Fever in the returning traveller

Question 1

What disease should be excluded in all people coming in from the tropics?

Define incubation period?

Answer 1

Malaria (Incubation 10-21 days)

Time from exposure to the presentation of disease

Question 2

History:

Collect a full travel history.

What would you ask?

What would you ask about each episode of travel?
What should you ask about? - 11

Answer 2

‘Have you ever been outside of [e.g. the UK, Malaysia]?’

‘Have you ever travelled to other parts of [UK, Malaysia, etc.]?’

‘When was the last time?’

‘And before that? And before that?….’

Itinerary - dates, times, mode of transport

Accomoddation
Activities
Food
Sexual activity - people tend to have more sex abroad
Vaccination/prophylaxis - prior or during

Question 3

Examination:

Rash:

• What causes a maculopapular rash?
• What causes a purpuric rash?
• What causes ulcers?
• What causes jaundice?

Answer 3

Dengue
EBV
HIV

Dengue
Meningococcal infection
Plague
DIC

Trypanosomiasis
Tick typhus

Viral hep
Enteric fever

Question 4

Diseases common from the Caribbean and Latin America

Answer 4

Arboviruses - dengue, Zika, yellow fever
Malaria
Bacterial - leptospirosis
Fungal - histoplasmosis

Question 5

Diseases common from South Asia

Answer 5

Arboviruses - dengue
Bacterial - enteric fever
Malaria

Question 6

Diseases common from Sub-Saharan Africa:

Answer 6

Malaria 
Bacterial - enteric fever 
Arboviruses - dengue, yellow fever 
Helminths - acute schistosomiasis
African trypanosomiasis

Question 7

What typical S+S are seen?

Answer 7

Fever
Rash
Arthralgia
GI symptoms – abdominal pain, diarrhoea, constipation, blood
Full systems review (N.B. neuro + GU)

Question 8

Investigations - same as patient presenting with fever or SIRS:

FBC
U&E’S
LFTs
Coag
ABG– SOB, D&V
Blood cultures
Throat/sputum/stool/urine/CSF as appropriate

Special tests:

• For malaria?
• Why is serology done? - look for antibodies in the blood.
• What is done for dengue, herpes and enteroviruses?

Answer 8

Investigations - same as patient presenting with fever or SIRS:

FBC
U&E’S
LFTs
Coag
ABG– SOB, D&V
Blood cultures
Throat/sputum/stool/urine/CSF as appropriate

Malaria films

Rickettsia, Dengue, HIV, Viral hepatitis, Syphillis

PCR