Flashcards in Fever in the Returned Traveler Deck (37):
What is the most important infection to rule out in a febrile traveler who has just returned from the Tropics?
Fever is most commonly seen in patients returning from what region?
Patients returning from what regions are the following Sx most commonly seen in:
Fever NYD: Subsaharan Africa
Dermatologic: Caribbean and South America
Acute Diarrhea: South Asian subcontinent
Chronic Diarrhea: Central America
What are the 5 things you want to know about when approaching diagnosis in a returned traveler?
1. Pre-travel prep (vaccines + malaria prophylaxis)
2. trip itinerary
3. epidemiology and exposure history
4. history and physical exam
5. lab tests according to differential diagnosis
What 5 vaccines are >90% effective?
What is the one vaccine that is 70% effective only?
What conditions have a short incubation period (21 days)?
-Dengue (3-5 d)***
-MALARIA*** (3 wks)
If a patient returns from the Tropics and has been back for >7 days and has fever what can we rule out?
(3-5d incubation period)
What are examples for infections resulting from the following exposures:
-Freshwater wading, flooding
-Freshwater wading (Schistosomiasis, leptospirosis)
-Insect bites: Malaria, dengue, rickettsiosis
-Animal bites: Rabies, Herpes B
-Sexual contact: HIV, syphilis, other STIs
-Unpasteurized dairy: Brucellosis, tick-borne, encephalitis
What are the 5 main infections seen after tropical travel?
Where do most patients diagnosed with Malaria return from?
Where is most Typhoid from?
Where is most Dengue from?
Caribbean and South East Asia
Fever from the tropics is _________ until proven otherwise?
What mosquito transmits Plasmodium spp ?
the night-biting Anopheles mosquito
What are the two most common Malaria species (these 2 kill)?
1. falciparum (presents soon- KILLER)
What regions are falciparum and vivax milaria from?
What are the thick and thin blood films used in Malaria helpful for in diagnosis?
-thick: sensitive, est. diagnosis
-thin: specific, for species identification
What are the main Malaria treatments?
1. *Malarone: atovaquone, proguanil (for uncomplicated malaria)
2. Chloroquine (non-falciparum spp, and facliparum spp. from chloroquine sensitive areas)
3. Artesunate (IV--> severe malaria, falciparum usually)
What causes Dnegue?
Flavivrus (from day-biting Aedes mosquitoes)
Where is Dengue from usually?
Caribbean and SE Asia
What is the incubation period of Dengue?
What are the Sx of Dengue?
Fever, Headache (retroorbital pain), muscle and joint pain (50%)= break-bone fever, nausea/vomiting, rash, hemorrhagic manifestations
What is the most concerning complication of Dengue?
(severe manifestations usually seen in locals, while travelers have febrile illness)
How is Dengue diagnosed?
-inc IgM, 4x inc in IgG
How is Dengue treated?
-fluid and electrolyte balance
-avoid salicylates and NSAIDS
What causes Typhoid?
-Salmonella Typhi (bacterial infx, GN Bacillus )
How is Typhoid transmitted?
Where is Typhoid most commonly from?
South Asian peninsula (India)
What is often the only Sx of Typhoid?
How is Typhoid diagnosed?
blood culture: GRAM NEGATIVE ROD (BACILLUS)
What are the Rx for Typhoid?
-1st line: Ceftriaxone (IV)
-Azithromycin or Cefixime PO
-AVOID FLUOROQUINOLONES- resistant in S. Asia
What causes Rickettsiosis (Tick bite fever)?
R. africae, R.conorii from tick
Where is Ricketssiosis mostly frmo?
S Africa, India, Mediterranean
What are the Sx of Rickettsios?
fever, regional adenopathy, rash, tache noire (eschar)...self limited over 1-2 wks...mild illness usually
What is the hallmark of someone returning from African Safari with Rickettsiosis?
TACHE NOIRE= ESCHAR
What are the tests performed/run for undifferentiated fever?
-CBC (low plts=malaria, low wbc=dengue/typhoid)
-Thick and thin blood films (malaria)
-Blood cultures (typhoid, other)
-Liver enzymes (viral hep, dengue)
-Chest x-ray (Pneumonia)
-Serology (dengue, ATBF)