The returning traveller and fever

Question 1

What are the most common worldwide diseases causing fever

Answer 1

Malaria
Dengue
Typhoid/enteric fever

Question 2

Where are rickettsial infecitons important

Answer 2

SE asia
Central asia
Sub saharan africa

Question 3

Golden questions in travel history

Answer 3

Have you ever been outside of the UK
When was the last time, before that, before that etc
Other parts of UK/country

Question 4

Travel history things to cover

Answer 4

Itinerary - dates, times, routes, mode of transport
Accomodation
Activities
Food
Sexual acitivity
Vaccinations/prophylaxis
Bed nets, insecticide, exposure to water and water source

Question 5

What to look for in a febrile traveller

Answer 5

Fever
Rash
Arthralgia
Gi symtpoms - abdo pain, diarrhoea, blood (constipation in typhoid fever)
Full systems review - urinary and neuro

Question 6

Investgiations febrile traveller

Answer 6

FBC, U+Es, LFTs
Coag
ABG/VBG
Blood cultures
Throat/sputum/urine/feaceal smaple for culture

Question 7

Specific tests for tropical fevers

Answer 7

Malaria films
Serology - rickettsiae, dengue, HIV, viral hepatitis, syphilis
PCR eg dengue (blood), herpes, enteroviruses (CSF), TB (not rapid or diagnostic)
Special stains - ZN/auramine (TB), grockott (fungi)
Special cultures - mycobacterial, fungal

Question 8

What alaways exclude in febrile traveller

Answer 8

Malaria with film

Question 9

When is acute PCR helpful

Answer 9

Acute dengue

Question 10

What febrile diseases tropical have a short incubation period <10 dyas

Answer 10

Influenza
Dengue
Yellow fever
Plague
Paratyphoid fever
Mediterranean spotted fever
African tick bite fever
Rocky mountain spotted fever

Question 11

Intermediate incubation period tropical diseases 10-21 dyas

Answer 11

Malaria
Viral haemorrhagic fevers
Typhoid
Scrub typhysu
Q fever
Afric trypanosomiasis
Relapsing fever - borrelia spp

Question 12

Long incbation period travel diseases >21 days

Answer 12

Malaria
Hep A,B,C,E (all excpt D)
Rabies
Schistosomiasis
Leishmaniasis
Amoebic liver abscess
TB
Filariasis
Brucellosis

Question 13

Viral causes of fever and rash from travel

Answer 13

Arboviruses - dengue, chikungunya
HIV seroconversion
herpes viruses - EBV, CMV
Measles
Viral haemorrhagic fever

Question 14

Bacterial causes of rahs and fever in returning travellers

Answer 14

Typhoid/paratyphoid
Meningococcal sepsis
Secondary syphilis
Mycoplasma

Question 15

Rickettsial causes of fever and rash in returning travellers

Answer 15

Spotted fevers
Murine typhus

Question 16

Protozoal causes of rash and fever in returning travellers

Answer 16

Malaria
Trypanosomiasis

Question 17

What would widespread macular rash with diarrhoea, fever and lymph node in traveller differentials be

Answer 17

SIRS - sepsis always consider
Virus - Arboviruses eg dengue, zika, chikungunya
EBV, CMV, HIV seroconcersion, measles
Toxin producing bacteria - Staph or group A strep
Rash - secondary syphilis, drug rection

Question 18

What is an arbovirus

Answer 18

Virus spread by ARthropod Borne

Question 19

Flavivirus examples

Answer 19

Zika
Dengue
Hep C

Question 20

aEDES mosquito how feed and breed

Answer 20

Day feeder, feed outdoors
Breed in standing water