Fever in returned traveller required immediate action if which 3 infections are suspected?
- faliparum malaria
- leptospirosis
- viral haemorrhagic fevers (VHF)
What factors increase risk of infection abroad?
Resource-poor settings (sanitation, infrastructure, HC)
Climate (unique vectors, high temp)
What important questions must be taken if someone has returned from abroad with an infection?
WHEN travelled (dates-incubation periods) & when ill
WHERE travelled (exact & previous travel)
WHY travelled (business vs safari etc)
Which tropical viruses present with a rash?
- Dengue fever
- HIV
- Rickettsia
Which tropical diseases present with diarrhoea?
- E.coli
- campylobacter
- salmonella
Which tropical diseases present with jaundice?
- Hep (A,E etc)
- Leptospirosis
Which type of infectious disease presents with eosinophilia?
Parasitic infection
How to test for Malaria (plasmodium)?
- clinical probability
- thick/thin blood films x3 - light microscopy
- Malaria antigen test / rapid diagnostic plasmodium proteins
- PCR plasmodium gene
Who is most at risk of malaria?
Sub-Saharan Africa (leading COD <5yo)
What is important in malaria control?
- vector control
(insecticide nets, housing, repellents, larvicide, reduce breeding sites, larvivorous fish) - better diagnosis
- effective treatment
- vaccine development
What are the clinical features of uncomplicated Malaria?
- fever
- myalgia
- headache
- vomiting
- pallor
- splenomegaly
How does severe malaria present in children?
Cerebral malaria
(impaired consciousness, reduced GCS/BCS<5, unable to sit/feed, seizures)
RDS
(Deep breathing, acidosis)
Severe anaemia
How does severe malaria present in adults?
- seizures, low GCS
- renal impairment (<0.4ml), low Cr
- acidosis, hypoglycaemia
- ARDS, pulmonary oedema
- anaemia, haemoglobinuria
- shock, DIC
How is malaria treated?
Uncomplicated PF - artemether +2nd
Complicated PF - IV artesunate
How does Dengue fever present?
‘Break bone’ disease
- fever, headache, retro-orbital pain, myalgia
- petechial rash / blanching erythema / maculopapular rash
- low plts, lymphopaenia
How to diagnose dengue fever
- clinical
- serology
- PCR
How does typhoid (‘enteric fever’) present? What are the serotypes?
- travel to countries with poor sanitation / contaminated food
- asymptomatic chronic carriers
Salmonella enterica - Typhi, Paratyphi ABC
!! Widespread AMR, vaccine partially effective
Name some tropical Protozoa
- Leishmaniasis
- African trypanosomiasis
- South American trypanosomiasis
Name three tropical worms
- schistosomiasis
- filariasis
- tapeworms
