febrile returning traveller

Question 1

what are the top 3 syndromes in returning travellers ?

Answer 1

•	Gastrointestinal 
•	Febrile illness 
o	Come back with fever 
o	But this cannot be localised to one area, hence why it is called febrile illness 
•	Dermatological 
o	Sunburn, sun damage

Question 2

what symptoms would a person with ETEC experience ?

Answer 2

o Anorexia, malaise and abdominal cramps
o Watery diarrhoea (no blood)‏
 Small-bowel predominant
o Fever, nausea and vomiting

Question 3

what are the ‘colitic symptoms’ and which organisms are they associated with ?

Answer 3

blood in stool, going frequently and having tenesmus (have to get to the toilet straight away)

Question 4

which mosquito is known for spreading dengue fever?

When do they bite?

Answer 4

aedes mosquito. Also spreads yellow fever

During the daytime

Question 5

which mosquitos are known for spreading malaria ?

when do they bite?

Answer 5

anopheline mosquito.

Bite from dusk until dawn

Question 6

which antibiotics would you give to a person with traveller’s diarrhoea and who would you treat?

Answer 6

quinolones e.g. ciprofloxacin, azithromycin.

Give to a person with a significant co-morbidity or if they have had the diarrhoea for a prolonged period of time

Question 7

name some methods used to avoid bites

Answer 7

•	Physical avoidance 
o	Indoors
	AC; screens
o	Impregnated netting
	Permethrin – sprayed on the netting to kill any insects that touch it. 
	“tucked in” 
	“mosquito free” 
o	Clothing
	Cover up (arms, legs, ankles, feet)
	Spray/soak clothing
•	Repellent
o	DEET

Question 8

what is the most common malarial parasite?

Answer 8

P. falciparum

Question 9

name some clinical features of malaria

Answer 9

o Fever, malaise, headache, myalgia, diarrhoea etc.
 All of these are non-specific so its important to take the history and test
o Anaemia
o Jaundice
o Renal impairment
 Particularly with falciparum as it makes the red cells sticky leading to clogging up of the blood vessels

Question 10

what are the treatments for malaria ?

Answer 10

o	Artemether compounds e.g. Riamet
	Drops parasite count much quicker 
	Much less side effects 
	Used much more than quinines 
o	Quinine and Doxycycline
	Quinine has lots of side effects e.g. tinnitus

Question 11

name the three main forms of malaria prophylaxis one can take

Answer 11

	Mefloquine
•	Once weekly
•	Psychiatric side effects
•	Has to be taken for 4 weeks after return 
	Doxycicline
•	Daily
•	Has to be taken for 4 weeks after return 
•	Photosensitisation
	Malarone
•	Minimal side effects
•	Cost
•	Only have to take for one week after return

Question 12

what features would someone with typhoid have initially?

Answer 12

	Fever
	Myalgia 
	Headache 
	Cough 
	Abdo pain 
	Constipation 
	Diarrhoea

Question 13

what GI symptoms will you see in typhoid?

Answer 13

o	Diarrhoea v Constipation
	50:50
	Diarrhoea more common in children
o	Abdominal pain
o	Rectal bleeding
o	Bowel perforation
	Hyperplasia Peyer’s patches
	Rare

Question 14

what neurological symptoms will can you see in typhoid?

Answer 14

	Headache (44 to 94%)
	Enteric encephalopathy
•	Altered consciousness/confusion
•	Increased mortality
•	Steroids – reduces inflammatory response and improves outcome

Question 15

how might typhoid be diagnosed?

Answer 15

o	Two most important: 
	Travel history
•	Area visited 
•	Food and drink consumed 
•	? pre-travel vaccination/advice 
	Blood culture 
•	60-80% positive 
•	Important to do even if they don’t have fever 
o	Stool culture 
	30% positive

Question 16

what are the clinical features of Dengue fever?

Answer 16

Commonly referred to as breakbone fever. 
Headache 
Fever 
Retro-orbital pain 
Arthralgia/myalgia 
Rash  
Cough 
Sore throat 
Nausea 
Diarrhoea

Question 17

name some causes of viral haemorrhagic fever

Answer 17

Lassa
Rats in West Africa

Ebola/Marburg
Giant fruit bat

CCHF
Most common viral haemorrhagic fever in the world
Tic is the vector
Makes people bleed so is very infectious

Yellow fever