Fever in the returning traveller Flashcards
General approach
Travel history Risk assess for highly infectious/life-threatening Clinical exam Danger signs Malaria film
Risk assessment
A B C Screen for sepsis Prevent transmissible infection
Risk of transmission
Resp Symptoms Vom + Diarr Rash/skin infection/wound Hospitalisation overseas Haemorrhage VHF risk
Sub-Saharan Africa
Malaria Dengue/Chikungunya Rickettsiae Enteric Fever (typhoid) Acute schistosomiasis Amoebic liver abscess Meningococcus Brucellosis HIV
Sub Saharan Africa main
Malaria Dengue Rickettsiae Typhoid HIV VHF (lassa, ebola)
Viral haemorrhagic fever risk
Consider if- fever AND travel to endemic area <21days
VHF initial management
Malaria film, clotted blood, EDTA blood Isolation Discuss with infectious diseases Virologist VHF PCR
South + central asia
Dengue Enteric fever malaria chikungunya TB
South east asia
Dengue enteric fever chikungunya malaria leptospirosis
Latin America + caribbean
Dengue/chik/zika
enteric fever
malaria
Tick typhus
Bite
Trypanosomiasis
Painful bite
Chancre
Anthrax
Necrotic ulcer
Oedema
Acute schistosomiasis
fresh/brackish water
2-12 weeks post exposure
Swimmer’s itch
eosinophilia
Leptospirosis
Swimming/rafting in fresh water <4wks exposure Jaundice conjunctival suffusion liver/renal impairment
Caves
Histoplasmosis
Rabies
Ebola
Animal contact/bites
Rabies
Brucella
Q fever
VHF
Unprotected sex
HIV Syphilis Viral hepatitis Gonococcaemia STi
FBC- Lymphopenia
Viral
Dengue
Typhoid
HIV
FBC- Low-normal WCC
Malaria
Viral
Typhoid
Rickettsial
FBC- neutrophilia
Bacterial
Amoebic
FBC- thrombocytopenia
Malaria
Dengue
Typhoid
Sepsis
FBC- eosinophilia
Schisto Fasciola Filaria Strongyloides Allergy/drug reaction
Malaria diagnosis
Thick and thin blood film
Rapid diagnostic tests detect Plasmodium spp. antigens
Malaria + fluid
Cautious fluid resuscitation
1-2ml/kg/hr
Malaria treatment
IV artesunate
IV quinine
Oral therapy
check blood film daily
Malaria treatment- uncomplicated P falciparum
Malarone
Riamet
Quinine
+ oral therapy
Malaria treatment- non falciparum
Chloroquine followed by primaquine
Check G6PD status
Arbovirus infection
Febrile illness, haemorrhagic fever, encephalitis
Dengue
3-14 incubation period
Aedes spp. mosquitos
Headache, myalgia, arthralgia, rash (initially erthyrodermic, then petechial)
Dengue treatment
Simple analgesia- avoid NSAIDs
Fluid balance
Chikungunya
Incubation 1-12
Fever + severe arthralgia
PCR or IgM diagnosis
Symptomatic relief, steroids
Typhoid or Paratyphoid
Salmonella Typhi or Paratyphi
Fever +++
GI bleeding, intestinal perforation + encephalopathy
