Fever in returned traveller Flashcards
1
Q
Presentation
A
- Fever
- Diarrhoea/vomitting
- Jaundice
- Lymphadenopathy
- Hepatosplenomegaly
- Resp symptoms
- Rash
2
Q
History for traveller with fever
A
- Travel within last 12 months
- Dates and duration of stay
- Time onset
- Accomodation rural vs urban
- Recreational activities/exposures - lakes, insects
- Type of food and water consumed
- Sexual history
- PMH and predisposition to infection (eg HIV, DM)
3
Q
Infections in traveller 0-10 days after exposure causes
A
- Dengue
- Rickettsia
- Viral (inc mono)
- GI (bacteria/amoeba)
4
Q
Infections 10-21 days post exposure in traveller causes
A
- Malaria
- Typhoid
- Primary HIV
5
Q
More than 21 days since exposure traveller infection causes
A
- Malaria
- Chronic bacterial infections (eg Brucella, coxiella, endocarditis, bone and joint infections)
- TB
- Parasitic infections (helminths/protozoa)
6
Q
Pre-travel immunisations and chemoprophylaxis
A
- Hepatitis A, B
- Typhoid
- Tetanus
- Childhood vaccines (inc MMR)
- Yellow fever and rabies where appropriate
- If travel to malaria areas, malria chemoprophylaxis taken
- Also enquire about protective meassures eg insect repellent, bed nets
7
Q
Clinical examination findings
A
Skin changes
Eye changes
Splenomegaly
Pulse rate slow for fever = typhoid
Neurological changes
8
Q
Investigations
A
- FBC
- LFTs
- U&Es
- Malaria blood films +/- antigen detection dipstick at least 3x over 24hrs
- Blood cultures x2
- Urinalysis +/- culture
- Stool culture +/- stool for ova, cysts and parasites
- CXR
- HIV, HepB&E, syphillis serology
9
Q
Cause of malaria
A
- Blood protozoa plasmodium species that is transmitted by night biting Anopheles mosquitos
10
Q
species of malaria
A
- Plasmodium Falciparum = most serious illness
- 90% originate in Africa
- Other species P.Vivax and P.ovale mostly SE asia
11
Q
Presentation of malaria
A
- Rigors
- High fevers
- Malaise
- Severe headache
- Myalgia
- Vague abdo pain
- N+V
- Diarrhoea
- Jaundice and hepatosplenomegaly
- Bloods - anaemia, thrombocytopaenia, leukopenia, abnormal LFTs
12
Q
What can untreated plasmodium falciparum result in?
A
- Hypoglycaemia
- Renal failure
- Pulmonary oedema
- Neurologic deterioration
- = death
13
Q
Where is typhoid fever common?
A
- SE asia
- Southern and central america
14
Q
Presentation of Typhoid
A
- Fever
- Anorexia
- Malaise
- Vague abdo pain
- Constipation/diarrhoea
- Dry cough
15
Q
Examination of typhoid
A
- Pulse temp disassociation
- Hepatosplenomegaly
- Rose spots
