Fever in the returning traveller Flashcards
What is the aim of the travel history?
To assess an individual’s risk of having acquired a specific infection i.e. to determine specific exposures/contacts depending on the geographical history.
What is important to note in the travel history?
The time of onset and duration of symptoms
When do most tropical infections become symptomatic?
Within 21 days of exposure
When do the majority of tropical infections present?
Within one month of leaving endemic areas
How many travellers report illness?
Almost 2/3
How many % of travellers will seek medical attention? How many of these require hospital admission?
8%
11%
How many present with fever? How many of these require hospital admission?
28%
26%
What are some of the most common causes of fever in the returning traveller?
Unspecified febrile illness
Malaria
Acute diarrhoeal illness
Don’t forget… as they are common.
non-tropical infections & non-infectious
causes
What to ask in the travel history? (6)
Where? - exact location & setting, e.g. rural, urban
When? - exact dates of travel, season e.g rainy
Why? - visiting family vs tourist
What? (exposures) - recreational, occupational (e.g. healthcare), cultural (e.g. burials), dietary, illness
Who? - travel companions, unwell contacts, sexual contacts
Preventative Measures/empiric therapy - vaccination (can affect serology results), malaria prophylaxis, compliance
Sub-Saharan Africa - name some diseases that can cause fever in the returning traveller? (6)
Malaria Dengue / Chikungunya Rickettsiae Enteric Fever (Typhoid) HIV/seroconversion illness Viral haemorrhagic fever (Lassa, Ebola, Marburg, Crimean-Congo HF)
What can cause fever in HIV/seroconversion illness patients?
OPPORTUNISTIC INFECTION
Epidemiology of VHF.
VERY RARE
Briefly discuss Lassa fever.
ENDEMIC, present in rodents, 20% of exposed become infected/develop symptoms, rural, not big outbreaks.
Consider VHF if…
Fever AND visited endemic area < 21 d
High possibility of VHF if any:
• Contact with / care for febrile person (>4h)
• Health care / laboratory / vet work
• Contact with confirmed cases / outbreak /
animals
• Shock, organ failure, haemorrhage
Briefly discuss ebola.
EPIDEMIC, 80% exposed develop symptoms
What is CCHF transmitted by?
Ticks
Initial management of VHF.
- Malaria film, clotted blood, EDTA blood
- Isolation / PPE / Infection control
- Discuss with Infectious Diseases / Micro
- Virologist, CCDC (Public Health)
- VHF PCR
- Keep a list of contacts who may need following up
Guidance: Advisory Committee for Dangerous Pathogens, Management of Hazard Group 4 viral
haemorrhagic fevers and similar human infectious
diseases of high consequence
What infection control precautions if a patient is ambulatory/self-caring/controlled body fluids?
Standard plus droplet precautions required:
- Hand hygiene
- Gloves
- Gown
- Fluid repellent surgical facemask
For aerosol or splash-inducing procedures:
- FFP3 respirator
- Eye protection
What infection control precautions if a patient is bruising, bleeding, uncontrolled vomiting or diarrhoea…
Standard plus droplet plus splash plus aerosol: Double gloves Fluid repellent disposable gown FFP3 respirator Eye protection
South and Central Asia - name some diseases that can cause fever in the returning traveller? (5)
Dengue Enteric Fever Malaria Chikungunya Tuberculosis
South East Asia - name some diseases that can cause fever in the returning traveller? (4)
Dengue
Enteric Fever
Chikungunya
Malaria
Latin America and Caribbean - name some diseases that can cause fever in the returning traveller? (3)
Dengue / Chik / Zika
Enteric Fever
Malaria
Plus fungal infections e.g. brucellosis, coccidioidomycosis, histoplasmosis
What illnesses have short incubation periods (<10 days)?
Bacterial / viral gastroenteritis
Dengue, Chik, Zika
Resp tract infection, UTI, meningitis,
Rickettsia
What illnesses have medium incubation periods (10-21 days)?
Malaria, Typhoid, Rickettsia, EBV, CMV, HIV, Leptospirosis, VHF, Trypanosomiasis Endemic fungi (histoplasmosis)
What illnesses have long incubation periods (>21 days)?
Malaria, HIV, Hepatitis A-E, TB Acute schistosomiasis, Amoebic liver abscess, Brucellosis, Visceral Leishmaniasis, Trypanosomiasis
Who is more at risk of getting some infections (malaria, typhoid, tuberculosis, hep A and sexually-transmitted infections incl. HIV) - tourists or people visiting friends and relatives in developing countries?
Why?
People visiting friends and relatives in developing countries
Less likely to seek pre-travel advice, occupational hazards, less likely to seek advice/take prophylaxis
A patient has returned from Sub-Saharan Africa. He has a history of swimming in fresh/brackish water 2-12 weeks ago. On examination, he has “swimmer’s itch”. On his lab results, he has a raised eosinophil count.
What is the diagnosis?
Acute Schistosomiasis
A patient has returned from South East Asia. He has a history of swimming/rafting in fresh water less than 4 weeks ago. On examination, he appears jaundiced and has conjunctival suffusion. On lab results, it shows liver/renal impairment.
What is the diagnosis?
Leptospirosis
A man has recently returned from a game park in Southern Africa, where he was bitten by a tick. He reports a headache. On examination, you notice he has a fever, also eschar (dry dark scab) and a maculopapular rash.
What is the diagnosis?
Tick Typhus
A man has recently returned from Sub-Saharan Africa where he was bitten by something, which was very painful.
On examination, you notice a chancre.
What is the diagnosis and what was he bitten by?
Trypanosomiasis
Tsetse fly
A man has returned from Africa. He has a necrotic ulcer and oedema. What is the diagnosis?
Anthrax
