Fever in Returning Traveler

Question 1

History taking in returning traveler with fever?

Answer 1

Where did it start?
Where does it hurt?
What makes it worse?
Where are you from and where have you been? And WHEN?!
Activities?
Preventative measures?

Question 2

Initial Lab Tests of patient with fever returning from travels?

Answer 2

Malaria smear
Blood cultures
CBC, ALT, urinalysis, CXR
Others… dengue serology

Question 3

Summarize Malaria

Answer 3

Symptoms - Fever and chills (assume malaria until proven otherwise)
Tests - Blood test is only way to diagnose
Treatment - Nonsevere = Malarone. Severe = IV artesunate

Question 4

Dengue Fever

Answer 4

Symptoms - Fever, Sunburn looking rash
Tests - Serology or PCR
Treatment - Symptomatic
Mosquito Aedes born virus!

Question 5

Two types of worms

Answer 5

Round worm = Ascaris

Long worm = Tape worm

Question 6

TB

Answer 6

Don’t miss TB!
Most important clue to diagnose is EPIDEMIOLOGICAL!
People in some countries of the world are up to 1000 X more likely to get TB than those in Canada! Crazy…

Question 7

High Eosinophils in blood work….

Answer 7

WORMS!

Question 8

Strongyloides:

• Signs
• Symptoms
• Treatments

Answer 8

• Only worm that can reproduce in your body! Can last a LONG TIME!
• Symptoms: Often asymptomatic… may have eosinophils! Can cause hyperinfection with pneumonia, meningitis, etc. With a very high fatality rate! Steroids main factor… SCREEN PATIENTS from tropical countries before giving steroids!
• Tests: Serology! (Eosinophilia), or stool test!
• Treatment: Albendazole

Question 9

Approach to patient with fever who comes in:

Answer 9

• History: Itinerary, temporal pattern, activaties, preventative measures
• Exam Including: Spleen, Rash
• TB high on list for Immigrants/refugees