Approach to Febrile Traveller Flashcards
There are 6 parts to the general approach to a febrile traveller
Routine hx
Focused travel hx
Physical findings
DDx
Lab confirmation
Mgmt decisions
What are the components of a routine hx?
Fever pattern
Full review of systems
PMHx
Meds
Consideration when looking at fever pattern
Consider non-infectious fever causes
Thromboembolism
Malignancy
Autoimmune disease
What should be included when looking travel history?
Itinerary
Timeline
Purpose of travel
Prophylactic measures
What should be assessed in the travel itinerary?
Areas travelled
Places of transit
Mode of travel
What should be assessed in the travel timeline?
Time spent in each area
This helps with Ddx
Longer trip = ↑ likelihood of travel related illness
What period of travel hx should be looked at?
6mo minimum; up to a year
What purpose of travel has the highest risk of acquiring travel related infections?
- Visiting friends and relatives r/t higher likelihood of street food exposure
What are prophylactic measures that can be taken pre-travel to reduce the the risk of travel related illness?
- Immunization (Routine & Travel related)
- Chemo-prophylaxis
What are prophylactic measures that can be taken during travel to reduce the the risk of travel related illness?
Appropriate clothing
Insecticides
Tick bite vigilance
Bed nets
Bottled drinking water
Avoid uncooked food
Handwashing
During the physical exam, what should be assessed?
Head to toe assessment
Be sure to look at mucous membranes, skin, and lymph nodes
Rose spots are associated with what disease?
Typhoid fever
Petechiae is associated with what travel related disease?
Dengue fever
Eschar is associated with what travel related disease?
Scrub typhus
This skin condition is associated with meningicoccus disease
Ecchymosis
The appearance of this in the mucous membrane is diagnostic of measles
Koplic spots
This is the top diagnosed disease in febrile travellers
Malaria - up to 30%
There is an exo-erythrocytic cycle and erythrocytic cycle to the plasmodium life cycle in the human body. What are the symptoms associated with the exo-erythrocytic cycle?
Elevated transaminases
There is an exo-erythrocytic cycle and erythrocytic cycle to the plasmodium life cycle in the human body. What are the symptoms associated with the erythrocytic cycle?
Hemolysis
Anemia
Splenomegaly
Thrombocytopenia
Cyclic fevers
Rigors
Headache
Vasular and endothelial dmg
Cyclic fever is associated with malaria. What causes this?
Release of pro inflammatory cytokines r/t rupture of RBC with schizont inside it
Diagnosis of malaria requires what type of diagnostic test to determine the presence of malaria and the type?
Thick and thin smear
Thick - is parasite present
Thin - what type is present
This diagnostic test is rapid and good for detection of p. Falciparum
Antigen test
This diagnostic test is able to detect very low lvl of plasmodium in the blood
PCR
What does the choice of oral anti-malarial tx depend on?
Malaria sp.
Region of travel and local resistance pattern
What pathogens can cause traveller’s diarrhea? (3)
Bacteria
Viruses
Parasites
What bacteria can cause traveller’s diarrhea? (6)
ETEC (most common)
Campylobacter jejune
Salmonella sp.
Shigella sp.
C. Diff
Vibrio sp.
What viruses can cause traveller’s diarrhea? (3)
Rotavirus
Norovirus
Adenovirus
What parasites can cause traveller’s diarrhea? (5)
Giardia lamblia
Cyclospora cayetensis
Crytospordium parvum
Cystisospora belli
Entamoeba histolytics
What are prophylaxis prevention options for traveller’s diarrhea?
ETEC vaccine — Dukoral
Bismuth subsalicylate (pepto bismol)
Abx prophylaxis isn’t recommended
What is the treatment for mild traveller’s diarrhea?
Loperamide
Pepto
Hydration and supportive care
What is the treatment for moderate traveller’s diarrhea?
Loperamide
May or may not use abx
Abx more effective with loperamide
What is the treatment for severe traveller’s diarrhea?
Abx
Supportive care
This pathogen causes typhoid fever
Salmonella enterica
Serotype typhi or paratyphi
What organs are impacted by typhoid fever?
GI tract and liver
Bacteremia —> bone marrow, gallbladder, sleeper, peyer’s patches in terminal ileum
What are the clinical features of typhoid fever?
Fever
Fatigue
Diarrhea/constipation
Rose spots (blanching pink/red rash)
Relative bradycardia
Abdominal tenderness
Hepato-splenomegaly
How is typhoid fever diagnosed?
Blood cultures
Bone marrow cultures
Stool culture
Widal test (poor specificity)
General labs — CBC and liver workup
What is the management of typhoid fever?
Depends on region of travel due to variation in resistance based on region
This travel related-illness is characterized by “breakbone fever” (fever, bone, and joint pain), and petechiae rash.
Dengue fever
What is the basic workup for a traveller returning with a fever?
CBC
Liver enzymes
Creatinine
Electrolytes
Blood culture
Urinalysis
