MI: Fever in the Returning Traveller Pt.2

Question 1

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

Answer 1

Dengue haemorrhagic fever and dengue shock - occurs in individuals who have previously been infected with a different dengue serotype and are then infected by another serotype

Question 2

List some diagnostic tests for dengue.

Answer 2

• Blood/urine PCR
• Serology (IgM 5-7 days)
• RDT

Question 3

How is dengue treated?

Answer 3

Identify those at risk of severe disease

Supportive

Question 4

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

Answer 4

Sphygmothermic dissociation

• typhoid,
• brucellosis,
• yellow fever,
• tularaemia

Question 5

What is typhoid fever caused by?

Answer 5

Salmonella typhi and paratyphi

Question 6

What type of organism is Salmonella typhi?

Answer 6

Gram-negative rod

Question 7

Outline the clinical features of typhoid fever.

Answer 7

• High prolonged fever (no rigors)
• Classical ‘pea green diarrhoea’
• Headache
• Relative bradycardia (sphygmothermic dissociation)
• Rose spots (rare)
• Constipation
• Hepatosplenomegaly
• Dry cough

Question 8

Describe the stages of typhoid?

Answer 8

1. Constipation, gradual rise in body temperature, relative bradycardia
2. Pesistant fever, hepatosplenomegaly, rose spots
3. GI bleeding, sepsis

Question 9

What is the incubation period of typhoid?

Answer 9

1-2 weeks

Question 10

List some complications of untreated typhoid.

Answer 10

• GI bleeding - congested Peyers patches
• Perforation
• Septicaemia
• Encephalopathy

Question 11

How is typhoid diagnosed?

Answer 11

• Cultures - stool, blood, bone marrow (rarely)
• Serology

Widel (RDT) - cheap but false positives

Question 12

What is the treatment for Typhoid?

Answer 12

Oral rehydration solution

Antibiotics

• Uncomplicated empirical - azithromycin
• Complicated - IV ceftriaxone

Question 13

What is mononucleosis caused by?

Answer 13

EBV or CMV

Question 14

What is a characteristic clinical feature of mononucleosis?

Answer 14

Tonsillar enlargement with exudates

Question 15

List some investigations for mononucleosis.

Answer 15

• Monospot
• IgM EBV/CMV

NOTE: always consider HIV

Question 16

What is a characteristic microscopic feature of mononucleosis?

Answer 16

Atypical lymphocytes

Question 17

What is leptospirosis and how is it spread?

Answer 17

Infection caused by Leptospira (spirochetes)

Commonly spread by rodents - associated with sewers and dirty water contaminated by rodent urine

Question 18

Describe the clinical presentation of leptospirosis

Answer 18

Weil’s - jaundice, renal failure, haemorrhage

Causes positive agglutination test - vascular

Question 19

How is leptospirosis diagnosed and treated?

Answer 19

Diagnosis

• PCR serum/urine/CSF
• Serology - IgM ELISA

Treatment

• Doxycycline
• Ceftriaxone
• Penicillin

Question 20

What is Lyme disease and how is it spread?

Answer 20

Infection by Borrelia
Spread by Ixodes ticks

Question 21

Describe the clinical presentation of lyme disease.

Answer 21

Question 22

How is Lyme disease diagnosed and treated?

Answer 22

Diagnosis

• Clinical
• ELISA
• PCR blood/CSF (imperfect)

Treatment

• Doxycyline
• Amoxicillin
• Ceftriaxone in neuroborreliosis

Question 23

What is lymphogranuloma venereum (LGV)?

Answer 23

STD caused by Chlamydia trachomatis (invasive serovars)

Sexual transmission then travels from innoculation site into lymphatic system

Question 24

Describe the clinical presenation of LGV

Answer 24

Question 25

How is LGV diagnosed and treated?

Answer 25

Diagnosis

• Serology
• Direct fluorscent antibody test
• PCR infected area/pus

Treatment

• Drainage of buboes/abscesses
• Antibiotics - doxycycline (1st), azithromycin (2nd)

(Contact tracing)