Traveller returning with Fever

Question 1

Key questions to ask for travel history?

Answer 1

• Which country and which regions
• Dates
• Urban or rural?
• Reason for travel - tourism, realtives etc
• Any special activities - scuba, mountaineering, caving?
• Risk exposures - sexual, poor quality water/food, insect bites/ticks, lake swimming, wildlife contact
• Vaccinations prior to travel?
• Malaria prophylaxis - if yes which drug, when started, any missed doses? still taking it?
• Did anyone else become ill?
• Were you unwell while away?

Question 2

Examination/assessment of travel disease

Answer 2

• Jaundice - malaria, hepatitis, leptospirosis
• Maculopapular rash - dengue, HIV,. syphilus
• Bloody diarrhoea - shigella, salmonella
• Hepatomegaly - enteric fever, leptospirosis, viral hepatitis
• Splenomegaly - malaria

Question 3

Investigations for traveller with fever

Answer 3

• FBC, LFT, U&Es
• Blood culture
• Malaria blood films - thick and thin
• HIV test
• Urine and stool culture
• CXR
• USS liver and spleen
• Serology for specific diseases eg dengue

Question 4

Infectious diseases common to sub-saharan africa

Answer 4

• Hepatitis A&B
• Typhoid
• Dengue
• Malaria
• Yellow fever
• Travellers diarrhoea - eg campylobacter, e-coli, norovirus etc

Question 5

Malarial treatment

Answer 5

• Notify PHE
• If pt taken prophylaxis, do not use same drug for treatment
• Artesunate, Chloroquine or Primaquine - antimalarial drugs, depending on severity of malaria

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