Travel History Flashcards
What are the common presentations in returning travellers?
Fever with or without localising symptoms or signs (diarhhoea, vomiting, rashes)
-most are self limiting but some can result in medical presentation
What are VFRs?
Why are they significant?
Visiting friends and relatives are disproportionately affected by the burden of imported infections => their immunity against it wanes after living here for a long time so they are affected more severely when they return to the endemic country
- malaria
- enteric fever (eg typhoid)
Where is malaria endemic?
Where is typhoid endemic?
Where is leptospirosis endemic?
Malaria => Subsaharan Africa but can be found everywhere
Typhoid => South East and Central Asia
Leptospirosis => South East Asia
What additional considerations would you make when taking a history
History of illness
- how long had they been overseas and how long has it been since they returned?
- accommodation
- food and water
- activities
- vaccinations beforehand (HepA, typhoid are endemic everywhere)
- sexual history
- think about what diseases are endemic/epidemic in the area
What investigations are vital in travellers, that you cannot afford to miss
Malaria screen
most common important thing to find
-incubation period of weeks to months
Describe the presentation of dengue fever
Mosquitos, wet and hot climates, normally self limiting, flavivirus
4-7 day fever with rash, muscle pain with GI symptoms
=> low platelets and WCC
May lead to haemorrhage but this is a rare complication
When can you rule out viral causes for gastro presentations
They have a very short incubation period of 1-3 days
-if they have present after this, very unlikely
What are 3 exposures that you must consider?
Insect bites, animal contact
What have you eaten
Sexual history
How may malaria present
- investigation findings
- how would you exclude it
- how would you manage this
Nighttime mosquito
Variable incubation period 8-14days
Flulike with N+V+D, abdo pain
Headphone parasites in RBCs
Low platelets, high bilirubin (RBCs breaking) with cyclical fever
Requires 3 blood films to exclude
IV artesunate, quinine
What are the complications of malaria?
Severe anemia Acute renal failure Bleeding/DIC Shock Pulmonary edema
Where would you get more info about endemic diseases in the region
NaTHNaC
Enteric fever
Bacterial infection, IP 6-30days
Fever, headache, abdo pain, N+C+D
Diagnosis by blood culture
What are the skin signs you might find in meningitis?
Koplik spots in mouth
Cigarette burn like rash
Non blanching rash
What diagnostic tests would you consider asking for
Blood cultures FBC, U&E, LFT, CRP Malaria film CXR Viral PCR, serology
Stool sample for parasites
