INFECTIOUS DISEASE: Traveller with fever/ travel infections Flashcards
Cause of malaria?
Blood protozoan (single celled organism) parasite - Plasmodium species. Spread via bites from female Anopheles mosquito carrying the disease.
Types of Plasmodium species causing malaria?
Plasmodium falciparum
Plasmodium vivax
Plasmodium ovale
Plasmodium malariae
Presentation of malaria - symptoms?
NON SPECIFIC
Abrupt onset rigors
High fever
Sweats
Severe headache
Myalgia
Malaise
Nausea
Vomiting
Main investigation for malaria?
Malaria blood film - need 3 to diagnose malaria
What do blood results for malaria show?
Anaemia
Thrombocytopenia
Leukopenia
Abnormal Liver enzymes
Management for complicated or severe malaria?
(Dr Tom said this is more likely to come up in exam)
Has to be IV:
- Artesunate (most effective, but not licensed)
- Quinine dihydrochloride
- a parasite counts of more than 2% will usually need parenteral treatment irrespective of clinical state
- intravenous artesunate is now recommended by WHO in preference to intravenous quinine
- if parasite count > 10% then exchange transfusion should be considered
- shock may indicate coexistent bacterial septicaemia - malaria rarely causes haemodynamic collapse
Complications from malaria by Plasmodium falciparum?
Cerebral malaria
Seizures
Reduced consciousness
AKI —> renal failure
Pulm oedema
DIC - disseminated intravascular coagulopathy
Severe haemolytic anaemia
Death
Blood film for malaria has been done. What other investigations to order?
Rapid antigen test
FBC - haemolysis, low HB, low platelets, thrombocytopenia
U&Es - AKI. high creatinine.
LFTs - ALT, jaundice (pre hepatic)
Glucose - reduced
Coagulation screen
Head CT if CNS symptoms - confusion - can see bleeding or signs of cerebral malaria
CXR - see ARDS
Management for uncomplicated malaria?
Admit P falciparum pts for treatment
Discuss with local ID unit
Oral options as follows:
1 Artemether with lumefantrine (called Riamet)
2 Proguanil and atovaquone (Malarone)
3 Quinine sulphate
4 Doxycycline
Management for complicated or severe malaria?
(Dr Tom said this is more likely to come up in exam)
Has to be IV:
- Artesunate (most effective, but not licensed)
- Quinine dihydrochloride
Main management for malaria with Plasmodium falciparum?
Admit
IV artesunate treatment
Monitor for complications.
Blood film for malaria has been done. What other investigations to order?
Rapid antigen test
FBC - haemolysis, low HB, low platelets, thrombocytopenia
U&Es - AKI. high creatinine.
LFTs - ALT, jaundice (pre hepatic)
Glucose - reduced
Coagulation screen
Head CT if CNS symptoms - confusion - can see bleeding or signs of cerebral malaria
CXR - see ARDS
Malaria prophylaxis advice to give pts?
Know where is high risk
Mosquito spray
Mosquito nets and barriers when sleeping
Antimalarial medication.
What should a travel Hx include about a persons acivity when they return unwell from abroad?
- Countries - stop overs / time
- Activities - lakes (water contact ) / rural backpacking
- water supply - bruhsing teeth / drinking
- Types of Food
- Insect bites - repellent / nets at night
- Accomodation
- Vaccination status / Prophylaxis for malaria taken
- Any symptoms? then or anyone travelling with
- Sexual Hx - condom use/ sex worker/ MSM
- Medical conditons - predispose to infection e.g. diabetes / immunosuppressive therapy
What DDx could a patient traveller coming form aboard have if they describe insect bites?
- Malaria
- Dengue fever
- Leishmaniasis
What DDx could a patient traveller coming form aboard have if they describe Diarrhoea?
- Giardia
- E.coli
- Ameobiasis
- typhoid / para typhoid
- schistomiasis
- tapeworm
What DDx could a patient traveller coming form aboard have if they describe abdominal pain?
- Typhoid / para typhoid
- schistomiasis
- giardia
- amoedbiais
- tapeworm / hookworm / roundworm
What DDx could a patient traveller coming form aboard have if they describe haematemesis?
- Dengue fever
- viral haemorrhagic fever
What DDx could a patient traveller coming form aboard have if they describe urinary symptoms?
- Schistomiasis - urinary freq / dysuria / haematuria