Microbiology 26: Fever In Returning Traveller Flashcards
List the 5 types of plasmodium that cause malaria ?
P.falciparum P.vivax P.ovale P.Malariae P.knowlesi
What is the treatment for non-falciparum malaria?
What is important to check before treatment?
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
How is malaria diagnosed ?
Which stains are used?
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
List 3 side effects of quinine ?
Cinchonism (quinine overdose) - dizzy, nausea, vomiting
Arrhythmias
Hyperinsulinaemia
List features on blood film suggestive of falciparum malaria ?
Plasmodium vivax and ovale?
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
What is the treatment of severe malaria ?
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
Which disease presents with arthralgia, myalgia, retro-orbital headache, fever and rash ?
What else can present like this, what is the difference?
Dengue
Chikungunya - arthralgia is more severe in this case
What is Sphygmothermic dissociation?
List some causes
Sphygmothermic dissociation is the term used to describe a high temperature with a relatively normal heart rate
Causes: typhoid, yellow fever, brucellosis, tularaemia
Rose spots are pathognomonic of which disease ?
What is this disease caused by?
Typhoid fever
Salmonella typhi and salmonella paratyphi
Vector for Dengue ?
Aedes mosquito
What is ‘mild’ falciparum malaria?
Mx?
No vomiting + <2% parasitaemia
Mx:
1st line: PO Malarone OR Riamet (Artemisin Combination Therapies)
Other option: PO Quinine
Major complication of dengue? Who is at risk
Dengue haemorrhagic fever and dengue shock
This is more likely to occur in individuals that have previously been infected with another serotype - overactive reaction
Clinical course of dengue?
- Febrile phase (3-4 days)
- Viraemia is high -> should do dengue PCR here - Critical phase (4-7 days)
- Patients may progress to shock, bleeding or organ impairment
- Seroconversion begins (IgG and IgM rise) - Recovery phase (7+ days)
- Rising levels of IgM + IgG -> recovery
What type of organism if salmonella typhi?
Gram -ve rod
Vector that carries malaria?
Female Anopheles mosquito
What are the symptoms of dengue?
Fever
Headache
Myalgia
BLANCHING RASH -> Can become non-blanching
What is the phrase “himalaya peak fevers” pathognemonic for?
Typhoid fever
Recall some differentials for fever and rash in the returning traveller
Viral: dengue, chickungunya, measles
Bacterial: typhoid (look for rose spots)
Recall some differentials for fever and abdo pain in the returning traveller
Typhoid fever (look for rose spots)
Amoebic liver abscess
Recall some differentials for fever and cytopaenias in the returning traveller
Dengue
Chickungunya
Typhoid
Malaria
Recall some differentials for fever and haemorrhage in the returning traveller
Viral haemorrhagic fevers (dengue/ ebola)
Meningococcaemia
Recall a differential for fever and eosinophilia in the returning traveller
Schistosomiasis
Recall some differentials for fever > 6 weeks post-travel in the returning traveller
Vivax malaria
Acute hepatitis
TB
Amoebic liver abscess
Ix for Dengue?
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
These are the clinical features of what condition?
Fever Headache Myalgia Erythrodermic rash Bleeding Hepatitis Severe: encephalitis, myocarditis
Dengue fever
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
Typhoid vaccination effectiveness?
- only PARTIALLY protective against S. typhi
- but NO protection against S. paratyphi
Cause of mononucleosis?
Characteristic clinical feature?
microscopic feature?
EBV or CMV
Tonsillar enlargement w/ exudates
Atypical lymphocytes
Ix for mononucleosis?
Monospot
IgM EBV/CMV
NOTE: always consider HIV
What is 2nd most common febrile illness in returning travellers from africa?
Rickettsia - causes fever, headache, myalgia and eschar (from tick bite)
Which diseases are caused by mosquitos?
- Malaria
- Elephantiasis
- Dengue
- Yellow fever
- West Nile virus
- Zika virus
Transmission of leishmaniasis?
Where from?
Transmitted by phlebotomine sandflies
Africa, middle east, america
