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Path - Microbiology > Fever in the returning traveller > Flashcards

Fever in the returning traveller Flashcards

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1
Q

what are the 3 key conditions associated with fever that you should be able to spot in the returning traveller?

A

Malaria

Dengue

Enteric fever

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2
Q

what are the 5 key elements of the travel hx?

A

Where did you go - details?

When did you go?

Why did you go?

What did you do?

What pre-travel vaccines/malaria prophylaxis did you take?

lectures + notes from gum/hiv placement

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3
Q

name diffferentials for fever and rash?

A

Measles

Dengue,

acute HIV

Others:

Chikungunya,

rickettsia

enteric fever (rose spots - rare)

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4
Q

Ddx for Fever and abdominal pain?

A

Enteric fever - past hx diarrhoea & vom b4 onset

Amoebic liver abscess

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5
Q

what is an undifferentiated fever?

A

fever with no diagnosis as such yet

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6
Q

if you get eosinophilia with fever what to think about?

A

parasitic infection and hypersensitivity reaction:

Acute schistosomiasis,

drug hypersensitivity,

fascioliasis,

other parasitic; spongyloides

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7
Q

Ddx for Fever and pulmonary infiltrates

A

Legionella

acute schistosomiasis,

Q fever

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8
Q

Ddx for Fever and altered mental status

A

Cerebral malaria,

viral or bacterial meningoencephalitis,

African trypanosomiasis

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9
Q

List viral causes that are possible ddx for Mononucleosis syndrome? :

inflamed tonsils, lymph node swelling, sores throat etc

A

EBV,

Acute HIV

Toxoplasma

CMV,

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10
Q

Ddx for Fever persisting >2 weeks?

A

just remember; its most of them!

Malaria, enteric fever, EBV, CMV, toxoplasmosis, acute HIV, acute schistosomiasis, brucellosis, TB, Q fever,

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11
Q

ddx for Fever with onset >6 weeks after travel?

A

vivax malaria,

acute hepatitis (B,C,E),

TB,

Amoebic liver abscess

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12
Q

what animals kills most humans a year?

A

mosquito

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13
Q

what causes causes 20% of childhood deaths in Africa?

A

malaria

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14
Q

name 6 conditions mosquitoes can cause?

A 
○ Malaria
		○ Elephantiasis 
		○ Dengue 
		○ Yellow fever 
		○ West Nile virus 
		○ Zika virus
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15
Q

which animal carries malaria?

A

Female Anopheles mosquito

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16
Q

plasmodium are which kind of organism?

A

protozoa

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17
Q

name the 5 plasmodium species.

which is most dangerous?

A

P. falciparum
Invades erythrocytes of all ages, may be drug resistant and can be life threatening

P. vivax and P. ovale
P. malariae
P. knowlesi

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18
Q

name 2 stages in mosquito life cycle in humans

A

erythrocytic and

Exoerythrocytic stages

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19
Q

a female anopheles mosquito bite releases what into blood?

what does this do?

A

sporozoites

infects liver

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20
Q

which organs/systems are involved in mosquito life cycle?

A

LIVER - maturation and rupture

Red blood cells - multiplication of parasite

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21
Q

Some parasites differentiate into sexual erythrocytic stages known as what?

A

gametocytes

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22
Q

parasites of which stage are responsible for the clinical manifestations of malaria?

A

Blood stage ; erythrocytic

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23
Q

where do sporozoites come from?

A

oocysts in the mosquito release them.

then they go to the saliva of mosquito

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24
Q

what is the ABCD of malaria prevention?

A

Awareness of risk – avoid malarious areas

Bite prevention – repellent, nets, clothing

Chemoprophylaxis – seek expert guidance

Diagnose and treat fast!

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25
Q

describe typical fevers in malaria?

A

Fevers – cyclical or continuous with spikes

Malaria paroxysm – chills, high fever, sweats

26
Q

what are schizonts and where are they found

A

when sporozoites are matured in liver they are called schizonts

27
Q

features of severe malaria?

A

High parasitaemia >20 or schizont
Altered consciousness with/ without seizures
Respiratory distress

haemoglobinuria - blackwater fever
severe anaemia
deranged lfts

etc

28
Q

diagnostic tests for malaria? which stains?

A

Thick and thin blood smears x3
-Field’s or Giemsa stain

Malaria antigen detection tests

29
Q

which stain for malaria diagnostics is better for species identification

A

giemsa

30
Q

which film is to identify species & quantify parasitaemia?

A

thin blood film

31
Q

Treatment for non p. Falciparum malaria?

A

Chloroquine – 3 days

Primaquine 30mg for 14 days weeks if G6PD normal
- kills Hypnozoites : good for p vivax

32
Q

most common complication in non Falciparum malaria?

