Fever in returned traveller

Question 1

Lifecycle of Malaria

Answer 1

Anopheline mosquito –> human

• -> Sporozoites in blood
• -> Sporozoites in the liver
• -> multiply in hepatocytes
• -> hepatocytes burst releasing merozoites into circulation
• -> merozoites infect RBCs
• -> Asexual division into schizonts
• -> release of daughter merozoites when RBCs burst

Question 2

Features of P. falciparium

Answer 2

Incubation 7-28 days
Multiple infected RBCs on blood film
Causes adhesion of RBCs to endothelium --> organ dysfunction
Cerebral malaria
Renal failure

Question 3

Features of P. Malariae

Answer 3

Persistant - difficult to treat

Question 4

Features of P. Vivax

Answer 4

Dormant liver stages = needs primaquine treatment

Question 5

Chemoprophylaxis for malaria?

Answer 5

Chloroquine sensitive = chloroquine

Chloroquine resistant = Doxycycline

Question 6

Treatment of malaria?

Answer 6

Uncomplicated PF:
- Artemether and lumefantrine
Severe PF:
- Artesunate or quinine IV

PV, PM or PO = chloroquine and primaquine

Question 7

Features of Typhoid?

Answer 7

S. Typhi and Paratyphi
Faecal-oral transmission - water bourne

Fever, abdominal pain, hepatosplenomegaly, neuropsychiatric changes, bradycardia, rose spots

Question 8

Complications of Typhoid?

Answer 8

GIT perforation
Endocarditis and pericarditis
Splenic or liver abscess
Endovascular
Chronic carriage --> carcinoma of gallbladder

Question 9

Treatment of typhoid?

Answer 9

Africa = Ciprofloxicin
Asia = Ceftriaxone and azithromycin

Question 10

Features of Dengue fever?

Answer 10

Aedes aegyptii mosquito

Fever, severe headache, MSK pain, rash
Leukopenia, neutropenia, thrombocytopenia

Question 11

Complications of dengue fever?

Answer 11

Dengue haemorrhagic fever

Dengue shock syndrome

Question 12

Treatment of dengue?

Answer 12

Supportive

Question 13

Features of Amoebiasis?

Answer 13

Entamoeba Histolytica
Ingestion –> excystation in SI –> trophozoite –> infection of LI

GIT = Dysentery, colitis, perforation, megacolon
Extra GIT = Liver abscess, lung abscess, brain abscess, GU disease

Question 14

Treatment of Amoebiasis?

Answer 14

Metronidazole

Question 15

Features and treatment of hepatitis A

Answer 15

Acute self limiting hepatitis
Faecal-oral transmission
Highly contagious

Supportive treatment
Vaccination

Question 16

Common causes of acute diarrhoea in travellers?

Answer 16

E. coli
Shigella
Salmonella
Campylobacter jejuni
Vibrio
Entamoeba
Crypto
Viruses

Question 17

Most common cause of chronic diarrhea in returned travellers?

Answer 17

Giardia Lamblia

Question 18

Treatment of travellers diarrhoea?

Answer 18

Azithromycin 1gm or norfloxacin 800mg

Loperamide

Question 19

Features of Ebola?

Answer 19

Virus - filovirus family

70% mortality
Transmission from infected bodily fluids
Supportive management

Question 20

Features of Zika virus?

Answer 20

Flavivirus
Mosquito bourne transmission, sexual transmission and vertical transmission

In children - mild illness
Adults = Acute febrile illness - fevers, rash, arthragias, CONJUNCTIVITIS
Fetal = microcephaly

Treatment = supportive

Question 21

Vaccinations for travellers?

Answer 21

ADT
HBV
HAV
Meningococcal
Polio
Typhoid
Cholera
Yellow fever
Japanese B encephalitis
Rabies