Global Travelers Flashcards
classic clinical triad for all species of malaria
Malaria hits FaST
F - ever
S - plenomegaly
T - hrombocytopenia
Fever is typically irregular for the first week and later may be periodic.
Patients usually have continuous symptoms initially followed by episodic pyrexia every 2 to 3 days, depending on the infecting species
 Malaria
Diagnosis is based on clinical presentation then confirmed with laboratory evidence of bloodborne protozoa
Malaria
presents after a typically short incubation period of 4 to 7 days with sudden high fever, headache, nausea, vomiting, severe myalgias (hence the term “break bone fever”), and rash usually lasting several days. Facial flushing, conjunctival injection (although uncommon), and retro-orbital pain can occur. After defervescence, a fine, pale, morbilliform rash develops on the trunk and spreads to the extremities and face.
 Dengue fever 
begins with fever and myalgias. After 2 to 7 days, as pyrexia improves, lassitude, fatigue, and shock develop with an ensuing mortality that is >10%. Clinical features include pleural effusions and bleeding diathesis
Severe dengue or dengue hemorrhagic fever
Once malaria is excluded, _____________ is commonly the cause of a febrile illness lasting >10 days
Typhoid fever
classically begins with fever and headache and then progresses to high fever with chills, headache, cough, abdominal distention, myalgias, constipation, and prostration. In epidemics, patients can present with acute diarrhea and vomiting, headache, and meningeal signs. However, 30% of patients present with constipation rather than diarrhea.17 Bradycardia relative to fever is classic (but may be absent); after several days of fever, a pale red macular rash may appear on the trunk (rose spots) among fair-skinned indi- viduals. As the disease progresses, splenomegaly develops
Typhoid fever
Current treatment recommendations for typhoid fever
fluoroquinolones (ciprofloxacin)
cephalosporins (cefixime and ceftriaxone)
azithromycin
duration of treatment dependent on severity of illness
papule at the bite site. The papule later becomes necrotic and forms a crusted black “tache noire” eschar. As organisms disseminate, patients develop fever, malaise, headache, lymphadenopathy, and splenomegaly.
Scrub typhus
less severe symptoms and localized lymphade nopathy associated with an eschar. Diagnosis is clinical, and serologic tests are confirmator
African tick typhus
rickettsial louse-borne disease caused by Rickettsia prowazekii
Typhus (Epidemic Louse-Borne Typhus)
high fevers after an 8- to 12-day incubation period. Severe headache is common, and a maculopapular rash appears between days 4 and 7, generally sparing palms and soles. The rash may be hemorrhagic. Diagnosis starts on clinical grounds and is confirmed with serologic testing.
Typhus (Epidemic Louse-Borne Typhus
clinical course can be asymptomatic, but often symptoms illus- trate a biphasic pattern. After an incubation of 2 days to 4 weeks, symp- toms may include high fever, severe headache, chills, myalgias, hepatitis (with or without jaundice), and nonspecific influenza-like complaints. Notable is conjunctival injection without purulent discharge.
LEPTOSPIROSIS
Leptospirosis treatment
Mild disease can be treated within the first 3 days of illness with PO amoxicillin or doxy- cycline, whereas more severe cases require IV penicillin, ceftriaxone, or ampicillin. Treatment duration is 7 to 14 days. Consider empiric therapy with PO doxycycline or IV penicillin (or ampicillin) when suspecting leptospirosis.
Transmitted by the Aedes mosquito. Symptoms may include conjunctivitis, headache, joint pain, fever, and malaise. Although does not commonly pose a serious threat to those infected, it has been associated with Guillain-Barré syndrome.
Zika
incubation period is 1 to 12 days (usually 2 to 3 days), and it presents with fever, severe myalgias, fatigue, headache, morbilliform rash, and occasional thrombocytopenia. Hemorrhagic complications are rare. Diagnosis is through increases of immunoglobulin M antibodies either in serum or the cerebrospinal fluid. Treatment is supportive
CHIKUNGUNYA
reproduces in body fluids and produces endotoxins affecting the liver, spleen, and capillaries. After incubation of 3 to 10 days, patients develop fever, chills, headache, and myalgias. In rare severe cases, acute respiratory distress syndrome, CNS involvement, and liver failure occur. After spontaneous abatement, fever may relapse several times. Diagnosis is made by clinical suspicion and confirmed by identifying spirochetes in blood peripheral smear, cerebrospinal fluid, or bone marrow.
