Fever in the Returning Traveller

Question 1

What conditions (which cause fever) are endemic in Sub-Saharan Africa?

Answer 1

malaria, HIV, dengue, chikungunya, rickettsiae, enteric fever (typhoid), VHF (ebola)

Question 2

What conditions (which cause fever) are endemic in South/Central Asia?

Answer 2

dengue, enteric fever, malaria, chikungunya and tuberculosis

Question 3

What conditions (which cause fever) are endemic in South East Asia?

Answer 3

dengue, enteric fever, chikungunya and malaria

Question 4

What conditions (which cause fever) are endemic in Latin America?

Answer 4

dengue, chikungunya, zika, enteric fever and malaria

Question 5

What condition may someone get if they were exposed to fresh/brackish water?

Answer 5

acute schistosmiasis

Question 6

What condition may someone get if they were exposed to swimming/rafting in fresh water?

Answer 6

can lead to leptospirosis

Question 7

What condition may someone get if they were exposed to game/safaris?

Answer 7

can lead to tick typhus, trypanosomiasis or anthrax

Question 8

What condition may someone get if they were exposed to caves?

Answer 8

can lead to histoplasmosis, rabies or ebola

Question 9

Explain how you would assess the likelihood that someone has VHF (ebola).

Answer 9

> Have they visited endemic area <21 days ago
Is there a high possibility of contact with an infected/febrile person for >4 hours
Involved in healthcare work
Present with shock, organ failure or haemorrhage

Question 10

Outline the treatment for malaria

Answer 10

Severe malaria is treated with IV artesunate or IV quinine (cardiac and blood glucose monitoring is required)

If pathogen is not falciparum –> chloroquine followed by primaquine (check G6PD status)

Question 11

Describe dengue fever

Answer 11

3-14 day incubation, transmitted by day-biting Aedes mosquitos, present with febrile illness and headache, with myalgia, arthralgia and a rash with is initially erythrodermic and later becomes petechial

Question 12

Describe chikungunya

Answer 12

1-12 day incubation, fever and arthralgia present and arthritis may develop

Question 13

What is enteric fever and what is it caused by?

Answer 13

Enteric fever = typhoid, caused by Salmonella Typhi or Paratyphi

Question 14

Describe enteric fever (typhoid)

Answer 14

Caused by Salmonella Typhi or Paratyphi with an incubation period of 1-3 weeks Symptoms may include headache, constipation/diarrhoea and dry cough. Treatment is with IV ceftriaxone (empirical until serology comes back)