Approach to Fever in Returned Traveller

Question 1

Fever in a returned traveller is __ until proven otherwise

Answer 1

Malaria

Question 2

Malaria vector

Answer 2

Female anopheles mosquito

Question 3

5 plasmodium species

Answer 3

P falciparum (most serious)
P vivax (has dormant phase)
P ovale (has dormant phase)
P malariae
P knowlesi

Question 4

Symptoms of uncomplicated malaria

Answer 4

Fever
Rigors
Headache
Myalgias
Anorexia
\+/- jaundice
Splenomegaly and pallor if chronic

Question 5

Symptoms of severe malaria (P falciparum)

Answer 5

Confusion/seizures/coma
Renal failure
Acute PE
Lactic acidosis, hypoglycemia
Severe anemia, coagulation abnormalities
Jaundice
Shock

Question 6

Treatment for severe malaria

Answer 6

Artesunate IV + doxy or clindamycin

Quinine instead of artesunate is second line

Question 7

Treatment for uncomplicated malaria

Answer 7

Artemether-lumefantrine

Can also give malarone or quinine + doxy/clinda

Question 8

Treatment for ovale and vivax

Answer 8

Chloroquine and primaquine

Primaquine gets the hypnozoites (dormant in liver)

Question 9

Big 3 fever viruses in travellers

Answer 9

Dengue
Chikungunya
Zika

Question 10

Top causes of fever

Answer 10

Malaria
Dengue/chikunguna/zika
Typhoid
Rickettsial fevers

Question 11

Clinical presentation of typhoid

Answer 11

Prolonged fever
Fatigue, headache +/- cough
Constipation (adults), diarrhea (kids)
Apathy and other neurocognitive findings
Relative bradycardia, leukopenia

Question 12

Treatment for typhoid

Answer 12

Ceftriazone or azithromycin

Question 13

3 things that can kill

Answer 13

Malaria
Typhoid
Some rickettsia