Fever In Returning Traveller Flashcards
Which travel-acquired infections typically have a short incubation period (onset < 2 weeks)?
Dengue
Chikungunya
Traveller’s diarrhea
Malaria
What is the organism that causes Mediterranean fever (AKA Malta fever)?
Brucellosis
What is the most common method of infection with Brucellosis?
Consumption of unpasteurized dairy products, such as raw milk, soft cheese, etc.
What are the clinical manifestations of Brucellosis (4)?
(1) Constitutional symptoms & fever (sweats can have a strong, mouldy odour)
(2) Arthralgias & Arthritis
(3) Hepatospenomegaly & lyphadenopathy
(4) GU involvement common (orchitis, cystitis)
Which type of malaria may present years later due to hypnoziotes in the liver?
(1) P. Ovale
(2) P. Vivax
What is the purpose of the thick smear look for in the diagnosis of malaria?
The thick smear looks for ANY parasite to make the diagnosis.
What is the purpose of the thin smear in the workup of malaria?
The thin smear identifies the degree of parasitemia (%) and is used to spectate the strain with staining.
What blood smear regimen needs to be sent in the workup for malaria?
Thick and thin blood smears x 3, separated by at least 6 hours over a 24 hour period.
What has the best negative likelihood ratio for ruling out malaria in a returning traveller?
Lack of fever
What physical exam finding has the best + LR for malaria in a returning traveller?
Splenomegaly + LR 6.5
What laboratory value has the highest + LR when you suspect malaria in a returning traveller?
Hyperbilirubinemia + LR 7.3
What are the criteria for severe malaria (8)?
(1) Neurological dysfunction
(2) Resp: ARDS or pulmonary edema
(3) Heme: DIC or severe anemia < 50
(4) Hypoglycemia
(5) Acidosis (pH < 7.25, HCO3 < 15)
(6) Renal Impairment (Cr > 265)
(7) High Lactate
(8) High parasitemia (> 5% in non-immune adults or > 10% in immune)
How would you treat uncomplicated malaria?
Depending on regional sensitivities from site of travel:
(A) Chloroquine
OR
(B) Atovaquone-Proguanil
(C) Quinine PLUS doxycycline
How would you treat a complicated malaria infection?
(1) IV artesunate x 48 hours then:
(A) Atovaquone-proguanil OR
(B) Doxycycline OR
(C) Clindamycin
What are the options for malaria chemoprophylaxis when travelling to an endemic area (3)?
(1) Chloroquine/Hydroxychloroquine when travelling to sensitive areas. Safe in preganancy.
(2) Atovaquone-Proguanil (Malarone)
(3) Doxycycline
What are the classic features of Dengue infection (6)?
(1) < 2 weeks from travel return
(2) Fever
(3) Maculopapular rash
(4) Retro-orbital pain
(5) Myalgias (“break-bone fever”)
(6) Cytopenias
What is the fetal defects are associated with Zika virus (4)?
Microcephaly
Intracranial Calcifications
Retinal & Hearing Abnormalities
Arthrogryposis (Multiple joint contractures)
In which two areas is Zika virus most endemic?
Caribbean
South America
When is testing for Zika virus indicated (2)?
Indicated in a relevant exposure and:
(1) Symptomatic within 3 days of arriving or 14 days of departing a high risk area.
(2) Symptomatic pregnant woman.
NO LONGER recommend screening of asymptomatic pregnant women.
Which medication do you need to avoid in a returning traveller until Dengue is ruled out?
NSAIDs
If a patient decides to travel to a Zika endemic area, what precautions can they take to prevent transmission?
Mosquito transmission, therefore:
Cover up
Light permethrin clothing
DEET
Bed Nets
What precautions are required for a patient admitted with suspected Ebola?
Droplet & Contact
Impermeable neck to tow with N95 and face shield.
