The Febrile Returning Traveller

Question 1

How can malaria be prevented?

Answer 1

• Bite avoidance (screens, netting, clothing, repellant)
• Chemoprophylaxis (mefloquine, doxycycline and malarone)

Question 2

What are the clinical features of malaria and how is it diagnosed?

Answer 2

• Clinical features include fever, malaise, headache, myalgia, diarrhoea, anaemia, jaundice, hepatosplenomegaly andnrenal impairment
• Diagnosis is done using thick blood film and antigen testing
• Thin blood film can identify the parasite

Question 3

What parasites are responsible for causing malaria? (bold is most severe and dangerous)

Answer 3

• Plasmodium falciparum (incubation of 7-14 days)
• Plasmodium vivax (incubation of 12-17 days)
• Plasmodium ovale (incubation of 15-18 days)
• Plasmodium malaria (incubation of 18-40 days)

Question 4

How is malaria treated?

Answer 4

• All patients with falciparum malaria should be admitted as they can deteriorate rapidly
• Oral options for uncomplicated malaria include:
  
  • Artemether with limefantrine (Riamet)
  • Proguanil and atovaquone (Malarone)
  • Quinine sulphate
  • Doxycycline
• IV options in severe or complicated malaria include:
  
  • Artesunate (most effective but not licensed)
  • Quinine dihydrochloride

Question 5

What organisms are responsible for causing typhoid?

Answer 5

• Salmonella typhi (incubation of 5-21 days)
• Salmonella paratyphi (incubation of 5-21 days)

Question 6

What are the clinical features of typhoid and how is it diagnosed?

Answer 6

• Clinical features include fever, myalgia, headache, cough, abdominal pain, constipation, diarrhoea, relative bradycardia and rectal bleeding
• Diagnosis using Hx, blood culture and stool culture

Question 7

How is typhoid treated?

Answer 7

• Quinolones, cephalosporins and azithromycin

Question 8

What are the clinical features of Dengue fever and how is it diagnosed?

Answer 8

• Clinical features include ‘Breakbone fever’, headache, fever, retro-orbital pain, arthralgia/myalgia, rash, cough, sore throat, nausea and diarrhoea
• Diagnosis from leucopenia, thrombocytopenia and transaminitis

Question 9

What is the maximum incubation period of VHF?

Answer 9

• 21 days

Question 10

What are the clinical features of VHF?

Answer 10

• Fever
• Non-specific
• Pharyngitis
• Conjunctival infection
• Chest pain
• Prostration
• Haemorrhage (petechiae, mucosal surfaces, haematuria etc.)
• Oedema
• Effusions
• ↓WCC
• ↓ platelets
• Prolonged PTT/APTT

Question 11

Complications of falciparum

Answer 11

• Cerebral malaria
• Seizures
• Reduced consciousness
• AKI
• Pulmonary oedema
• DIC
• Severe haemolytic anaemia
• Multi-organ failure and death