Teaching Clinic: Returned Traveler Flashcards
- 34 M admitted to Medical Ward
- Chinese; non-smoker, non drinker
- Good past health
- Fever, malaise for 3 days
What Hx should we ask?
TOCC
* Travel: N Thailand/Burma border 2 weeks ago
* Occupation: businessman
* Contact: no contact with febrile patient or animal
* Cluster: 2 friends and well
Ask for travel history for up to 1 year!
- Dates of travel and duration of stay
- Type of accomodation
- Activities
- Insect bite
- Needle/ blood exposure
- Sex Hx
- Soil/ water contact
- Chemoprophylaxis
- 34 M admitted to Medical Ward
- Chinese; non-smoker, non drinker
- Good past health
- Fever, malaise for 3 days
What Hx should we ask?
Malaria
Dengue fever
Tyhoid fever
Rickettsioses
Leptospirosis
Melioidosis
Mild jaundice
Splenomegaly
WCC 5000 Platelet 100,000 Hb 10.5 Aspartate transaminase (AST) 220 Bilirubin 60 Ustix: RBC +++
Plasmodium falciparum
Treatment of malaria
- Artensunate / mefloquine combined treatment
- No parasite seen on day of discharge
What are the different types of malaria?
Life cycle of Plasmodium
S/S of malaria
Pathophysiology of multi-organ failure of malaria
What physical sign will be present in some malaria patients?
P falciparum
- Usual location
- Sequalae
- parasitemia > 5 %
- altered consciousness or seizure oliguria
- jaundice
- severe normocytic anemia
- hypoglycemia
- organ failure
Treatment of P falciparum
- Emergence of quinine resistant PF in SEA and central Asia (efflux pump)
- Open-label study: mortality decreased by 1/3 with Artemisinin based therapy
- Cardiotoxicity and hypoglycemia with quinine therapy
- Recommend Artemisinin based therapy
Treatment: PV, PM & PO
Prevention on malaria
35M Policeman Mui Wo, Lantau Island Fever, headache, cough Splenomegaly, lymphdenopathy Shock and DIC ICU care
Dx
Rickettsiae disease Chigger bites Weil Felix test +ve Specific Ab for O. tsutsugamushi +ve Doxycycline 100mg bd for 1 week
What is this?
40M Returned from Maine, US Fever, headache, myalgias Rash on left flank
Give doxycyline, amoxicillin, cefuroxime
What is Dengue?
What is dengue fever primary infection?
What happens in secondary infection of Dengue Haemorrhagic Fever?
