Returning Traveler with Fever

Question 1

What are key areas to focus on in a history of a returning traveler with a fever?

Answer 1

• contacts
• where, how long for, when did symptoms start
• any bites - insects/animals
• any swimming/walking on beaches
• sexual contacts
• drugs/alcohol
• tattoos/piercings
• what accommodation
• food and drink
• vaccinations/prophylaxis/protection measures

Question 2

What organisms cause malaria?

Answer 2

• Plasmodium falciparum
• Plasmodium vivax
• Plasmodium ovale
• Plasmodium knowlesi
• Plasmodium malariae

Question 3

What is the treatment for malaria?

Answer 3

Severe:
IV artesunate (1st line)
IV quinine (2nd line)

Uncomplicated: 
Oral Riamet (1st line)
Oral Quinine + oral doxycycline/clindamycin (2nd line)

Question 4

What are the typical severe malaria clinical features?

What are the lab findings and signs of severe malaria?

Answer 4

• impaired consciousness (GCS below 11)
• prostration (extreme weakness/fatigue)
• convulsions (more than 2 in 24h)
• shock (SBP below 80mmHg)
• abnormal spontaneous bleeding
• BM below 2.2mmol/L
• metabolic acidosis
• normocytic anaemia
• haemoglobinuria
• more than 20% RBCs infected with parasites
• hyperlactaemia
• AKI
• pulmonary oedema
• high bilirubin

Question 5

What are the typical malaria symptoms?

Answer 5

• fever and chills
• rigors
• headache
• N + V, sometimes D
• jaundice and anaemia
• muscle pains

Question 6

What is enteric fever?

Answer 6

Tyhpoid/paratyphoid fever caused by Salmonella typhi/paratyhpi

Question 7

Sings and symptoms of enteric fever:

Answer 7

• fatigue
• headache
• diarrhoea/constipation
• anorexia
• relative bradycardia
• abdo pain
• rose spots (rash)
• dry cough
• hypotension

Question 8

What is the treatment of enteric fever?

Answer 8

Oral azithromycin 1g 1st day then 500mg daily afterwards (1st line)
IV meropenem 1g every 8 hours if unable to have oral (2nd line)

Question 9

What are the complications of enteric fever?

Answer 9

Intestinal bleeding and perforation with peritonitis

Question 10

What are other mosquito-borne infections, other than malaria?

Answer 10

• Dengue fever
• Yellow fever
• Chikungunya
• West Nile/Japanese encephalitis
• Zika virus
• Elephantiasis

Question 11

What are some vector-borne diseases (other than via mosquitos)?

Answer 11

• Lyme disease
• Rickettsial disease
• Leishmaniasis
• Human African trypanosomiasis (sleeping sickness)
• Relapsing fever

Question 12

What are some Zoonoses infections?

Answer 12

• Anthrax
• Bartonella
• Brucellosis
• Coxiella burnetii (Q fever)
• Leptospiosis
• Y pestis
• Toxoplasmosis

Question 13

What is viral haemorrhagic fever?

Answer 13

Severe, multi-organ disease where the endothelium is damaged and homeostasis is impaired. Hemorrhage is a complication that can be life-threatening.
Examples are Ebola, Dengue, Yellow Fever, Lassa fever