Fever in the Returned Traveler Flashcards
What is the most important infection to rule out in a febrile traveler who has just returned from the Tropics?
MALARIA
Fever is most commonly seen in patients returning from what region?
Subsaharan Africa
Patients returning from what regions are the following Sx most commonly seen in:
Fever NYD:
Dermatologic Sx:
Acute diarrhea
Chronic diarrhea
Fever NYD: Subsaharan Africa
Dermatologic: Caribbean and South America
Acute Diarrhea: South Asian subcontinent
Chronic Diarrhea: Central America
What are the 5 things you want to know about when approaching diagnosis in a returned traveler?
- Pre-travel prep (vaccines + malaria prophylaxis)
- trip itinerary
- epidemiology and exposure history
- history and physical exam
- lab tests according to differential diagnosis
What 5 vaccines are >90% effective?
What is the one vaccine that is 70% effective only?
> 90%:
- Yellow fever
- hep A
- hep B
- meningococcal meningitis
- Japanese encephalitis
70%:
-Typhoid
What conditions have a short incubation period (21 days)?
Short:
- Dengue (3-5 d)***
- Typhus
- bacterial enteritis
- typhoid
- HIV
- SARS
Long:
- MALARIA*** (3 wks)
- viral hepatitis
- tuberculosis
- schistosomiasis
If a patient returns from the Tropics and has been back for >7 days and has fever what can we rule out?
Dengue
3-5d incubation period
What are examples for infections resulting from the following exposures:
- Freshwater wading, flooding
- Animal bites
- sexual contact
- unpasteurized dairy
- Freshwater wading (Schistosomiasis, leptospirosis)
- Insect bites: Malaria, dengue, rickettsiosis
- Animal bites: Rabies, Herpes B
- Sexual contact: HIV, syphilis, other STIs
- Unpasteurized dairy: Brucellosis, tick-borne, encephalitis
What are the 5 main infections seen after tropical travel?
- MALARIA
- Dengue fever
- Rickettsiosis
- Typhoid
- Mononucleosis
Where do most patients diagnosed with Malaria return from?
Subsaharan Africa
Where is most Typhoid from?
Indian subcontinent
Where is most Dengue from?
Caribbean and South East Asia
Fever from the tropics is _________ until proven otherwise?
Malaria
What mosquito transmits Plasmodium spp ?
the night-biting Anopheles mosquito
What are the two most common Malaria species (these 2 kill)?
- falciparum (presents soon- KILLER)
2. vivax
What regions are falciparum and vivax milaria from?
- falciparum: Africa
- vivax: Asia
What are the thick and thin blood films used in Malaria helpful for in diagnosis?
- thick: sensitive, est. diagnosis
- thin: specific, for species identification
What are the main Malaria treatments?
- *Malarone: atovaquone, proguanil (for uncomplicated malaria)
- Chloroquine (non-falciparum spp, and facliparum spp. from chloroquine sensitive areas)
- Artesunate (IV–> severe malaria, falciparum usually)
What causes Dnegue?
Flavivrus (from day-biting Aedes mosquitoes)
Where is Dengue from usually?
Caribbean and SE Asia
What is the incubation period of Dengue?
3-5 days
What are the Sx of Dengue?
Fever, Headache (retroorbital pain), muscle and joint pain (50%)= break-bone fever, nausea/vomiting, rash, hemorrhagic manifestations
What is the most concerning complication of Dengue?
Hemorrhagic shock!
severe manifestations usually seen in locals, while travelers have febrile illness
How is Dengue diagnosed?
-leukopenia, thrombocytopenia
- inc IgM, 4x inc in IgG
- PCR testing
How is Dengue treated?
- fluid and electrolyte balance
- antipyretics
- avoid salicylates and NSAIDS
What causes Typhoid?
-Salmonella Typhi (bacterial infx, GN Bacillus )
How is Typhoid transmitted?
fecal-oral transmission
Where is Typhoid most commonly from?
South Asian peninsula (India)
What is often the only Sx of Typhoid?
Fever
How is Typhoid diagnosed?
blood culture: GRAM NEGATIVE ROD (BACILLUS)
What are the Rx for Typhoid?
- 1st line: Ceftriaxone (IV)
- Azithromycin or Cefixime PO
- AVOID FLUOROQUINOLONES- resistant in S. Asia
What causes Rickettsiosis (Tick bite fever)?
R. africae, R.conorii from tick
Where is Ricketssiosis mostly frmo?
S Africa, India, Mediterranean
What are the Sx of Rickettsios?
fever, regional adenopathy, rash, tache noire (eschar)…self limited over 1-2 wks…mild illness usually
What is the hallmark of someone returning from African Safari with Rickettsiosis?
TACHE NOIRE= ESCHAR
What are the tests performed/run for undifferentiated fever?
- CBC (low plts=malaria, low wbc=dengue/typhoid)
- Thick and thin blood films (malaria)
- Blood cultures (typhoid, other)
- Liver enzymes (viral hep, dengue)
- Urinalysis (UTI)
- Chest x-ray (Pneumonia)
- Serology (dengue, ATBF)
What causes the following:
- S. Asia trip, fever, GN Bacillus/bacteremia?
- S Africa travel, cigarette burn lesion
- Caribbean, SE Asia, fever within 3 days return, sore mm., better quick?
- Typhoid
- Rickettsia/ATBF
- Dengue
