Fever in Returned Traveller

Question 1

Main diagnosis of people coming back with fever?

Answer 1

Malaria
It represents about 70% of tropical infections

Question 2

Main cause of fever if travelled to SS Africa
To Latin America?
To Asia?

Answer 2

Malaria
Leptospirosis for Latin America
Dengue for SE Asia

Question 3

Pattern of fever helpful?

Answer 3

Continuous fever: malaria, Enteric fever, P knowelsi
Biphasic (saddleback)- Dengue, YF and Leptospirosis

Question 4

What are the rule in signs?

Answer 4

Eschar: Rickettsiosis
Chancre: Syphillis, trypanosomiasis
Rose spot: Enteric fever
Symmetrical arthritis: Chicunguyna
Conjunctival suffusion: Leptospirosis
Rash and conjunctivitis: Zika
Rash (White island, dead sea): Dengue
Anosmia: COVID-19

Question 5

Who are special groups of travellers?

Answer 5

Paeds (increased risk of diarrhoea and animal bites)
Elderly
Immunocompromised
Pregnant woman
Expats
VFR (often do not attend pre-travel consultation, local posture more important, more at risk of vaccine preventable infections)

Question 6

When is initial screening in a person with fever as a returned traveller?

Answer 6

If any signs of severity including haemorrhagic conditions
qSOFA score >2
Transmissable infection?
Rpaidly progressive?
Severe malaria?

Question 7

What should be included in your initial work up?

Answer 7

Blood cultures
Malaria tests
STI checks
Keep an acute serum
PCR resp viruses
Stool culture if you suspect Enteric fever

Question 8

Empirical treatment for
-Bacterial sepsis
-P Falciparum
-Meloidosis
-Rickettsiosis

Answer 8

-Broad spec abx
-Artesunate
-carbapenem or ceftazidime
-doxycycline

Question 9

Malaria back from endemic Country with undifferentiated fever

Answer 9

P Falciparum

Question 10

Trip to India/Nepal/Pakistan/Bangladesh with high fever, Brady, abdo pain

Answer 10

Enteric fever

Question 11

Fresh water exposure in Lake Malawi with fever, eosinophil and hepatomegaly

Answer 11

Schistosomiasis

Question 12

Mosquito bite in urban area in tropical country with fever, headache, myalgia, retro orbital pai, Rash and thrombocytopenia

Answer 12

Dengue

Question 13

Rafting in Thailand presents with fever, myalgia and Conjunctival icterus

Answer 13

Leptospirosis

Question 14

European holiday trekking in woods presents with fever and confusion

Answer 14

Tick born encephalitis

Question 15

Trip to South Africa, on safari

Answer 15

Rickettsiosis (tick borne)