Fever in the returning traveller Flashcards
Most tropical infections becomes symptomatic within [] days of exposure
21 days
- Fever AND travel to endemic area < 21 d - think ?
- Fever AND travel to endemic area < 21 d - think Viral Haemorrhagic Fever
When diagnosing malaria - what investigation must you do? [1]
must be excluded using peripheral blood smear testing for
the malarial parasite
Bladder calcfication is associated with
Dengue
Rickettsia fevers
Malaria
Chikungunya
Leptospirosis
Schistosomiasis
Bladder calcfication is associated with
Dengue
Rickettsia fevers
Malaria
Chikungunya
Leptospirosis
Schistosomiasis
First line treatment for malaria? [1]
IV artesunate or quinine
if severe
Typhoid and paratyphoid are caused by [] and [] (types A, B & C) respectively
Typhoid and paratyphoid are caused by Salmonella typhi and Salmonella paratyphi (types A, B & C) respectively
Describe how typhoid/paratyphoid are transmitted [1]
Describe common features [6]
typhoid is transmitted via the faecal-oral route (also in contaminated food and water)
Features:
* initially systemic upset
* relative bradycardia
* abdominal pain, distension
* constipation: although Salmonella is a recognised cause of diarrhoea, constipation is more common in typhoid
* rose spots: present on the trunk in 40% of patients, and are more common in paratyphoid
A patient presents with these spots on his chest.
He also complains of feeling unwell and abdominal pain. What is the most likely cause of infection?
Thyphoid - rose spots
present on the trunk in 40% of patients, and are more common in paratyphoid
If you suspect that someone has typhoid, where would there recent travel history be? [1]
Typical after SE Asia travel
Dengue fever is a viral infection that can progress to viral [] fever
Dengue fever is a viral infection that can progress to viral haemorrhagic fever
Dengue is transmitted by the [] mosquito
transmitted by the Aedes aegypti mosquito
Describe how patients with dengue fever can be classified [3]
dengue fever:
* without warning signs
* with warning signs
severe dengue (dengue haemorrhagic fever)
Describe the classic presentation of dengue fever [5]
- fever
- headache (often retro-orbital)
- myalgia, bone pain and arthralgia (‘break-bone fever’)
- pleuritic pain
- facial flushing (dengue)
- maculopapular rash
- haemorrhagic manifestations e.g. positive tourniquet test, petechiae, purpura/ecchymosis, epistaxis
What are the warning signs of dengue fever? [4]
abdominal pain
hepatomegaly
persistent vomiting
clinical fluid accumulation (ascites, pleural effusion)
Describe what is meant by severe dengue (dengue haemorrhagic fever) [2]
What do 20-30% of patients develop after ^? [1]
this is a form of disseminated intravascular coagulation (DIC) resulting in:
* thrombocytopenia
* spontaneous bleeding
* around 20-30% of these patients go on to develop dengue shock syndrome (DSS)
Describe what a chikungunya infection is like [1]
Tropical mosquito infection
Inc period 1-12 days
Causes severe arthralgia
Schistosomiasis, or bilharzia, is a parasitic flatworm infection. The three main species of schistosome are S. mansoni, S. japonicum and S. haematobium.
Describe the acute manifestations of infection
swimmers’ itch
acute schistosomiasis syndrome (Katayama fever)
* fever
* urticaria/angioedema
* arthralgia/myalgia
* cough
* diarrhoea
* eosinophilia
Schistosomiasis, or bilharzia, is a parasitic flatworm infection. The three main species of schistosome are S. mansoni, S. japonicum and S. haematobium.
Describe how a chronic infection of Schistosoma haematobium would present (hint - where do the eggs lay?) [3]
These worms deposit egg clusters (pseudopapillomas) in the bladder, causing inflammation.
The calcification seen on x-ray is actually calcification of the egg clusters, not the bladder itself.
Can cause an obstructive uropathy and kidney damage typically presents as a’swimmer’s itch’ in patients who have recently returned from Africa:
* frequency
* haematuria
* bladder calcification
Schistosomiasis, or bilharzia, is a parasitic flatworm infection. The three main species of schistosome are S. mansoni, S. japonicum and S. haematobium.
Describe you investigate a chronic infection of Schistosoma haematobium?
- for asymptomatic and symptomatic patients [2]
Investigation
for asymptomatic”
- patients serum schistosome antibodies are generally preferred
symptomatic patients:
- the gold standard for diagnosis is urine or stool microscopy looking for eggs
How do you treat
Schistosoma haematobium? [1]
single oral dose of praziquantel
Schistosomiasis, or bilharzia, is a parasitic flatworm infection. The three main species of schistosome are S. mansoni, S. japonicum and S. haematobium
Where do these effect? [2]
How can this present? [1]
These worms mature in the liver and then travel through the portal system to inhabit the distal colon
Their presence in the portal system can lead to progressive hepatomegaly and splenomegaly due to portal vein congestion.
A patient has recently been on holiday to Africa.
They show you a bite they have on their leg.
What is the most likely diagnosis for their fever
Dengue
Rickettsia fevers
Malaria
Chikungunya
Leptospirosis
Schistosomiasis
A patient has recently been on holiday to Africa.
They show you a bite they have on their leg.
What is the most likely diagnosis for their fever
Dengue
Rickettsia fevers
Malaria
Chikungunya
Leptospirosis
Schistosomiasis
Shows Eschar
A patient has recently been on holiday to Africa.
They show have an extreme itch and also a rash which is shown below.
What is the most likely diagnosis for their fever
Dengue
Rickettsia fevers
Malaria
Chikungunya
Leptospirosis
Schistosomiasis
A patient has recently been on holiday to Africa.
They show have an extreme itch and also a rash which is shown below.
What is the most likely diagnosis for their fever
Dengue
Rickettsia fevers
Malaria
Chikungunya
Leptospirosis
Schistosomiasis
chloroquine
every 48hrs
most common type of non-falciparum malaria
toxoid
