Fever in the Returning Traveller

Question 1

Which conditions should you exclude in a fever in a returning traveller?

Answer 1

1. HIV in all

2. Malaria in those returning from tropics

Question 2

What is this a presentation of?
Fatigue, headache, anorexia. Marked fever, ‘stepwise’. Abdominal pain, bradycardia, cough, constipation. Diarrhoea and splenomegaly. Traveller returned from India/Pakistan/Bangladesh.

Answer 2

Enteric fever - typhoid and paratyphoid

Question 3

How is enteric fever (typhoid and paratyphoid) diagnosed and treated?

Answer 3

1. Isolation of salmonella typhi from blood.

2. Azithromycin + IV ceftriaxone

Question 4

What is this a presentation of?
Fever up to 40, N&V, headache, myalgia, arthralgia, petechiae arise on tourniquet use. Abdominal pain, mucosal bleeding, hepatomegaly, shock, severe bleeding, liver failure.

Answer 4

Dengue fever (virus)

Question 5

How is dengue fever diagnosed and treated?

Answer 5

1. PCR during viraemia (1st 5d of fever), serology after 5d
2. Low plt, WCC, raised ALT/AST, low GCS.
3. Treat with supportive fluid management.

Question 6

What is this a presentation of?

Fever, headache, myalgia, anorexia, N&V, bradycardia, abdominal pain, jaundice, AKI.

Answer 6

Yellow fever

Question 7

How is yellow fever diagnosed and treated?

Answer 7

1. Clinical and travel history, PCR in 1st 3d, serology after.
2. Supportive treatment, live vaccine effective for life.