Malaria, Dengue, Typhoid Flashcards
Clinical signs of uncomplicated dengue fever
- Fever + rash + arthralgia (breakbone fever)
- Persistent N&V
- Lethargy or restlessness
- Retro-orbital pain
- Photophobia
- Lymphadenopathy
Clinical signs of dengue haemorrhagic fever
- Severe fever
- Oedema
- Haematemesis, bleeding gums
Management of uncomplicated dengue fever
- oral fluids
- paracetamol
What anti-pyretics to avoid for dengue fever?
Why to avoid these?
Avoid aspirin, ibuprofen
Due to bleeding risk (dengue already causes haemolysis)
What 3 features indicate severe dengue?
- Severe plasma leakage (shock)
- Severe bleeding (haematemesis)
- Severe organ involvement (deranged LFTs, reduced GCS)
What bedside test to do for dengue
Tourniquet test
Put tourniquet around limb, leave for a while, if petechiae form = positive
What bloods to do for dengue
- FBC (high Hct, low WBC, low platelets)
- LFTs
- Dengue viral PCR
- IgG and IgM antibodies
List the 5 types of malaria
- falciparum
- vivax
- ovale
- malariae
- knowlesi
Which is the most severe type of malaria
Falciparum
Which patient groups are at risk for developing more severe malaria?
- pregnant women
- pts with absent/ poorly functioning spleen
- children
- elderly
Name some malaria prophylaxis drugs
- Doxycycline
- Mefloquine
- Malarone
- Chloroquine
Common side effects of doxycycline
- photosensitivity
- GI upset
Rare but severe side effects of mefluoquine
- hallucinations
- seizures
How does P. Falciparum lead to cerebral malaria
- Falciparum causes RBC to become stickier
- Tendency to occlude small blood vessels
- Anoxic damage to vital organs
- Cerebral malaria
Which plasmodium causes black water fever
P. Falciparum
Describe black water fever
Severe haemolytic anaemia.
Causes increased bilirubin and haemoglobin casts due to kidney dysfunction
What do thick and thin blood smears show in malaria
o Thick: determine if they have malaria
o Thin: determine subspecies
Apart from tests to diagnose malaria, what other investigations should be done
- BM: check for hypoglycaemia
- FBC: anaemia + thrombocytopenia ( decreased platelets)
- U&Es: increase bilirubin, increased lactate dehydrogenase (from intravascular haemolysis)
Type of rash typical of typhoid
Non-blanching rose spots on chest
Other clinical features of typhoid
- Abdominal pain
- Bloody diarrhoea
- Peritonitis
- Malaise, arthralgia, anorexia
- Relative bradycardia (pulse disproportionately slow)
- Headache
Respi complications of typhoid
Typhoid lobar pneumonia
Haematology complications of typhoid
Haemolytic anaemia (increased risk if G6PD deficiency), severe toxaemia
CNS complications of typhoid
Meningitis, delirium, reduced GCS
GI complications of typhoid
Severe GI haemorrhage, perforation
Investigations for typhoid
- FBC: neutropenia, leukopenia, thrombocytopenia
- CRP
- U&Es
- LFTS: abnormal ALT
- Culture: blood, bone marrow, rose spot (diagnostic)
