Global Health

Question 1

fever in returning traveler - travel history

Answer 1

past 12 months

• Travel details and disruptions (destinations, dates and timing of symptom onset)
• Setting: Rural vs urban, living conditions, altitude, season (i.e., rainy or dry)
• Activities: VFR or professional, community involvement, environments
• Potential exposures: Food consumption & handling/prep’n (w risk for exposure to unpasteurized dairy, meat, seafood); drinking water and fresh water sources (i.e., for swimming, washing); sick contacts; insect bites (especially mosquitos, ticks); animal bites or other animal exposures; sexual encounters
• Pre-travel preparation:
  Counselling, vaccinations, malaria chemoprophylaxis, PPE (clothing, nets and repellant)
• Medical care: (Health care contacts and medications received while travelling and since return)

Question 2

Why are visiting friends and relative higher risk of infection

Answer 2

• are less likely to seek pre-departure advice and more likely to travel for longer periods,
• are more likely to be exposed to local food, drink and infectious contacts, for longer periods often underappreciate the severity of certain endemic infections
• often underappreciate that immunity to malaria wanes over time

Question 3

Host risk factors for infection

Answer 3

Unvaccinated
Compromised/suppressed immunity
Low wt/poor nutritional status
Young age < 1 month

Question 4

Diarrhea DDx

Answer 4

Rotavirus
E. coli
Shigella
Salmonella
Campylobacter
Yersinia
Giardia 
Amebiasis

Question 5

Hepatomegaly Ddx

Answer 5

Hepatitis A, B, E
Typhoid fever
Leptospirosis
Malaria
Amebiasis

Question 6

Splenomegaly Ddx

Answer 6

EBV
Typhoid fever
Malaria
Visceral leishmaniasis

Question 7

Hemorrhagic Rash Ddx

Answer 7

Dengue
VHF
Meningococccus
Rocky Mountain spotted fever (RMSF)

Question 8

Fever and rash ddx

Answer 8

Fever and rash
Dengue
Chikungunya
Acute HIV
Measles
Zika
Viral exanthems (i.e., Roseola)
Rickettsiae
Enteric fever  (Salmonella)
Leptospirosis

Question 9

Fever and low WBC DDx

Answer 9

Dengue
Chikungunya
Rickettsiae
Enteric fever  (Salmonella)
Leptospirosis
Malaria

Question 10

Fever in returning traveler onset >2 weeks

Answer 10

EBV
CMV
Acute HIV
Enteric fever (Salmonella)
Brucellosis
Toxoplasmosis
Q fever
mTB
Leptospirosis
Malaria
Visceral leishmaniasis
Amoebic liver abscess

Question 11

Fever in returning traveler onset <2 weeks

Answer 11

Viral upper or lower respiratory tract infections
Viral gastroenteritis
Arboviruses
Hepatitis A
Acute otitis media
Pneumonia
Urinary tract infection
Enteric fever
Leptospirosis
Malaria

Question 12

3 most important travel-related causes of fever

Answer 12

malaria
traveller’s diarrhea and enteric fever
dengue

Question 13

What causes typhoid fever and what is incubation period

Answer 13

Salmonella typhi or Salmonella paratyphi

7-14 days

Question 14

What is dengue caused by

Answer 14

flavivirus

Question 15

Cross Cultural Communication Framework?

Answer 15

Listen

• Assess pt’s understanding of their health condition
• Elicit expectations for the encounter

Explain
- Your own perception remembering pt might have different take based on background

Acknowledge

• Be respectful when discussing the differences between their views and your own
• Assess for disparate belief systems that may lead to a therapeutic dilemma

Recommend
- Develop and propose a tx plan to the patient and their family

Negotiate
- Reach an agreement on the tx plan in partnership with the pt and family, incorporating culturally relevant approaches that fit with the patient’s perceptions of health and healing