A

splenic rupture

33
Q

Treatment for mild Falciparum malaria?

A

Oral Malarone ™ :4 tablets daily with food for three days

ACT – artemisinin combination therapies

Oral quinine 600mg tds (salt)
-then doxycycline 100mg od for 1 week

34
Q

preferred drug in Treatment of Severe Falciparum Malaria?

A

IV Artesunate

35
Q

CASE 1

54 year old man from Sierra Leone
OE
GCS 15
T 39 C HR 110 BP 100/70 Sats 96% OA
CVS/ respiratory/ abdominal examination unremarkable
Investigations
Hb 108 Plt 110 Bilirubin 40 ALT 60
CRP 200 Cr 140
HIV negative
Malaria: RDT positive, Falciparum malaria

Parsitaemia is 20%. What treatment would you start?

A

IV Artesunate

this is sever malaria - parasitaemia >2!

36
Q

CASE 2

53 year old from Thailand

PC – 1/52 fever, headache, joint pain, rash
HPC
Return from Thailand 5/7 before admission
Similar symptoms 1/52 prior to these – unwell for 3 days then got better. Had Amoxicillin.
Painful joints
No malaria prophylaxis
Examination
T 39, BP 130/80 P- 90 Conjuctival injection
Cardiorespiratory, abdominal examination –
unremarkable

lymphopenic

A

Dengue - eye involvement

37
Q

vector of dengue fever?

A

Vector: Aedes mosquito

spreads a flavivirus

38
Q

triad of dengue?

A

Fever, headache, myalgia

rash in 50%

39
Q

3 types of dengue?

A

mild febrile/

dengue haemorrhagic/

dengue shock.

40
Q

when do DHF and shock syndromes occur?

A

rare in travellers

Occur in those previously infected with a different Dengue serotype

41
Q

clinical presentation of dengue ?

A

Retro-orbital, erythrodermic rash, bleeding, hepatitis, encephalitis, myocarditis.

brain, eyes, skin liver, heart

42
Q

Ivx for dengue?

A

Serology - IgM 5-7 days

PCR

43
Q

treatment for dengue?

A

none

44
Q

3 phases of dengue?

A

febrile

critical - shock, bleeding, organ impairement

recovery

45
Q

Case 3

PC – fever, sweats, constipation, dry cough
HPC
Fortnight in India 2/52 prior
Anorexia, 5kg weight loss, diarrhoea before constipation
Confused/ vacant
PM – Ix for nephrotic syndrome at HH
Examination
T 39 C. 110/70 P=130 Sats 98% RR=30
HS = I+II Gallop rhythm JVP-angle of mandible
Chest – fine bibasal inspiratory creps
Abdomen – mild suprapubic tenderness

gram neg rods on macs

A

enteric fever - salmonella typhi

46
Q

patient present with:

High prolonged fever
Headache
Rose spots (rare)
Constipation
Dry cough

these are typical of?

A

enteric fever

47
Q

Ivx for mononucleosis?

A

Monospot

IgM+ EBV/CMV

HIV test

48
Q

which disease presents as:

Fever, headache, myalgia

+/- eschar

A

Rickettsial Disease

49
Q

Rickettsia is what type of organism?

A

Obligate intracellular bacteria

50
Q

what is the Second most common febrile illness in returning travellers from Africa?

A

Rickettsial Disease

51
Q

what are the vectors of Rickettsial Disease ?

A

Arthropod vectors – ticks, lice, mites

52
Q

Spotted fevers, African tick bite fever are aka?

A

Rickettsial Disease

53
Q

diagnosis and treatment of rickettsia?

A

Dx: acute and convalescent serology

Rx: doxycycline

54
Q

Longer duration diarrhoea increases likelihood of ?

A

protozoa/parasites

e.g. giardiasis, entaemeoba

55
Q

characterise Bacterial/viral diarrhoea?

A

usually quick and short

56
Q

cercaria, a free-swimming larval stage in which a parasitic fluke obtained from water causes which fever?

A

Katayama fever

57
Q

name some examples of viral haemorrhage fevers

A

are characterized by fever and bleeding disorders

Dengue
Yellow fever
Lassa fever
Ebola
Hantavirus
58
Q

List the main travel vaccines

A

Yellow fever
Typhoid
Rabies
Hep A + B

NOT Malaria!!!

59
Q

List travel meds : oral

A

Malarone - this is NOT a vaccine!!

Take before AND DURING the trip

60
Q

What differential must you not forget for a

PC: Fever and joint pain

A

Chikungungya!

Popular around india and se asia region

Its usually hard to differentiate from Dengue

Path - Microbiology (27 decks)

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