Teaching Clinic: Returned Traveler Flashcards
- 34 M admitted to Medical Ward
- Chinese; non-smoker, non drinker
- Good past health
- Fever, malaise for 3 days
What Hx should we ask?
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
- 34 M admitted to Medical Ward
- Chinese; non-smoker, non drinker
- Good past health
- Fever, malaise for 3 days
What Hx should we ask?
Malaria
Dengue fever
Tyhoid fever
Rickettsioses
Leptospirosis
Melioidosis
Mild jaundice
Splenomegaly
WCC 5000 Platelet 100,000 Hb 10.5 Aspartate transaminase (AST) 220 Bilirubin 60 Ustix: RBC +++
Plasmodium falciparum
Treatment of malaria
- Artensunate / mefloquine combined treatment
- No parasite seen on day of discharge
What are the different types of malaria?
Life cycle of Plasmodium
S/S of malaria
Pathophysiology of multi-organ failure of malaria
What physical sign will be present in some malaria patients?
P falciparum
- Usual location
- Sequalae
- parasitemia > 5 %
- altered consciousness or seizure oliguria
- jaundice
- severe normocytic anemia
- hypoglycemia
- organ failure
Treatment of P falciparum
- 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
Treatment: PV, PM & PO
Prevention on malaria
35M Policeman Mui Wo, Lantau Island Fever, headache, cough Splenomegaly, lymphdenopathy Shock and DIC ICU care
Dx
Rickettsiae disease Chigger bites Weil Felix test +ve Specific Ab for O. tsutsugamushi +ve Doxycycline 100mg bd for 1 week
What is this?
40M Returned from Maine, US Fever, headache, myalgias Rash on left flank
Give doxycyline, amoxicillin, cefuroxime