Fever in returning traveller

Question 1

Causes of Fever in returning travller

Answer 1

Malaria (check prophylaxis)
Dengue (rash)
Typhoid
Rickettsia
Bacterial Diarrhoea
UTI
Pneumonia
HIV Seroconversion
Brucella
Viral Haemorrhagic Fevers
(Ebola/lassa fever) etc
Timing is key

Question 2

Typhoid pathogens

Answer 2

Salmonella typhi and paratyphi
Anaerobic Gram -ve bacillus
Enteric fever infecting Peyers patches
Transmitted by food and water

Question 3

Symptoms of typhoid

Answer 3

Fever, headache, abdo pain, diarrhoea or constipation
Rose spots (30%), relative bradycardia (non-specific and

Question 4

Diagnosis of Typhoid

Answer 4

Hx
Blood cultures
Stool

Question 5

Management of Typhoid

Answer 5

IV Fluids
Oral or IV antibiotics
Notifiable disease

Question 6

V severe malaria >2% parasitaemia
48 hr rhythm (tertian)
Blood Film: Young trophozoites (rings) in the absence of mature trophozoites and schizonts. Crescent shaped gametocytes.
Most common esp Africa and Asia

Answer 6

P Falciparum

Question 7

Treatment for P Falciparum

Answer 7

If stable 1 week Quinine then Doxycycline, Clindamycin, Fansidar

Question 8

Chronic liver stage (hypnozites)
48hr rhythm
Blood film: Schuffner’s dots, >20 merozites?schizont

Answer 8

P Vivax

Question 9

Treatment for P Vivax

Answer 9

Cholorquine then primaquine

Question 10

Chronic Liver stage (hypnozites)
48 hr rhythm
Schuffner’s dots

Answer 10

P Ovale

Question 11

P Ovale

Answer 11

Chloroquine then primaquine

Question 12

Benign
72 hr rhythm (Quartan)
Similar mophology to Plasmodium Knowlesi

Answer 12

P Malariae

Question 13

P Falciparum Ix

Answer 13

Thick film - parasitaemia
Thin film - distinguish species
Various antigen test
Bloods: WCC rarely raised, 70% reduced platelets, 50% deranged LFTs, 30% anaemia

Question 14

Signs of P Falciparum

Answer 14

COmmon - fever, splenomegaly, No signs

Uncommon - Focal neurology, Reduced GCS, coma, Shock, Hepatomegaly

Question 15

Symptoms of P Falciparum

Answer 15

Common - Fever + rigors (also from septicaemia)
Flu-like illness
Headache
Back Pain
Myalgia
Nausea + Vomiting

Uncommon - Diarrhoea
Abdominal cramps
Cough
Dark Urine

Question 16

Treatment of P Falciparum

Answer 16

Mild - Quinine + Doxy/Clinda
Or Malarone (Atovoquone/Proguanil
Or Riamet (artmether and lumefantrine)

Severe - Artmesinin combination therapy (ACT)
Or Quinine + Doxy/Clinda

Question 17

Features of complicated P Falciparum

Answer 17

Impaired consciousness of seizures
Renal impairment
Acidosis
ph 2%, Pregnancy, vomiting