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Microbiology > Fever In The Returning Traveller > Flashcards

Fever In The Returning Traveller Flashcards

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1
Q

What are the least common dx for imported fever?

A

Resp infection

UTI

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2
Q

What are the remaining dx for imported fever?

A 
Diarrhoeal disease non typhoid 
Enteric fever typhoid 
Dengue fever 
Hep 
TB 
HIV seroconversion
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3
Q

What are the important questions to ask in evaluating imported fever?

A

What infections are possible given exposure?
Which infections are more probable given clinical findings?
Which infections are treatable or transmissible?

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4
Q

What should be asked in a travel history?

A 
Where did you go?
When did you go and come back?
When did the symptoms begin?
Urban or rural areas?
What was the purpose of your travel?
What pre travel vaccines/malaria prophylaxis did you take?
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5
Q

What pre travel advice can be included?

A

Vaccines- hep B, hep a
Yellow fever, Japanese b encephalitis can cross react with other Flaviviral serology
Meningitis hajj/ Africa A/C/W135
Typhoid vaccine not completely protective
Remember measles, rubella, diphtheria, pertussis, polio, tetanus
Malaria- no prophylaxis 100% effective

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6
Q

What diseases have an incubation period of longer than 3 weeks?

A 
Hepatitis 
HIV 
Typhoid 
TB
Malaria, schistoma, amoebic liver abcess, filaria
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7
Q

Which diseases have an incubation period from 10-21 days?

A 
Malaria
Enteric fever
Rickettsia 
Brucella 
Leptospirosis 
VHF if in endemic area
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8
Q

Which diseases have an incubation period of less than 10 days?

A 
Enteric fever
Dengue
Chikungunya
Influenza 
Typhus
VHF
Malaria
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9
Q

What diesease is likely with fever, rash and LNs?

A

Rickettsia

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10
Q

What disease is likely with bites and rashes from animals?

A

Rabies

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11
Q

What diseases are likely from water exposure?

A

Leptospirosis

Schistsomiasis

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12
Q

What diseases are likely from sexual contact?

A

HIV
Syphilus
STI

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13
Q

What diseases are likely from food, meat milk cheese?

A

Brucellosis
E. coli
Toxoplasmosis
Raw fish- paragonimiasis

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14
Q

What diseases are likely from animals?

A

Avian flu
MERs cov
VHF

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15
Q

What diseases are likely from contact with sick people or funeral visit?

A

Flu
MERs
VHF

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16
Q

What is VHF?

A

Highly infectious, high mortality
Incubation period less than 21 days
Haemorrhage not always present eg Ebola virus disease
Non vaccines

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17
Q

What are the risk factors for VHF?

A 
Unexplained deaths in region
Traditional funeral rites 
Bush meat 
Cave exploration 
Healthcare workers
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18
Q

What is the fever pattern with dengue?

A

saddle back

2 temps, with a febrile 1-3 days in between

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19
Q

What are the fever patterns with malaria?

A

48 hours- p falciparum, vivax, ovale

72 hours- malariae

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20
Q

What should be particularly noted in a clinical exam?

A 
Rash
Jaundice 
LNs 
Hepatosplenomegaly 
Eschar 
Haemorrhage
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21
Q

What are the initial ix?

A 
Blood films- malaria and antigen tests
Blood cultures 
Serology for HIV, hepatitis
Imported fever service at RIPL, porton down (arbovirus, flavivirus, rickettsia) 
FBC, UE, LFT, CRP 
Resp samples isolate 
Radiology
22
Q

What diseases commonly present with systemic febrile illness?

A

Malaria
Dengue
Typhoid

23
Q

What diseases commonly present with diarrhoea?

A

Usually self limiting but if prolonged, giardiasis

24
Q

What diseases commonly present with skin complaints?

A

Rickettsia
Arbovirus
Cutaneous larva migrans

25
Q

What diseases commonly present with resp illness?

A

Influenza H5N1 H7N9

Mers

26
Q

What percentage of fevers have no cause identified?

A

25%

27
Q

How is malaria transmitted?

A

Bites of anopheles mosquito

28
Q

What are the 5 types of malaria?

A

Falciparum- can cause severe malaria, more than 1 million death pa, 3-4000000 infected
Ovale and vivax- can cause relapsing malaria
Malariae
Knowelsi- Borneo, severe and rapidly fatal disease

29
Q

What are the risk factors for malaria?

