Fever in returning traveller

Question 1

Symptoms

Answer 1

Resp: SOB + cough

GI: diarrhoea

CNS: photophobia, headache, meningism and encephalitis

Skin: rash + jaundice

Question 2

What to ask in history:

Answer 2

Where 
When 
What symptoms 
How - Activities 
Unprotected sex

Question 3

Rickettsia symptoms

Answer 3

○ Fever
○ Severe headache
○ Rash
○ Myalgia

Question 4

Brucella epidemiology and how it’s acquired

Answer 4

North America

Drinking unpasteurised milk

Question 5

Conditions

Answer 5

Cytomegalovirus 
Dengue 
HIV 
Meningococcus 
Rickettsia 
Typhoid fever  
Enteric fever

Question 6

Dengue fever location

Answer 6

Dengue - Arbovirus

Location: Africa, Asia and south America

Question 7

Dengue presentation

Answer 7

Asymptomatic
Non specific febrile illness
Lasts 1- 5 days
Improves 3 - 4 days after rash

Question 8

Treatment of Dengue

Answer 8

Supportive

Question 9

Re - infection of dengue

Answer 9

Dengue haemorrhagic fever

Dengue shock syndrome

Question 10

Salmonella typhi organism

Answer 10

Salmonella - enterobacteriaceae
Aerobic
Gram negative rod

Virulence:

• Low infectious dose
• Survives gastric acid
• Fimbriae - adhere to Peyer’s patches
• resides within macrophages - liver, spleen and bone marrow

Question 11

Organism that causes typhoid fever

Answer 11

Salmonella typhi

Question 12

Typhoid fever presentation

Answer 12

Mild diarrhoea
Myalgia
Headache

Severe disseminated disease - multi-organ involvement

Can cause intra-intestinal bleeding and perforation

Question 13

Mode of spread of typhoid fever

Answer 13

Faecal–oral route via contaminated food and water

Question 14

Incubation of typhoid fever

Answer 14

1–3 weeks

Question 15

Paratyphoid fever

Answer 15

Caused by salmonella paratyphi - clinically similar to typhoid fever but y less severe

No vaccine available to prevent paratyphoid infection

Question 16

Tetanus

Answer 16

Clostridium tetani release tetanus toxin

Transport: Tetanus spores are present in soil or manure an dcan spread to human via wounds

Question 17

Symptoms of tetanus

Answer 17

Muscle stiffness - usually involves the jaw (lockjaw) and neck - then becomes generalized

Complications :

• respiratory failure
• convulsions
• bone fractures
• cardiac problems

Question 18

Yellow fever virus and spread

Answer 18

Flavivirus

Spread: spread by the bite of infected mosquitoes

Question 19

Yellow fever symptoms

Answer 19

Fever
Mmalaise
Photophobia
Headache

Severe:

• Sudden onset fever
• vomiting
• prostration
• may progress to jaundice and haemorrhage

Question 20

Treatment of yellow fever

Answer 20

no treatment

Question 21

Enteric fever presentation

Answer 21

Fever 
Headache 
Abdominal discomfort 
Dry Cough 
Relative bradycardia

Question 22

Intubation period of enteric fever

Answer 22

7 - 14 days

Question 23

Complications of enteric fever

Answer 23

Intestinal haemorrhage + perforation

Question 24

Investigations of enteric fever

Answer 24

Basic obs 
Bloods 
- FBC:
 - moderate anaemia 
 - lymphopenia 
- CRP 
- LFTS 
- U+Es

Blood and stool culture

Question 25

Amoebiasis

Answer 25

Caused by: Entamoeba Histolytica

Spread: feaco - oral

Question 26

Presentations of Amoebiasis

Answer 26

Asymptomatic - 90%
Abdominal pain
Blood diarrhoea

Question 27

Complications of Amoebiasis

Answer 27

Ulceration
Bowel perforation
Peritonitis
Liver or lung abscess

Question 28

How to diagnose Amoebiasis

Answer 28

Stool x 3 microscopy - cysts

Serology

Question 29

Treatment of Amoebiasis

Answer 29

Tissue invasion: Metronidazole tds - 10 days

Gut: Paromomycin