Malaria, Dengue, Typhoid

Question 1

Clinical signs of uncomplicated dengue fever

Answer 1

• Fever + rash + arthralgia (breakbone fever)
• Persistent N&V
• Lethargy or restlessness
• Retro-orbital pain
• Photophobia
• Lymphadenopathy

Question 2

Clinical signs of dengue haemorrhagic fever

Answer 2

• Severe fever
• Oedema
• Haematemesis, bleeding gums

Question 3

Management of uncomplicated dengue fever

Answer 3

• oral fluids

- paracetamol

Question 4

What anti-pyretics to avoid for dengue fever?

Why to avoid these?

Answer 4

Avoid aspirin, ibuprofen

Due to bleeding risk (dengue already causes haemolysis)

Question 5

What 3 features indicate severe dengue?

Answer 5

1. Severe plasma leakage (shock)
2. Severe bleeding (haematemesis)
3. Severe organ involvement (deranged LFTs, reduced GCS)

Question 6

What bedside test to do for dengue

Answer 6

Tourniquet test

Put tourniquet around limb, leave for a while, if petechiae form = positive

Question 7

What bloods to do for dengue

Answer 7

• FBC (high Hct, low WBC, low platelets)
• LFTs
• Dengue viral PCR
• IgG and IgM antibodies

Question 8

List the 5 types of malaria

Answer 8

1. falciparum
2. vivax
3. ovale
4. malariae
5. knowlesi

Question 9

Which is the most severe type of malaria

Answer 9

Falciparum

Question 10

Which patient groups are at risk for developing more severe malaria?

Answer 10

• pregnant women
• pts with absent/ poorly functioning spleen
• children
• elderly

Question 11

Name some malaria prophylaxis drugs

Answer 11

• Doxycycline
• Mefloquine
• Malarone
• Chloroquine

Question 12

Common side effects of doxycycline

Answer 12

• photosensitivity

- GI upset

Question 13

Rare but severe side effects of mefluoquine

Answer 13

• hallucinations

- seizures

Question 14

How does P. Falciparum lead to cerebral malaria

Answer 14

1. Falciparum causes RBC to become stickier
2. Tendency to occlude small blood vessels
3. Anoxic damage to vital organs
4. Cerebral malaria

Question 15

Which plasmodium causes black water fever

Answer 15

P. Falciparum

Question 16

Describe black water fever

Answer 16

Severe haemolytic anaemia.

Causes increased bilirubin and haemoglobin casts due to kidney dysfunction

Question 17

What do thick and thin blood smears show in malaria

Answer 17

o Thick: determine if they have malaria

o Thin: determine subspecies

Question 18

Apart from tests to diagnose malaria, what other investigations should be done

Answer 18

• BM: check for hypoglycaemia
• FBC: anaemia + thrombocytopenia ( decreased platelets)
• U&Es: increase bilirubin, increased lactate dehydrogenase (from intravascular haemolysis)

Question 19

Type of rash typical of typhoid

Answer 19

Non-blanching rose spots on chest

Question 20

Other clinical features of typhoid

Answer 20

• Abdominal pain
• Bloody diarrhoea
• Peritonitis
• Malaise, arthralgia, anorexia
• Relative bradycardia (pulse disproportionately slow)
• Headache

Question 21

Respi complications of typhoid

Answer 21

Typhoid lobar pneumonia

Question 22

Haematology complications of typhoid

Answer 22

Haemolytic anaemia (increased risk if G6PD deficiency), severe toxaemia

Question 23

CNS complications of typhoid

Answer 23

Meningitis, delirium, reduced GCS

Question 24

GI complications of typhoid

Answer 24

Severe GI haemorrhage, perforation

Question 25

Investigations for typhoid

Answer 25

• FBC: neutropenia, leukopenia, thrombocytopenia
• CRP
• U&Es
• LFTS: abnormal ALT
• Culture: blood, bone marrow, rose spot (diagnostic)