Microbiology 26: Fever In Returning Traveller

Question 1

List the 5 types of plasmodium that cause malaria ? Which is most common to cause malaria?

Answer 1

P.falciparum (MOST COMMON)
P.vivax
P.ovale
P.Malariae
P.knowlesi

Question 2

What is the initial treatment for non-falciparum malaria ?

What do you give after 1st Tx?

Answer 2

Chloroquine: for 3 days

Primaquine: for 14 days

Question 3

What must you test for before starting on primaquine?

What is a complication?

Answer 3

G6PD deficiency - primaquine can cause haemolysis

Splenic rupture

Question 4

How is malaria diagnosed ?

Answer 4

• Thick smear: screen for parasites
• Thin smear: identify species and quantify parasitaemia
• Rapid antigen test:

Question 5

List 3 side effects of quinine ?

Answer 5

• Cinchonism- dizzy, nauesues, vomiting
• Arrhythmias
• Hyperinsulinaemia

Question 6

List 2 features on blood film suggestive of falciparum malaria ?

Answer 6

Headphone shaped parasites in red cells
Red cells with more than 1 parasite in it

Question 7

What is the treatment of severe malaria (if around 20% parasitaemia)?

Answer 7

• IV artusanate (MAIN)
• (If not available then IV quinine)
• followed by artemisinin + lumefantrine

Question 8

Which disease presents with arthralgia, myalgia, retro-orbital headache, fever and rash (erythrodermic), conjunctival injection ?

Answer 8

Dengue

Question 9

Sphygmothermic dissociation is associated with which disease ? (When your Heart rate is relatively bradycardic for the high temperature)

Answer 9

Typhoid fever

NB give the high temp, you would expect a high HR, but in typhoid you have relative bradycardia (so it may be normal, but this is low/abnormal given the high temp)

Question 10

Rose spots are pathognomonic of which disease ?

Answer 10

Typhoid fever

Question 11

Which mosquito causes Dengue ?

Answer 11

AIDES

Question 12

list diseases mosquitoes can cause (6)

Answer 12

• malaria
• encephalitis
• dengue
• yellow fever
• west nile virus
• zika virus

Question 13

Features of malaria

Answer 13

• fevers: cyclical or continuous with spikes
• paroxysm- chills, high fever, sweats
• severe: end-organ damage

Question 14

treatment for MILD falciparum malaria (lower parasitaemia) (3)

Answer 14

• oral malarone (atovaquone + proguanil)
• artermisinin combination therapy (artemesin + lumefantrine)
• oral quinine (with doxy/clindamycin)

Question 15

hwta is the treatment of choice for severe malaria

Answer 15

IV artesunate

Question 16

list clinical features of dengue fever

Answer 16

• fever
• headache
• myalgia
• erythrodermic rash
• bleeidng
• hepatitis
• if severe - encephalitis, myocarditis
• can progress to dengue haemorrhagic fever/ dengue shock
• inv = serology, PCR
• treatment: supportive

Question 17

features of typhoid fever

Answer 17

• high fever, headache, rose spots, constipation, dry cough
• complications: GI bleeding, perforation, encephalopathy

Question 18

treatment for typhoid fever

Answer 18

• empirical ceftriaxone
• azithromycin

Question 19

features of infectious mononucleosis

Answer 19

• EBV/CMV
• tonsillar enlargement with exudates
• atypical lymphocytosis
• always consider HIV

Question 20

Organism spreading malaria

Answer 20

Anopheles mosquito

Question 21

Organism causing typhoid

Answer 21

Salmonella typhi or paratyphi

Gram -ve rod

Question 22

Rickettsial Disease

Features

Answer 22

• intracellular bacteria
• Invades endothelial cells causing a vasculitis
• Spotted fevers: RMSF, MSF, African tick bite fever
• Fever
• Headache
• Myalgia
• +/- Eschar (dead tissue that sheds or falls off from the skin)