Fever in the Returning Traveller Flashcards
Examples of VHF
Ebola
Lassa
What spreads Crimean congo haemorrhagic fever
ticks
What causes rickettsiae?
African tick-bite fever
Scrub typhus
What is enteric fever
Typhoid
What type of microorganism is histoplasma?
Fungus
What is dengue and chikungunya?
Both viruses
Different but carried by the same mosquitoes
What microorganism is rickettsiae?
Gram negative bacteria
What microorganism is shistosomiasis?
Parasitic worm
Also known as snail fever and bilharzia
Cause of amoebic liver abscess
Amebiasis = infection of intestine with parasite entamoeba histolytica
What microorganism is meningococcus?
Gram negative bacterium
Can cause meningococcemia = life threatening sepsis
Example of gram positive cocci
Staphylococci
Cause of brucellosis
Gram negative bacteria - Brucella
Main example of a retrovirus
HIV
Main example of arbovirus
Yellow Fever
- commonest are dengue and chik
What is trypanosomiasis
Protozoan
Spread by African Tsetse fly
What is leishmaniasis
Protozoan
Sandfly transmits
Can be visceral, cutaneous or mucocutaneous
What features of malaria indicate a serious infection
- cerebral involvement (seizures, impaired consciousness)
- respiratory involvement (ARDS, pulmonary oedema)
- shock
- bleeding
- parasitaemia >10%
- platelets <20
- anaemia Hb>8
- hypoglycaemia <2.2mmol/L
- renal failure = oliguria
- creatinine >265 mol/L
- haemoglobinuria
- acidosis ph<7.3
Features of Dengue and presentation
3-14 day incubation
can range from primary mild to 2ndry haemorrhagic/shock
transmitted by mosquitoes
symptoms = headache, myalgia, arthralgia, rash
rash goes from erythrodermic than petechial
Warning signs in dengue
Severe if organs damaged and plasma leakage
- ab pains, persistent vomiting, lethargic, hepatomegaly
Treatment of dengue
analgesia
no NSAIDs
monitor fluid balance
Diagnosis of dengue
serum, EDTA blood for kidney function, RDTs, FBCs
Features of chikungunya
1-12 day incubation
- fever and arthralgia and develop arthritis
- East Africa first then South and East Asia, Europe, South America/Caribbean
Diagnosis of chikungunya
PCR or IgM
Treatment of chikungunya
Steroids for arthritis
Symptomatic relief
Features of enteric fever
- salmonella typhoid/parathyphi
- 1-3 weeks incubation
- fever!!!
- non specific symptoms = headache, constipation, diarrhoea, dry cough
Complications of enteric fever
GI bleed, intestinal perforation, encephalopathy
Treatment for enteric fever
Vaccinations only partially effective and not against paratyphoid
IV ceftriaxone while waiting sensitivity results
- oral ciprofloxacin treats sensitive organisms
- azithromycin for non complicated disease
- isolated in hospital and notify PH
Features of rickettsia
- game parks in South Africa, tick typhus
- 5-10 day incubation
- fever, headache, rash, myalgia
- lymphadenitis less common
treatment of rickettsia
Doxycycline if no contraindication
- azithromycin is alternative
What is ZIka
- aedes mosquito-borne flavivirus
- Similar to Dengue/Chik
- sexual transmission
- linked to Guillian Barre & microcephaly
What may lymphopenia indicate?
Dengue, HIV, Typhoid
What may low-normal WBC indicate?
Malaria, Typhoid, Rickettsia
What may neutrophilia indicate?
Bacterial, Amoebic
What may thrombocytopenia indicate?
Malaria, dengue, typhoid, sepsis
What may eosinophilia indicate?
Schisto
fasciola
FIlaria
Drug Reaction/Allergy
What to consider if severe malaria?
ICU admission
Microorganism for malaria
Plasmodium falciparum
Malaria Management
- fluid resus
- lactate elevated
- pulmonary oedema risk
- aim for 1-2 ml/kg/hr of crystalloid
treatment for severe malaria
- IV artesunate OR - IV quinine - oral therapy when becomes improved - check blood film daily
indications for IV therapy for malaria
- severe/complicated
- parasitaemia >2% for presence of schizonts
- vomiting
- pregnancy
Treatment for uncomplicated malaria
- oral therapy with malarone/riamet/quinine and doxy or clinda
Treatment for non-falciparum malaria
- chloroquine followed by primaquine
- check G6PD status
