Microbiology 26: Fever In Returning Traveller Flashcards

1
Q

List the 5 types of plasmodium that cause malaria ?

A
P.falciparum
P.vivax
P.ovale
P.Malariae
P.knowlesi
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2
Q

What is the treatment for non-falciparum malaria?

What is important to check before treatment?

A

Acute:
Chloroquine 3 days (note not used in falciparum due to increased resistance)

Prevention of relapse:
Primaquine 30mg for 14 days
(particularly important for P. vivax)

Check G6PD levels before primaquine as it can lead to extensive heamolysis

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3
Q

How is malaria diagnosed ?

Which stains are used?

A

Rapid diagnostic test (Paracheck-PF and OptiMAL-IT)

Thick blood film = see if any parasites present (sensitive)
+
thin blood film = Gives you a closer look at what type of parasite/species + quantification of parasitaemia (specific?)

Stains used = Giemsa and Field’s stains

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4
Q

List 3 side effects of quinine ?

A

Cinchonism (quinine overdose) - dizzy, nausea, vomiting

Arrhythmias

Hyperinsulinaemia

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5
Q

List features on blood film suggestive of falciparum malaria ?

Plasmodium vivax and ovale?

A

Falciparum:

  • Maurer’s clefts
  • Headphone shaped parasites in red cells
  • Red cells with more than 1 parasite in it

Plasmodium vivax and ovale:
- Schuffner’s dots

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6
Q

What is the treatment of severe malaria ?

A

ABC approach

Correct hypoglycaemia

Hydration - careful to avoid overload

IV artusanate
(If not available then IV quinine)

Daily parasitaemia monitoring

F/U w/ PO antimalarials

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7
Q

Which disease presents with arthralgia, myalgia, retro-orbital headache, fever and rash ?

What else can present like this, what is the difference?

A

Dengue

Chikungunya - arthralgia is more severe in this case

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8
Q

What is Sphygmothermic dissociation?

List some causes

A

Sphygmothermic dissociation is the term used to describe a high temperature with a relatively normal heart rate

Causes: typhoid, yellow fever, brucellosis, tularaemia

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9
Q

Rose spots are pathognomonic of which disease ?

What is this disease caused by?

A

Typhoid fever

Salmonella typhi and salmonella paratyphi

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10
Q

Vector for Dengue ?

A

Aedes mosquito

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11
Q

What is ‘mild’ falciparum malaria?

Mx?

A

No vomiting + <2% parasitaemia

Mx:
1st line: PO Malarone OR Riamet (Artemisin Combination Therapies)

Other option: PO Quinine

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12
Q

Major complication of dengue? Who is at risk

A

Dengue haemorrhagic fever and dengue shock

This is more likely to occur in individuals that have previously been infected with another serotype - overactive reaction

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13
Q

Clinical course of dengue?

A
  1. Febrile phase (3-4 days)
    - Viraemia is high -> should do dengue PCR here
  2. Critical phase (4-7 days)
    - Patients may progress to shock, bleeding or organ impairment
    - Seroconversion begins (IgG and IgM rise)
  3. Recovery phase (7+ days)
    - Rising levels of IgM + IgG -> recovery
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14
Q

What type of organism if salmonella typhi?

A

Gram -ve rod

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15
Q

Vector that carries malaria?

A

Female Anopheles mosquito

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16
Q

What are the symptoms of dengue?

A

Fever
Headache
Myalgia
BLANCHING RASH -> Can become non-blanching

17
Q

What is the phrase “himalaya peak fevers” pathognemonic for?

A

Typhoid fever

18
Q

Recall some differentials for fever and rash in the returning traveller

A

Viral: dengue, chickungunya, measles

Bacterial: typhoid (look for rose spots)

19
Q

Recall some differentials for fever and abdo pain in the returning traveller

A

Typhoid fever (look for rose spots)

Amoebic liver abscess

20
Q

Recall some differentials for fever and cytopaenias in the returning traveller

A

Dengue

Chickungunya

Typhoid

Malaria

21
Q

Recall some differentials for fever and haemorrhage in the returning traveller

A

Viral haemorrhagic fevers (dengue/ ebola)

Meningococcaemia

22
Q

Recall a differential for fever and eosinophilia in the returning traveller

A

Schistosomiasis

23
Q

Recall some differentials for fever > 6 weeks post-travel in the returning traveller

A

Vivax malaria

Acute hepatitis

TB

Amoebic liver abscess

24
Q

Ix for Dengue?

A

Torniquet test - little haemorrhages where torniquet was due to thrombocytopaenia

Bloods:
FBC - leukopaenia, thrombocytopaenia
LFT - elevated
Albumin - may be low

PCR - febrile phase
Serology - critical phase

25
These are the clinical features of what condition? ``` Fever Headache Myalgia Erythrodermic rash Bleeding Hepatitis Severe: encephalitis, myocarditis ```
Dengue fever
26
What condition has the following presentation? ``` High prolonged fever Headache Rose spots - RARE Constipation Dry cough ``` Incubation perioid? Mx?
Typhoid fever 7-18 days Before sensitivites: Ceftriaxone (2g IV OD) OR Azithromyocin 7 days If fully sensitive: Ciprofloxacin
27
Typhoid vaccination effectiveness?
- only PARTIALLY protective against *S. typhi* | - but NO protection against *S. paratyphi*
28
Cause of mononucleosis? Characteristic clinical feature? microscopic feature?
EBV or CMV Tonsillar enlargement w/ exudates Atypical lymphocytes
29
Ix for mononucleosis?
Monospot IgM EBV/CMV NOTE: always consider HIV
30
What is 2nd most common febrile illness in returning travellers from africa?
Rickettsia - causes fever, headache, myalgia and eschar (from tick bite)
31
Which diseases are caused by mosquitos?
- Malaria - Elephantiasis - Dengue - Yellow fever - West Nile virus - Zika virus
32
Transmission of leishmaniasis? Where from?
Transmitted by phlebotomine sandflies Africa, middle east, america