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PATH FINAL > MI: Fever in the Returning Traveller > Flashcards

MI: Fever in the Returning Traveller Flashcards

1
Q

List some diseases caused by mosquitoes.

A
  • Malaria
  • Elephantiasis
  • Dengue
  • Yellow fever
  • West Nile virus
  • Zika virus
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2
Q

What is the vector for malaria?

A

Anopheles mosquito (female)

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3
Q

What are the five species of Plasmodium.

A
  • Plasmodium falciparum
  • Plasmodium vivax
  • Plasmodium ovale
  • Plasmodium malariae
  • Plasmodium knowlesi
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4
Q

Outline the life cycle of Plasmodium within humans.

A
  • Within humans there is an erythrocytic stage and an extra-erythrocytic stage
  • It reproduces within red blood cells and causes haemolysis
  • There is also a liver stage where the parasite lays dormant within the liver
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5
Q

List the components of malaria prevention.

A
  • Awareness of risk
  • Bite prevention
  • Chemoprophylaxis
  • Diagnose promptly and treat without delay
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6
Q

Describe the clinical features of malaria.

A
  • Cyclical or continuous fevers with spikes
  • Malria paroxysms - chills, high fever, sweats
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7
Q

List some clinical features of severe malaria.

A
  • High parasitaemia (technically >2% - but might not make people from Africa particularly ill) OR 1 schizont (cell with multiple parasites)
  • Altered consciousness
  • ARDS
  • Circulatory collapse
  • Metabolic acidosis
  • Renal failure
  • Hepatic failure
  • Coagulopathy
  • Severe anaemia
  • Hypoglycaemia
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8
Q

What is the main investigation for malaria?

A
  • Perform 3 thick and thin blood films
  • Thick - screening for parasites (sensitive)
  • Thin - identifying the species and quantifying the parasite (proportion of red cells that have been parasitised)
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9
Q

List two examples of malaria rapid antigen tests.

A

Paracheck-PF

OptiMAL-IT

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10
Q

Which stains are used for malaria?

A

Giemsa

Field’s

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11
Q

Outline the treatment options for non-falciparum malaria.

A
  • Chloroquine - 3 days
  • Primaquine - 30 mg for 14 days
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12
Q

What must you do before giving someone primaquine?

A

Screen for G6PD deficiency as primaquine can cause extensive haemolysis

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13
Q

What are the complications of non-falciparum malaria?

A

Very rare but there are reports of splenic rupture

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14
Q

What counts as ‘mild’ falciparum malaria?

A
  • Not vomiting
  • Parasitaemia < 2 %
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15
Q

Outline the treatment options for mild falciparum malaria.

A
  • First line = Artemisin combination therapy (ACT) e.g. Riamet (artemether-lumefantrine)
  • Occasionally oral malarone (atovaquone and proguanil)*
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16
Q

Outline the treatment of severe falciparum malaria.

A
  • ABCDE approch
  • Correct hypoglycaemia
  • Cautious hydration
  • Organ support if necessary
  • IV artesunate
  • Daily parasitaemia monitoring
  • Follow on with oral antimalarials
17
Q

Why is quinine not used in this situation?

A

Extensive side effects:

  • Cinchonism: tinnitus, dizziness, nausea and vomiting
  • Arrhythmias
  • Hyperinsulinaemia
18
Q

What is the vector for dengue?

A

Aedes mosquito

19
Q

Outline the clinical features of dengue.

A
  • Fever
  • Headache
  • Myalgia
  • Erythrodermic rash
  • Bleeding
  • Hepatitis
  • Severe: encephalitis, myocarditis
20
Q

What are the complications of dengue? In which circumstances does this tend to occur?

A
  • Dengue haemorrhagic fever and dengue shock
  • This occurs in individuals who have previously been infected with a different dengue serotype
21
Q

Which tropical virus is similar to dengue? What is a key difference?

A
  • Chikungunya
  • Arthralgia is more severe
22
Q

List some diagnostic tests for dengue.

A
  • Serology (IgM 5-7 days)
  • PCR
23
Q

How is dengue treated?

A

Identify those at risk of severe disease

Supportive

24
Q

Outline the clinical course of dengue.

A

Fever reduces after about 4-5 days

25
Q

What is the term used to describe a high temperature with a relatively normal heart rate? List some causes.

A
  • Sphygmothermic dissociation
  • Causes: typhoid, yellow fever, brucellosis, tularaemia
26
Q

What is typhoid fever caused by?

A

Salmonella typhi and paratyphi

27
Q

What type of organism is Salmonella typhi?

A

Gram-negative rod

28
Q

Outline the clinical features of typhoid.

A
  • High prolonged fever
  • Headache
  • Rose spots
  • Constipation
  • Dry cough
29
Q

What is the incubation period of typhoid?

A

7-18 days

30
Q

List some complications of typhoid.

A
  • GI Bleeding
  • Perforation
  • Encephalopathy
31
Q

What is the treatment for Typhoid?

A
  • Empirical ceftriaxone (2 g IV OD)
  • Azithromycin PO 500 mg BD 7 days
32
Q

What is mononucleosis caused by?

A

EBV or CMV

33
Q

What is a characteristic clinical feature of mononucleosis?

A

Tonsillar enlargement with exudates

34
Q

List some investigations for mononucleosis.

A
  • Monospot
  • IgM EBV/CMV

NOTE: always consider HIV

35
Q

What is a characteristic microscopic feature of mononucleosis?

A

Atypical lymphocytes

PATH FINAL (36 decks)

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