Microbiology 17 - Fever in the returning traveller

Question 1

Fever + Rash?

Answer 1

dengue, rickettsial, enteric fever

Question 2

fever + petechial rash in returning traveller, top ddx?

Answer 2

Dengue

Question 3

Rose spots

Answer 3

enteric fever (Salmonella typhi)

Question 4

fever in returning traveller + constipation?

Answer 4

Enteric fever/typhoid

Question 5

fever with onset >6 weeks after travel - which malaria?

Answer 5

Malaria vivax

Question 6

most severe and life threatening malaria type

Answer 6

Falciparum

Question 7

what are all the types of malaria infection?

Answer 7

Falciparum
Ovale
Vivax
Malariae
Knowlesi

Question 8

double-dotted rings/ more than one parasite per RBC = which malaria?

Answer 8

Falciparum

Question 9

Schuffner’s dots seen in which malaria?

Answer 9

Ovale and vivax

Question 10

Where is knowlesi commonly found? what do we worry about?

Answer 10

SEA

Behaves like falciparum so potentially life threatening

Question 11

Drug resistance developing in which malaria?

Answer 11

Falciparum

Question 12

what determines severity of malaria?

Answer 12

Parasitaemia

Question 13

Parasitaemia of what level suggests severe disease in a non-endemic area for malaria?

Answer 13

> 2%

Question 14

what is malaria paroxysm?

Answer 14

Fevere, chills and sweats

Question 15

diagnosis of malaria?

Answer 15

3 x thick and thin smears (Field’s or Giemsa)

Question 16

what are thick and thin smear used for?

Answer 16

thick: identify parasites
thin: identify species and QUANTIFY PARASITAEMIA

Question 17

treatment of non-falciparum malaria

Answer 17

chloroquine (3 days) + primaquine 14 DAYS (check G6PD)

Question 18

treatment of mild falciparum malaria

Answer 18

oral malarone or artemisinin combination therapies (ACT)

Question 19

treatment of severe falciparum malaria

Answer 19

IV - IV artesunate

Question 20

WHAT IS Primaquine particularly useful for?

Answer 20

to treat the liver stage of malaria, the hypnozoites

Question 21

blood sugars in severe falciparum malaria

Answer 21

HYPOGLYCAEMIA

Question 22

important SE of IV quinine

Answer 22

hyperinsulinaemia –> severe hypoglycaemia

Question 23

second line to IV artesunate

Answer 23

IV quinine

Question 24

undifferentiated fever with a rush/ sun-burn like rash = ?

Answer 24

Dengue fever

Question 25

what is the vector for dengue fever?

Answer 25

Aedes aegypti mosquito

Question 26

which conditions are caused by flaviviruses?

Answer 26

Dengue
West nile
Yellow fever

Question 27

main clinical features of dengue

Answer 27

Fever, headache (retro-orbital), arthralgia, erythrodermic rash
thrombocytopenia, lymphopenia

Question 28

where is dengue commonly from?

Answer 28

SEA

Question 29

What can Dengue fever progress to?

Answer 29

Dengue haemorrhagic fever and dengue shock (occur in pts previously infected with a different Dengue serotype)

Question 30

management of normal and severe dengue?

Answer 30

normal - self limiting

DHF/shock - have NO antivirals so just supportive treatment

Question 31

Investigations for Dengue

Answer 31

PCR blood/urine

Serology - IgM in 5-7 days

Question 32

relative bradycardia + fever in returning traveller = ?

Answer 32

Typhoid fever (A fever should normally send the pulse up)

Question 33

gram negative rod

Answer 33

salmonella typhi

Question 34

most common place for typhoid fever

Answer 34

India/ south Asia

Question 35

high prolonged fever + rose spots + constipation +headache +dry cough

Answer 35

enteric fever/ typhoid

Question 36

treatment of enteric fever

Answer 36

IV ceftriaxone then azithromycin (PO)

Question 37

Fever in a returning traveller + scabby looking lesions/ sloughy ulcer. What are they called? and what is the top Ddx?

Answer 37

Eschar

Rickettsial disease

Question 38

WHAT IS A COMplication of typhoid?

Answer 38

GI perforation as the bacterium is in the Peyer’s patches