Fever in the returning travellor

Question 1

Typhoid fever cause

Answer 1

Salmonella thphi

Question 2

Transmission of Typhoid

Answer 2

faecal oral spread

Question 3

Symptoms of Typhoid

Answer 3

Asymptoatic period of 7-14 days
Fever
Flu like symptoms (headache, malaise, myalgia)
Cough

Question 4

Signs of typhoid

Answer 4

Rose spots on abdomen
hepatosplenomegaaly
relative bradycardia

Question 5

Diagnosis of typhoid

Answer 5

Travel history (area visited, food and drink, pre-travel vaccine) 
cultures (stool + in 30%, bloods +ve in 60-70%)

Question 6

Treatment of typhoid

Answer 6

14 days
Quinolones – cure rate 96%
3rd generation cephalosporins – cure rate 90-95%
Azithromycin – cure rate 95%

Question 7

Vaccine for typhoid

Answer 7

yes

70% effective

Question 8

Dengue fever cause

Answer 8

flavivirus infection

Question 9

transmission of dengue fever

Answer 9

Day time biting aedes mosquito

Question 10

Clinical features of dengue fever

Answer 10

Abrupt onset of fever, rigors and headache. Fever lasts about 5 days and may recover to give a second peak

“break bown” fever - intense joint and muscle pain of the back
Maculopapular rash develops between 3-5 days (limbs then trunk)

nausea and vomitting

Question 11

Diagnosis of dengue fever

Answer 11

Lab (FBC)

• leucopenia
• thrombocytopenia
• transaminitis

Question 12

Complications of degnue fever

Answer 12

Usually self-limiting

Dengue haemorrhagic fever or dengue shock syndrome

Increased vascular permeabilty, thromboycopenia, fever, bleeding

Question 13

Viral haemorrhagic fever

Answer 13

Lassa, ebola/marburg or yellow fever

Question 14

Viral haemorrhagic fever incubation period

Answer 14

21 days

Question 15

Clnical presenation of ebola

Answer 15

exposure (up to 21 days)

non specific febrile illness influenza like symptoms + GI symptoms

then improvement

Haemorrhagic manifestations (petechia, mucosal surfaces)

Sepsis syndrome

Death

Question 16

Travel history

Answer 16

1. Where were they?
2. Time
3. . Purpose
4. Acitivtes
5. Pre-travel vaccine/prophylaxis
6. return time
7. How long have they been unwell for

Question 17

Treatment of dengue fever

Answer 17

• No specific antiviral therapy
• supportive management on ICU for DHF or DSS
• Targeted fluid resuscitation, blood products for coagulopathy; ventilatory support

Question 18

Lassa organism & transmissom

Answer 18

arenavirus - direct contact with rats in west africa

Question 19

Lassa Clinical features

Answer 19

asymptomatic - up to 90%

Incubation period is 7-18 days

1st week - fever, malaise, myalgia, and severe backacke

Deterioration to haemorrhagic fever after 1 week (epistaxis, GI haemorrhage)

Lassa fever- facial oedema, pharyngeal ulceration

Question 20

Lassa investigations

Answer 20

Virus isolated from blood and pharyngeal secretions

Serology ELISA

Lab (leucopenia, and acute renal failure)

Question 21

Treatment

Answer 21

Ribavirin - 1st week of treatment

Convalescent serum

Adherence to strict isolation

Question 22

Organism that causes ebola and transmission

Answer 22

Ebola Virus, filovirus

Person-person and from contaminated blood

Question 23

Investigations ebola virus

Answer 23

Isolating the ebola virus disease can be confirmed by isolating the virus from blood or serology

Question 24

treating ebola

Answer 24

No drug treatment

Convalescent serum

adherence with strict isolation policies