Tropical disease in the child (malaria, typhoid, dengue) Flashcards
What vector transmits malaria?
Female anopheles mosquito
How common is malaria?
Over 40% of wolrd population live in an area where female anopheles mosquitos transmit malaria
Causes over 300,000 child deaths in Africa each year due to Plasmodium falciparum
What are the clinical features of malaria?
Fever (often not cyclical)
Diarrhoea
Vomiting
Flu-like symptoms
Jaundice
Anaemia
Thrombocytopenia
What is the incubation time?
Typically onset is 7-10 days after inoculation
But infections can present months later (depending on Plasmodium species)
What are the complications of malaria in children?
Severe anaemia - especially common in children
Cerebral anaemia
How is malaria diagnosed?
Thick and thin blood films - species (falciparum, vivax, ovale, malariae, or knowlesi) is confirmed on a thin blood film. Repeated films may be necessary.
Rapid diagnostic tests (RDT) - can also be used
What is the management of uncomplicated and severe falciparum anaemia?
If uncomplicated P. falciparum disease:
- Artemisinin combination therapy (such as artemether with lumefantrine or artenimol with piperaquine phosphate)
- Quinine is second line (usually given with an antibiotic)
If severe P. falciparum disease:
- Parenteral artesunate then after at least 24 hours treatment, switch to oral artemisinin combination therapy
- Supportive care +/- intensive care
Notify all cases to the local Health Protection Team (HPT)
What is the management of non-falciparum malaria?
If non-Falciparum malaria (Plasmodium vivax and less commonly by P. ovale, P. malariae, and P. knowlesi):
- Artemisinin combination therapy (such as artemether with lumefantrine) or chloroquine
What are the presenting features of typhoid in children?
- Worsening fever
- Headaches
- Cough
- Anorexia
- Malaise
- Myalgia
- GI symptoms (constipation or diarrhoea) but may not appear until the second week
- Splenomegaly
- Bradycardia
- Rose coloured spots on the trunk
What is the cause of typhoid?
Infection with Salmonella typhi or paratyphi
What are the complications of typhoid?
- GI perforation
- Myocarditis
- Hepatitis
- Nephritis
- Infection with multi-drug resistant strains particularly from Indian subcontinent
What is the management of typhoid?
- Supportive care: IV fluids and antipyretics
- Suspected: Ceftriaxone and azithromycin
-
Known:
- Ciprofloxacin 7d treatment
- If no response after 4/5d of treatment add azithromycin
- If encephalopathic, add high-dose dexamethasone
What are the clinical features of Dengue fever?
Fine erythematous rash - after resolution of this rash a secondary rash with desquamation may occur.
Myalgia
Arthralgia
High fever
What is the management of dengue?
Notifiable disease
-
WHO group A (no warning signs)
- Tolerating adequate fluid volume, passing urine every 6hrs –> sent home
- Rest and take oral fluids (rehydration products)
- Monitor for warning signs
- Paracetamol and tepid sponging can be used to reduce fever
-
WHO group B (developing warning signs)
- Hospital admission
IV/oral fluids - Monitor for progression of warning signs
- Discharge once patient is afebrile for >48hrs
- Hospital admission
-
WHO group C (established warning signs)
- Hospital admission to ICU
- Consider blood transfusion
- IV 0.9% NaCl: maintenance + 5% fluid deficit
- 100ml/kg for first 10kg
- 50ml/kg for second 10kg
- 20ml/kg for >20kg
- Monitoring for worsening signs
- Investigation for other causes
- Discharge once patient is afebrile for >48hrs
What is the pathophysiology of dengue haemorrhagic fever? What is the management?
AKA dengue shock syndrome
Occurs when a person previously infected becomes infected with a different strain of the virus.
The partially effective immune response augments the severity of infection causing severe capillary leak syndrome leading to hypotention as well as haemorrhagic manifestations.
With fluid resuscitation most children recover fully.
