis, malaria, typhoid
Amoebic abscess, schistosomiasis, filariasis
HIV, TB

Question 18

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

Answer 18

Blood films;

BEFORE antibiotics;

ova/cysts/parasites

Question 19

[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: _______

Answer 19

Rose spots;

Eschar

Question 20

[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

Answer 20

Salmonella (enteritidis & typhi), Shigella, Campylobacter, Yersinia, Vibrio, C.difficile ;

Giardia, Entamoeba, cryptosporidia;

Malaria, leptospirosis

Question 21

[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: __________________

Answer 21

Avian flu H5N1/H7N9;

MERS;

Seasonal influenza, Strep pneumoniae, Legionella, pertussis

Question 22

[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)

Answer 22

Meningococcus;

Listeria

Nipah encephalitis

Question 23

[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

Answer 23

Ancylostoma, Necator

Adrenal insufficiency