RELAPSING FEVER
the most common cause of acute hemorrhagic fever in temperate climates
Neisseria meningitidis
incubation of 3 to 6 days, patients develop fever, headache, myalgias, conjunctival injection, abdominal pain, prostration, facial flushing, and relative bradycardia. In most cases, patients recover, but in others, fever remission lasts a few hours to several days, followed by renewed high fever, jaundice, vomiting, shock, multiorgan failure, and bleeding diathesis
Yellow fever
Yellow fever triad
Yellow fever makes you yellow, black and bum.
jaundice, black emesis, and albuminuria
Symptoms begin 2 to 21 days after exposure with fever, myalgia, malaise, diarrhea, abdominal pain, and vomiting, and progress to hem- orrhage, shock, and end-organ failure. Mortality is high, but those who recover have an antibody response that lasts about 10 years.
EBOLA AND MARBURG VIRUSES
prehemorrhagic period is characterized by the sudden onset of fever, headache, myalgia, dizziness, and, possibly, altered mental status. The hem- orrhagic period is short (2 to 3 days), develops rapidly, and usually begins between the third and fifth day of disease. The most common bleeding sites are the nose, GI system (hematemesis, melena, and intra-abdominal), uterus (menometrorrhagia) and urinary tract (hematuria), and the respira- tory tract (hemoptysis). Thrombocytopenia is common.
CRIMEAN-CONGO HEMORRHAGIC FEVER
incubation period of 3 to 16 days, the disease presents as a viral syndrome with insidious onset of fever, malaise, headache, sore throat, retrosternal chest pain, back pain, abdominal pain, and myal- gias. Varied and nonspecific symptoms persist for 4 to 6 days, at which time the patient suddenly deteriorates and becomes gravely ill
LASSA FEVER
main features are high fever, prostration, severe sore throat with dysphagia and yellow-white exudates, abdominal pain, diarrhea, and vomiting. Only one third of patients experience bleeding, which may include oozing from the gums, hematemesis, melena, hematochezia, hemoptysis, hematuria, or brain hemorrhage.
LASSA FEVER
sudden high fever, headache, nuchal rigidity, vomiting, and seizures (especially infants) after the incubation time of 5 to 15 days. A variety of pyramidal and extrapyramidal signs may develop soon after fever. If the outcome is fatal, it usually occurs in the first 10 days
JAPANESE ENCEPHALITIS
Unilateral periorbital edema (Romaña sign) or painful cutaneous edema at the site of skin penetration (chagoma) is followed by a toxemic phase with parasitemia causing lymphadenopathy and hepatospleno- megaly. The acute phase generally lasts 2 to 4 weeks but may last up to 3 months. Next is a long, asymptomatic, latent phase when nerve ganglion cells are gradually destroyed, leading to depressed cardiac and GI function. Cardiac complications include myocarditis, dysrhythmias, cardiomyopathy, and sudden death. Chagas-induced heart disease is the leading form of congestive heart failure in much of Latin America
AMERICAN TRYPANOSOMIASIS (CHAGAS’ DISEASE)
When Katayama syndrome occurs, fever is accompanied by head ache, cough, urticaria, diarrhea, hepatosplenomegaly, and eosinophilia.
SCHISTOSOMIASIS (BILHARZIA OR SNAIL FEVER)
small papule slowly enlarging and forming a painless shallow skin ulcer with a noticeable rolled edge like a volcano, with a raised edge and central crater, often with a scab.
CUTANEOUS LEISHMANIASIS
The most common tropical travel dermatoses in ill individuals requiring therapy are ___(3)____.
cutaneous larva migrans
insect bites including bites with bacterial superinfections
abscesses
allergic reactions
