Fever in the Returned Traveler Flashcards

1
Q

What is the most important infection to rule out in a febrile traveler who has just returned from the Tropics?

A

MALARIA

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2
Q

Fever is most commonly seen in patients returning from what region?

A

Subsaharan Africa

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3
Q

Patients returning from what regions are the following Sx most commonly seen in:

Fever NYD:

Dermatologic Sx:

Acute diarrhea

Chronic diarrhea

A

Fever NYD: Subsaharan Africa

Dermatologic: Caribbean and South America

Acute Diarrhea: South Asian subcontinent

Chronic Diarrhea: Central America

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4
Q

What are the 5 things you want to know about when approaching diagnosis in a returned traveler?

A
  1. Pre-travel prep (vaccines + malaria prophylaxis)
  2. trip itinerary
  3. epidemiology and exposure history
  4. history and physical exam
  5. lab tests according to differential diagnosis
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5
Q

What 5 vaccines are >90% effective?

What is the one vaccine that is 70% effective only?

A

> 90%:

  • Yellow fever
  • hep A
  • hep B
  • meningococcal meningitis
  • Japanese encephalitis

70%:
-Typhoid

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6
Q

What conditions have a short incubation period (21 days)?

A

Short:

  • Dengue (3-5 d)***
  • Typhus
  • bacterial enteritis
  • typhoid
  • HIV
  • SARS

Long:

  • MALARIA*** (3 wks)
  • viral hepatitis
  • tuberculosis
  • schistosomiasis
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7
Q

If a patient returns from the Tropics and has been back for >7 days and has fever what can we rule out?

A

Dengue

3-5d incubation period

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8
Q

What are examples for infections resulting from the following exposures:

  • Freshwater wading, flooding
  • Animal bites
  • sexual contact
  • unpasteurized dairy
A
  • 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
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9
Q

What are the 5 main infections seen after tropical travel?

A
  • MALARIA
  • Dengue fever
  • Rickettsiosis
  • Typhoid
  • Mononucleosis
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10
Q

Where do most patients diagnosed with Malaria return from?

A

Subsaharan Africa

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11
Q

Where is most Typhoid from?

A

Indian subcontinent

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12
Q

Where is most Dengue from?

A

Caribbean and South East Asia

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13
Q

Fever from the tropics is _________ until proven otherwise?

A

Malaria

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14
Q

What mosquito transmits Plasmodium spp ?

A

the night-biting Anopheles mosquito

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15
Q

What are the two most common Malaria species (these 2 kill)?

A
  1. falciparum (presents soon- KILLER)

2. vivax

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16
Q

What regions are falciparum and vivax milaria from?

A
  • falciparum: Africa

- vivax: Asia

17
Q

What are the thick and thin blood films used in Malaria helpful for in diagnosis?

A
  • thick: sensitive, est. diagnosis

- thin: specific, for species identification

18
Q

What are the main Malaria treatments?

A
  1. *Malarone: atovaquone, proguanil (for uncomplicated malaria)
  2. Chloroquine (non-falciparum spp, and facliparum spp. from chloroquine sensitive areas)
  3. Artesunate (IV–> severe malaria, falciparum usually)
19
Q

What causes Dnegue?

A

Flavivrus (from day-biting Aedes mosquitoes)

20
Q

Where is Dengue from usually?

A

Caribbean and SE Asia

21
Q

What is the incubation period of Dengue?

A

3-5 days

22
Q

What are the Sx of Dengue?

A

Fever, Headache (retroorbital pain), muscle and joint pain (50%)= break-bone fever, nausea/vomiting, rash, hemorrhagic manifestations

23
Q

What is the most concerning complication of Dengue?

A

Hemorrhagic shock!

severe manifestations usually seen in locals, while travelers have febrile illness

24
Q

How is Dengue diagnosed?

A

-leukopenia, thrombocytopenia

  • inc IgM, 4x inc in IgG
  • PCR testing
25
Q

How is Dengue treated?

A
  • fluid and electrolyte balance
  • antipyretics
  • avoid salicylates and NSAIDS
26
Q

What causes Typhoid?

A

-Salmonella Typhi (bacterial infx, GN Bacillus )

27
Q

How is Typhoid transmitted?

A

fecal-oral transmission

28
Q

Where is Typhoid most commonly from?

A

South Asian peninsula (India)

29
Q

What is often the only Sx of Typhoid?

A

Fever

30
Q

How is Typhoid diagnosed?

A

blood culture: GRAM NEGATIVE ROD (BACILLUS)

31
Q

What are the Rx for Typhoid?

A
  • 1st line: Ceftriaxone (IV)
  • Azithromycin or Cefixime PO
  • AVOID FLUOROQUINOLONES- resistant in S. Asia
32
Q

What causes Rickettsiosis (Tick bite fever)?

A

R. africae, R.conorii from tick

33
Q

Where is Ricketssiosis mostly frmo?

A

S Africa, India, Mediterranean

34
Q

What are the Sx of Rickettsios?

A

fever, regional adenopathy, rash, tache noire (eschar)…self limited over 1-2 wks…mild illness usually

35
Q

What is the hallmark of someone returning from African Safari with Rickettsiosis?

A

TACHE NOIRE= ESCHAR

36
Q

What are the tests performed/run for undifferentiated fever?

A
  • 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)
37
Q

What causes the following:

  1. S. Asia trip, fever, GN Bacillus/bacteremia?
  2. S Africa travel, cigarette burn lesion
  3. Caribbean, SE Asia, fever within 3 days return, sore mm., better quick?
A
  1. Typhoid
  2. Rickettsia/ATBF
  3. Dengue