Fever in a returned traveller - Typhoid, paratyphoid, Malaria

Question 1

Typhoid + paratyphoid

• epid
• organism

Answer 1

• children and young adults
• South Central Asia (brown), southern Africa
• due to lack of sanitation, overcrowding etc

salmonella typhi, salmonella paratyphi

Question 2

Typhoid

Clinical features, week 1-3

Answer 2

Week 1 - worsening fever, chils
Week 2 - abdo pain, rose spots (salmon rash)
Week 3 - hepatosplenomegaly, intestinal bleeding, perforation –>septic shock

Question 3

Typhoid dx

Answer 3

Stool/blood culture

Question 4

Typhoid rx

Answer 4

Azith or cipro

Question 5

Malaria

• parasite
• transmission

Answer 5

Plasmodium falciparum (most severe form), P. vivax, P. ovale (cause relapsing disease), P. malariae, P. knowlesi

Anopheles mosquito

Question 6

Malaria

Life cycle - brief

Answer 6

1. Anopheles mosquito bites –>transmits sporoxites into blood
2. Go to liver
3. In P viva and oval will remain dormant
4. Schizonts rupture–>release merozoites –>invade RBC
5. Mosquito bites infected person –>t/f to another person

Question 7

Malaria
Clinical features

Dx

Answer 7

• fever (wax and wane)
• palpable spleen, jaundice
• non specific sx - reduced GCD, convulsions, bleeding, shock, anaemia, AKI etc

-blood film, thick + thin x3 sets 12-24 hours apart

Question 8

Malaria

Treatment

Answer 8

1. Uncomplicated - artemesin combination therapy (ACT) or chloroquine (depending on region susceptibility
2. Re-infection or treatment failure –> ACT
3. P vivax –>eradication therapy with primaquine (MUST have normal G6PD function)
4. Severe –> IV artesunate –> oral ACT post
5. Add Cef 2g daily if bacteraemic

Question 9

Primaquine contraindication

Answer 9

G6PD deficiency –> haemolytic anaemia

Question 10

Malaria eradication therapy

Answer 10

Primaquine

Question 11

Severe malaria treatment

Answer 11

IV artesunate –> oral when well

Question 12

Liver abscess organism

Answer 12

Klebsiella

Entamoeba histolytica

Question 13

Loeffler syndrome

Answer 13

1. Secondary to rounfworm larvae - Ascaria, hookworms, strongyloides
2. P/w resp symptoms - CXR - migratory bilateral round infiltrates + eosinophilia
3. Dx - larvae in resp secretions or gastric aspirates
4. Very sensitive to pred

Question 14

Legionnaire’s

Answer 14

cruise ships/hotels/conference
caused by legionella
p/w fever, resp symptoms, headache, myalgia