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Path - Microbiology > Fever in the returning traveller > Flashcards

Fever in the returning traveller Flashcards

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
describe typical fevers in malaria?
Fevers – cyclical or continuous with spikes Malaria paroxysm – chills, high fever, sweats
26
what are schizonts and where are they found
when sporozoites are matured in liver they are called schizonts
27
features of severe malaria?
High parasitaemia >20 or schizont Altered consciousness with/ without seizures Respiratory distress haemoglobinuria - blackwater fever severe anaemia deranged lfts etc
28
diagnostic tests for malaria? which stains?
Thick and thin blood smears x3 -Field’s or Giemsa stain Malaria antigen detection tests
29
which stain for malaria diagnostics is better for species identification
giemsa
30
which film is to identify species & quantify parasitaemia?
thin blood film
31
Treatment for non p. Falciparum malaria?
Chloroquine – 3 days Primaquine 30mg for 14 days weeks if G6PD normal - kills Hypnozoites : good for p vivax
32
most common complication in non Falciparum malaria?
splenic rupture
33
Treatment for mild Falciparum malaria?
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
preferred drug in Treatment of Severe Falciparum Malaria?
IV Artesunate
35
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?
IV Artesunate this is sever malaria - parasitaemia >2!
36
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
Dengue - eye involvement
37
vector of dengue fever?
Vector: Aedes mosquito spreads a flavivirus
38
triad of dengue?
Fever, headache, myalgia rash in 50%
39
3 types of dengue?
mild febrile/ dengue haemorrhagic/ dengue shock.
40
when do DHF and shock syndromes occur?
rare in travellers Occur in those previously infected with a different Dengue serotype
41
clinical presentation of dengue ?
Retro-orbital, erythrodermic rash, bleeding, hepatitis, encephalitis, myocarditis. brain, eyes, skin liver, heart
42
Ivx for dengue?
Serology - IgM 5-7 days | PCR
43
treatment for dengue?
none
44
3 phases of dengue?
febrile critical - shock, bleeding, organ impairement recovery
45
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
enteric fever - salmonella typhi
46
patient present with: ``` High prolonged fever Headache Rose spots (rare) Constipation Dry cough ``` these are typical of?
enteric fever
47
Ivx for mononucleosis?
Monospot IgM+ EBV/CMV HIV test
48
which disease presents as: Fever, headache, myalgia +/- eschar
Rickettsial Disease
49
Rickettsia is what type of organism?
Obligate intracellular bacteria
50
what is the Second most common febrile illness in returning travellers from Africa?
Rickettsial Disease
51
what are the vectors of Rickettsial Disease ?
Arthropod vectors – ticks, lice, mites
52
Spotted fevers, African tick bite fever are aka?
Rickettsial Disease
53
diagnosis and treatment of rickettsia?
Dx: acute and convalescent serology Rx: doxycycline
54
Longer duration diarrhoea increases likelihood of ?
protozoa/parasites | e.g. giardiasis, entaemeoba
55
characterise Bacterial/viral diarrhoea?
usually quick and short
56
cercaria, a free-swimming larval stage in which a parasitic fluke obtained from water causes which fever?
Katayama fever
57
name some examples of viral haemorrhage fevers
are characterized by fever and bleeding disorders ``` Dengue Yellow fever Lassa fever Ebola Hantavirus ```
58
List the main travel vaccines
Yellow fever Typhoid Rabies Hep A + B NOT Malaria!!!
59
List travel meds : oral
Malarone - this is NOT a vaccine!! Take before AND DURING the trip
60
What differential must you not forget for a | PC: Fever and joint pain
Chikungungya! Popular around india and se asia region Its usually hard to differentiate from Dengue

Path - Microbiology (27 decks)

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