Fever in the Returning Traveller

Question 1

Examples of VHF

Answer 1

Ebola

Lassa

Question 2

What spreads Crimean congo haemorrhagic fever

Answer 2

ticks

Question 3

What causes rickettsiae?

Answer 3

African tick-bite fever

Scrub typhus

Question 4

What is enteric fever

Answer 4

Typhoid

Question 5

What type of microorganism is histoplasma?

Answer 5

Fungus

Question 6

What is dengue and chikungunya?

Answer 6

Both viruses

Different but carried by the same mosquitoes

Question 7

What microorganism is rickettsiae?

Answer 7

Gram negative bacteria

Question 8

What microorganism is shistosomiasis?

Answer 8

Parasitic worm

Also known as snail fever and bilharzia

Question 9

Cause of amoebic liver abscess

Answer 9

Amebiasis = infection of intestine with parasite entamoeba histolytica

Question 10

What microorganism is meningococcus?

Answer 10

Gram negative bacterium

Can cause meningococcemia = life threatening sepsis

Question 11

Example of gram positive cocci

Answer 11

Staphylococci

Question 12

Cause of brucellosis

Answer 12

Gram negative bacteria - Brucella

Question 13

Main example of a retrovirus

Answer 13

HIV

Question 14

Main example of arbovirus

Answer 14

Yellow Fever

- commonest are dengue and chik

Question 15

What is trypanosomiasis

Answer 15

Protozoan

Spread by African Tsetse fly

Question 16

What is leishmaniasis

Answer 16

Protozoan
Sandfly transmits
Can be visceral, cutaneous or mucocutaneous

Question 17

What features of malaria indicate a serious infection

Answer 17

• 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

Question 18

Features of Dengue and presentation

Answer 18

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

Question 19

Warning signs in dengue

Answer 19

Severe if organs damaged and plasma leakage

- ab pains, persistent vomiting, lethargic, hepatomegaly

Question 20

Treatment of dengue

Answer 20

analgesia
no NSAIDs
monitor fluid balance

Question 21

Diagnosis of dengue

Answer 21

serum, EDTA blood for kidney function, RDTs, FBCs

Question 22

Features of chikungunya

Answer 22

1-12 day incubation

• fever and arthralgia and develop arthritis
• East Africa first then South and East Asia, Europe, South America/Caribbean

Question 23

Diagnosis of chikungunya

Answer 23

PCR or IgM

Question 24

Treatment of chikungunya

Answer 24

Steroids for arthritis

Symptomatic relief

Question 25

Features of enteric fever

Answer 25

- salmonella typhoid/parathyphi - 1-3 weeks incubation - fever!!! - non specific symptoms = headache, constipation, diarrhoea, dry cough

Question 26

Complications of enteric fever

Answer 26

GI bleed, intestinal perforation, encephalopathy

Question 27

Treatment for enteric fever

Answer 27

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

Question 28

Features of rickettsia

Answer 28

- game parks in South Africa, tick typhus - 5-10 day incubation - fever, headache, rash, myalgia - lymphadenitis less common

Question 29

treatment of rickettsia

Answer 29

Doxycycline if no contraindication | - azithromycin is alternative

Question 30

What is ZIka

Answer 30

- aedes mosquito-borne flavivirus - Similar to Dengue/Chik - sexual transmission - linked to Guillian Barre & microcephaly

Question 31

What may lymphopenia indicate?

Answer 31

Dengue, HIV, Typhoid

Question 32

What may low-normal WBC indicate?

Answer 32

Malaria, Typhoid, Rickettsia

Question 33

What may neutrophilia indicate?

Answer 33

Bacterial, Amoebic

Question 34

What may thrombocytopenia indicate?

Answer 34

Malaria, dengue, typhoid, sepsis

Question 35

What may eosinophilia indicate?

Answer 35

Schisto fasciola FIlaria Drug Reaction/Allergy

Question 36

What to consider if severe malaria?

Answer 36

ICU admission

Question 37

Microorganism for malaria

Answer 37

Plasmodium falciparum

Question 38

Malaria Management

Answer 38

- fluid resus - lactate elevated - pulmonary oedema risk - aim for 1-2 ml/kg/hr of crystalloid

Question 39

treatment for severe malaria

Answer 39

``` - IV artesunate OR - IV quinine - oral therapy when becomes improved - check blood film daily ```

Question 40

indications for IV therapy for malaria

Answer 40

- severe/complicated - parasitaemia >2% for presence of schizonts - vomiting - pregnancy

Question 41

Treatment for uncomplicated malaria

Answer 41

- oral therapy with malarone/riamet/quinine and doxy or clinda

Question 42

Treatment for non-falciparum malaria

Answer 42

- chloroquine followed by primaquine | - check G6PD status