A 
Travel 
Rural more than urban 
Low standard of sleeping accommodation 
Lack of preventative measures
Long duration of stay
30
Q

What is the incidence of malaria?

A

UK imported- 2000 a year 75% falciparum
Africa- more than 90% falciparum
200-300 cases of severe malaria in UK, mortality up to 8 %
Resistance to chloroquine of falciparum almost universal

31
Q

What are the clinical features of malaria?

A

7 days-3 months post exposure

Fevers, myalgia, headache, shivers/rigours, GI tract problems

32
Q

What details are need for malaria film?

A

thick and thin
Takes at least 1 hour to perform and interpret
At least 3 negative films over 48 hours, malaria unlikely
Need parasite count and stage to assess severity

33
Q

What is needed for the antigen malaria test?

A

Rapid, simple to perform and interpret
10-100 times less sensitive than thick film in best hands
May be positive in previously treated malaria
PCR most sensitive but not routinely available

34
Q

What is the sequlae for falciparum?

A

Mild- parastaemia, no schizonts
Temp- less than 39 degrees
No complications
Severe- parastaemia, schizonts, non ambulant,
Complications- shock, renal failure, pulmonary oedema, severe anaemia (Hb

35
Q

What is the treatment for uncomplicated falciparum?

A

Quinine 600 mg tds po plus doxycycline 100 mg od po 7 days or clinda 450 mg tds if pregnant

36
Q

What are the adverse effects of standard malaria medication?

A

Nausea, deafness, tinnitus
Complete 7 days of rx
Monitor blood glucose

37
Q

What are the alternative regimes of malaria treatment?

A

Riamet- 4 tabs at 0, 8,24,36, 48, 60 hours

Malarone- 4 tabs od for 3 days

38
Q

What is the treatment for severe falciparum?

A

IV quinine 20mg/kg over 4 hours loading dose (omit if taking oral quinine derivative (chloroquine, mefloquine)
10mg/kg IV tds to follow
Arrhythmogenic and causes hypoglycaemia
Cardiac and BM monitoring mandatory

39
Q

What is artemisinins?

A

Derived from plants
Used by Chinese herbalists for more than 2000 years
Synthetic derivatives: artesunate water soluble, artemether lipid soluble
Highly effective antimalarials with rapid parasite clearance
Recommended in combo with other drugs

40
Q

What are the benefits of IV artesunate?

A

More effective and better tolerated than quinine
Effective against parasite ring forms, faster reduction in parastaemia
Potentially reduces sequestration
Benefit greater with higher parasite load
Recommended as 1st line for severe malaria, not licensed in UK

41
Q

How is non falciparum treated?

A

Chloroquine effective
For vivax and ovale give primaquine to eradicate hypnozoites
Check g6pd level before giving primaquine and it is contraindicated in pregnancy and breastfeeding

42
Q

What is the ABCD of malaria prevention?

A

Awareness of risk
Bite prevention
Chemo prophylaxis
Diagnose promptly

43
Q

What is enteric fever caused by?

A 
Salmonella typhi, paratyphi
Gram negative bacilli, acid tolerant 
Spread by contaminated food, water, unsanitary conditions 
No animal reservoir 
Incubation period- 7-14 days
44
Q

What are the symptoms of enteric fever?

A 
Fever, stepwise 
Relative bradycardia 
Abdominal pain and colic 
Constipation 
Cough
Rose spots 
Leukopenia, borderline thrombocytopenia 
Mild transamintis chronic carriage important for spread and persistance
45
Q

What are the ix for typhoid?

A 
Isolate patient
Blood and stool cultures 
Inform lab of risk 
Stool culture positive in 90% in 1st week of illness 
More than 3 blood cultures
Bone marrow and aspirate most sensitive
46
Q

What is the mx for typhoid?

A

Start IV ceft and gentamicin if shocked
Discuss with id
Notify public health

47
Q

What is dengue fever?

A

Transmitted by aedes aegyptii and aedes albopictus Mosquitos
Day time biting and prevalent in urban areas
Short incubation 1 week
Myalgia, break one fever, retro orbital pain
Sunburn like rash

48
Q

What is the clinical course for dengue?

A

Defevescence around day 4-5

Complications may also develop at this time

49
Q

What is the management for dengue fever?

A

Exclude malaria
Serology for dengue fever plus or minus PCR
Generally uncomplicated, supportive rx
Refer to infection specialist

50
Q

What is the most common dx for imported fever?

A

Malaria

Microbiology (15 decks)

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