Fever in the Returning Traveler Flashcards
What is the pathophysiology of enteric fever/typhoid?
Caused by salmonella typhi and salmonella paratyphi.
Transmitted via faecal-oral route
What are the symptoms of Enteric fever/typhoid?
- Systemic upset: headaches, fever, arthralgia,
- Dry cough
- Bradycardia,
- Abdominal pain and distention,
- Constipation
- Rose spots (on trunk)
What are the possible complications of thyphoid/enteric fever?
- Osteomyelitis (especially in sickle cell where salmonella is one of the most common pathogens)
- GI bleeding/perforation
- Meningitis
- Cholecystisis
- Chronic carriage
What are the investigations for enteric fever?
- Blood culture
- Stool culture (less sensitive)
- Serology (least sensitive)
What is the treatment of enteric fever/thyphoid?
Ceftriaxone or azithromycin
Describe features of dengue fever
- Virus transmitted by mosquitoes. Incubation of 7 days
- Can be classified as dengue fever with/without warning signs or severe dengue fever
What are the signs and symptoms of dengue fever?
- Fever,
- headache, often retro-peritoneal,
- Myalgia, bone pain (bone-break fever),
- Pleuritic pain,
- Facial flushing,
- Maculopapular rash,
- Haemorrhagic manifestations,
- Warning signs - abdominal pain, hepatomegaly, persistent vomiting, fluid accumulation
What are signs of severe dengue?
- DIC, resulting in thrombocytopenia or spontaneous bleeding
- Can go on to develop dengue shock syndrome
What are the investigations for dengue fever?
- Bloods show leukopenia, thrombocytopenia and raised aminotransferases
- Diagnostic tests are serology, nucleic acid amplification and NS1 antigen testing
What is the treatment for dengue fever?
- Symptomatic treatment as they are no antivirals available
What is yellow fever?
Type of viral haemorrhagic fever spread by mosquitoes.
Presents with sudden onset high fever, rigors, nausea, then jaundice, haematemesis and oliguria
Name some other examples of viral haemorrhagic fever
- Lassa: contact with rats,
- Ebolla
- Crimean-congo fever
- South american HF,
- Rift valley fever
What is the presentation of viral haemorrhagic fever?
21 day incubation period
Followed by non specific febril illness
Haemorrhagic manifestations
Followed by sepsis then death
What are the most causes of fever in the following countries:
* Sub-saharan Africa
* South Central Asia
* Southeast Asia
Sub-Saharan Africa - P. falciparum
South Central Asia - Enteric Fever
Southeast Asia - Dengue
What is Shistosomiasis and its presentation
Parasitic infection which presents with swimmer’s itch followed by acute shcistosomiasis syndrome:
- Fever
- Urticaria
- Arthralgia,
- Cough,
- Diarrhoea,
- Eosinophilia.
It can then lead to bladder symptoms
