Microbiology 26: Fever In Returning Traveller

Question 1

List the 5 types of plasmodium that cause malaria ?

Answer 1

P.falciparum
P.vivax
P.ovale
P.Malariae
P.knowlesi

Question 2

What is the treatment for non-falciparum malaria?

What is important to check before treatment?

Answer 2

Acute:
Chloroquine 3 days (note not used in falciparum due to increased resistance)

Prevention of relapse:
Primaquine 30mg for 14 days
(particularly important for P. vivax)

Check G6PD levels before primaquine as it can lead to extensive heamolysis

Question 3

How is malaria diagnosed ?

Which stains are used?

Answer 3

Rapid diagnostic test (Paracheck-PF and OptiMAL-IT)

Thick blood film = see if any parasites present (sensitive)
+
thin blood film = Gives you a closer look at what type of parasite/species + quantification of parasitaemia (specific?)

Stains used = Giemsa and Field’s stains

Question 4

List 3 side effects of quinine ?

Answer 4

Cinchonism (quinine overdose) - dizzy, nausea, vomiting

Arrhythmias

Hyperinsulinaemia

Question 5

List features on blood film suggestive of falciparum malaria ?

Plasmodium vivax and ovale?

Answer 5

Falciparum:

• Maurer’s clefts
• Headphone shaped parasites in red cells
• Red cells with more than 1 parasite in it

Plasmodium vivax and ovale:
- Schuffner’s dots

Question 6

What is the treatment of severe malaria ?

Answer 6

ABC approach

Correct hypoglycaemia

Hydration - careful to avoid overload

IV artusanate
(If not available then IV quinine)

Daily parasitaemia monitoring

F/U w/ PO antimalarials

Question 7

Which disease presents with arthralgia, myalgia, retro-orbital headache, fever and rash ?

What else can present like this, what is the difference?

Answer 7

Dengue

Chikungunya - arthralgia is more severe in this case

Question 8

What is Sphygmothermic dissociation?

List some causes

Answer 8

Sphygmothermic dissociation is the term used to describe a high temperature with a relatively normal heart rate

Causes: typhoid, yellow fever, brucellosis, tularaemia

Question 9

Rose spots are pathognomonic of which disease ?

What is this disease caused by?

Answer 9

Typhoid fever

Salmonella typhi and salmonella paratyphi

Question 10

Vector for Dengue ?

Answer 10

Aedes mosquito

Question 11

What is ‘mild’ falciparum malaria?

Mx?

Answer 11

No vomiting + <2% parasitaemia

Mx:
1st line: PO Malarone OR Riamet (Artemisin Combination Therapies)

Other option: PO Quinine

Question 12

Major complication of dengue? Who is at risk

Answer 12

Dengue haemorrhagic fever and dengue shock

This is more likely to occur in individuals that have previously been infected with another serotype - overactive reaction

Question 13

Clinical course of dengue?

Answer 13

1. Febrile phase (3-4 days)
   - Viraemia is high -> should do dengue PCR here
2. Critical phase (4-7 days)
   - Patients may progress to shock, bleeding or organ impairment
   - Seroconversion begins (IgG and IgM rise)
3. Recovery phase (7+ days)
   - Rising levels of IgM + IgG -> recovery

Question 14

What type of organism if salmonella typhi?

Answer 14

Gram -ve rod

Question 15

Vector that carries malaria?

Answer 15

Female Anopheles mosquito

Question 16

What are the symptoms of dengue?

Answer 16

Fever
Headache
Myalgia
BLANCHING RASH -> Can become non-blanching

Question 17

What is the phrase “himalaya peak fevers” pathognemonic for?

Answer 17

Typhoid fever

Question 18

Recall some differentials for fever and rash in the returning traveller

Answer 18

Viral: dengue, chickungunya, measles

Bacterial: typhoid (look for rose spots)

Question 19

Recall some differentials for fever and abdo pain in the returning traveller

Answer 19

Typhoid fever (look for rose spots)

Amoebic liver abscess

Question 20

Recall some differentials for fever and cytopaenias in the returning traveller

Answer 20

Dengue

Chickungunya

Typhoid

Malaria

Question 21

Recall some differentials for fever and haemorrhage in the returning traveller

Answer 21

Viral haemorrhagic fevers (dengue/ ebola)

Meningococcaemia

Question 22

Recall a differential for fever and eosinophilia in the returning traveller

Answer 22

Schistosomiasis

Question 23

Recall some differentials for fever > 6 weeks post-travel in the returning traveller

Answer 23

Vivax malaria

Acute hepatitis

TB

Amoebic liver abscess

Question 24

Ix for Dengue?

Answer 24

Torniquet test - little haemorrhages where torniquet was due to thrombocytopaenia

Bloods:
FBC - leukopaenia, thrombocytopaenia
LFT - elevated
Albumin - may be low

PCR - febrile phase
Serology - critical phase

Question 25

These are the clinical features of what condition?

Fever 
Headache 
Myalgia 
Erythrodermic rash 
Bleeding 
Hepatitis 
Severe: encephalitis, myocarditis

Answer 25

Dengue fever

Question 26

What condition has the following presentation?

High prolonged fever 
Headache 
Rose spots - RARE
Constipation 
Dry cough

Incubation perioid? Mx?

Answer 26

Typhoid fever

7-18 days

Before sensitivites:
Ceftriaxone (2g IV OD)
OR Azithromyocin 7 days

If fully sensitive:
Ciprofloxacin

Question 27

Typhoid vaccination effectiveness?

Answer 27

• only PARTIALLY protective against S. typhi

- but NO protection against S. paratyphi

Question 28

Cause of mononucleosis?

Characteristic clinical feature?

microscopic feature?

Answer 28

EBV or CMV

Tonsillar enlargement w/ exudates

Atypical lymphocytes

Question 29

Ix for mononucleosis?

Answer 29

Monospot
IgM EBV/CMV

NOTE: always consider HIV

Question 30

What is 2nd most common febrile illness in returning travellers from africa?

Answer 30

Rickettsia - causes fever, headache, myalgia and eschar (from tick bite)

Question 31

Which diseases are caused by mosquitos?

Answer 31

• Malaria
• Elephantiasis
• Dengue
• Yellow fever
• West Nile virus
• Zika virus

Question 32

Transmission of leishmaniasis?

Where from?

Answer 32

Transmitted by phlebotomine sandflies

Africa, middle east, america