Fever in Returned Traveller Flashcards
Main diagnosis of people coming back with fever?
Malaria
It represents about 70% of tropical infections
Main cause of fever if travelled to SS Africa
To Latin America?
To Asia?
Malaria
Leptospirosis for Latin America
Dengue for SE Asia
Pattern of fever helpful?
Continuous fever: malaria, Enteric fever, P knowelsi
Biphasic (saddleback)- Dengue, YF and Leptospirosis
What are the rule in signs?
Eschar: Rickettsiosis
Chancre: Syphillis, trypanosomiasis
Rose spot: Enteric fever
Symmetrical arthritis: Chicunguyna
Conjunctival suffusion: Leptospirosis
Rash and conjunctivitis: Zika
Rash (White island, dead sea): Dengue
Anosmia: COVID-19
Who are special groups of travellers?
Paeds (increased risk of diarrhoea and animal bites)
Elderly
Immunocompromised
Pregnant woman
Expats
VFR (often do not attend pre-travel consultation, local posture more important, more at risk of vaccine preventable infections)
When is initial screening in a person with fever as a returned traveller?
If any signs of severity including haemorrhagic conditions
qSOFA score >2
Transmissable infection?
Rpaidly progressive?
Severe malaria?
What should be included in your initial work up?
Blood cultures
Malaria tests
STI checks
Keep an acute serum
PCR resp viruses
Stool culture if you suspect Enteric fever
Empirical treatment for
-Bacterial sepsis
-P Falciparum
-Meloidosis
-Rickettsiosis
-Broad spec abx
-Artesunate
-carbapenem or ceftazidime
-doxycycline
Malaria back from endemic Country with undifferentiated fever
P Falciparum
Trip to India/Nepal/Pakistan/Bangladesh with high fever, Brady, abdo pain
Enteric fever
Fresh water exposure in Lake Malawi with fever, eosinophil and hepatomegaly
Schistosomiasis
Mosquito bite in urban area in tropical country with fever, headache, myalgia, retro orbital pai, Rash and thrombocytopenia
Dengue
Rafting in Thailand presents with fever, myalgia and Conjunctival icterus
Leptospirosis
European holiday trekking in woods presents with fever and confusion
Tick born encephalitis
Trip to South Africa, on safari
Rickettsiosis (tick borne)