Infection in the returning traveller Flashcards
Clinical presentations
Fever Abdominal pain and diarrhoea Cough and other chest symptoms Weight loss Rashes, arthralgia, organomegaly, lymphadenopathy Jaundice Pre-existing conditions
Fever - what?
Malaria until proven otherwise Enteric fevers Viral illnesses included arboviruses (Dengue) Pneumonias Hepatitis Brucellosis HIV Relapsing fever (borrelia) Leptospirosis Leischmaniasis Schistosomiasis
Malaria species
Transmitted by anopheles mosquito Plasmodium falciparum: MALIGNANT • Severe in young, non-immune and pregnant people • Incubation 7-14 days P vivax, P ovale, P malariae: BENIGN • Uncomplicated but chronic relapsing • Incubation longer
Severe malaria
One or more of: • Cerebral malaria • Severe normocytic anaemia • Renal failure • Hyperparasitaemia • Pulmonary oedema • Hypoglycaemia • Circulatory collapse • Spontaneous bleeding/DIC • Repeated generalised convulsions • Acidosis • Malarial haemoglobulinuria
Other manifestations of malaria
Impaired consciousness, but rousable Prostration Severe weakness Jaundice Hyperpyrexia
Malaria in pregnancy
Avoid travel if possible More severe: • ↑ parasitaemia • Hypoglycaemia • ARDS • Cerebral malaria Foetal complications: • Fetal distress • Fetal malformation • Loss of pregnancy • IUGR • Premature birth
Malaria investigations
Blood film - at least three to exclude malaria FBC Glucose U+E LFT Clotting Blood cultures CXR
Management of malaria
Quinine for P. falciparum
In severe illness:
• IV quinine, ITU, ?blood exchange transfusion, ventilation
• Remember other CNS infections in cerebral malaria
In benign malaria
• Chloraquine and primaquine
Malaria prophylaxis
Mefloquine (Larium) Malarone (proguanil and atorvaquone) Doxycycline Chloraquine Chloraquine and proguanil
Diarrhoea
Exclude malaria if fever present Travellers diarrhoea mostly E. coli Salmonella and campylobacter Enteric fevers Shigella (dysentery) Cholera Parasites (giardia, amoebic dysentery)
Dengue fever
Arbovirus - mosquito
Incubation 5-8 days
Clinical features:
• Fever, headache, myalgia, arthralgia, cough
• Maculopapular rash 3-5 days after onset of illness
• Usually self-limiting, recovery 3-4 days after rash onset
• Can occasionally progress to more severe dengue haemorrhagic fever
Dengue fever management
Supportive:
• IV fluids
• Correct thrombocytopenia/coagulopathy if bleeding
• Monitor FBC etc
Typhoid and paratyphoid (enteric fever)
Due to S. typhi or S. paratyphi Clasically present with (stepwise): 1. Fever 2. Headache 3. Abdominal pain Complications: • Bowel perforation/haemorrhage • Metastatic infections eg osteomyelitis • Relapse/chronic infection (gall bladder)
Typhoid and paratyphoid (enteric fever) management
Blood culture best (also send stool) Leukopenia often seen Abx: cephlasporins and ciprofloxacin Fluid replacement Check stools after treatment
Leischmaniasis
Pancytopenia
Sandfly
Incubation period 3 months
