Teaching Clinic: Returned Traveler Flashcards

1
Q
  • 34 M admitted to Medical Ward
  • Chinese; non-smoker, non drinker
  • Good past health
  • Fever, malaise for 3 days

What Hx should we ask?

A

TOCC
* Travel: N Thailand/Burma border 2 weeks ago
* Occupation: businessman
* Contact: no contact with febrile patient or animal
* Cluster: 2 friends and well

Ask for travel history for up to 1 year!

  • Dates of travel and duration of stay
  • Type of accomodation
  • Activities
  • Insect bite
  • Needle/ blood exposure
  • Sex Hx
  • Soil/ water contact
  • Chemoprophylaxis
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2
Q
  • 34 M admitted to Medical Ward
  • Chinese; non-smoker, non drinker
  • Good past health
  • Fever, malaise for 3 days

What Hx should we ask?

A

Malaria
Dengue fever
Tyhoid fever
Rickettsioses
Leptospirosis
Melioidosis

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3
Q

Mild jaundice
Splenomegaly
WCC 5000 Platelet 100,000 Hb 10.5 Aspartate transaminase (AST) 220 Bilirubin 60 Ustix: RBC +++

A

Plasmodium falciparum

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4
Q

Treatment of malaria

A
  • Artensunate / mefloquine combined treatment
  • No parasite seen on day of discharge
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5
Q

What are the different types of malaria?

A
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6
Q

Life cycle of Plasmodium

A
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7
Q

S/S of malaria

A
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8
Q

Pathophysiology of multi-organ failure of malaria

A
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9
Q

What physical sign will be present in some malaria patients?

A
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10
Q

P falciparum
- Usual location
- Sequalae

A
  • parasitemia > 5 %
  • altered consciousness or seizure oliguria
  • jaundice
  • severe normocytic anemia
  • hypoglycemia
  • organ failure
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11
Q

Treatment of P falciparum

A
  • Emergence of quinine resistant PF in SEA and central Asia (efflux pump)
  • Open-label study: mortality decreased by 1/3 with Artemisinin based therapy
  • Cardiotoxicity and hypoglycemia with quinine therapy
  • Recommend Artemisinin based therapy
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12
Q

Treatment: PV, PM & PO

A
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13
Q

Prevention on malaria

A
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14
Q

35M Policeman Mui Wo, Lantau Island Fever, headache, cough Splenomegaly, lymphdenopathy Shock and DIC ICU care

Dx

A

Rickettsiae disease  Chigger bites Weil Felix test +ve Specific Ab for O. tsutsugamushi +ve Doxycycline 100mg bd for 1 week

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15
Q

What is this?

40M Returned from Maine, US Fever, headache, myalgias Rash on left flank

A

Give doxycyline, amoxicillin, cefuroxime

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16
Q

What is Dengue?

A
17
Q

What is dengue fever primary infection?

A
18
Q

What happens in secondary infection of Dengue Haemorrhagic Fever?

A
19
Q
A