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Immunology > Fever in the Returned Traveler > Flashcards

Flashcards in Fever in the Returned Traveler Deck (37):
1

What is the most important infection to rule out in a febrile traveler who has just returned from the Tropics?

MALARIA

2

Fever is most commonly seen in patients returning from what region?

Subsaharan Africa

3

Patients returning from what regions are the following Sx most commonly seen in:

Fever NYD:

Dermatologic Sx:

Acute diarrhea

Chronic diarrhea

Fever NYD: Subsaharan Africa

Dermatologic: Caribbean and South America

Acute Diarrhea: South Asian subcontinent

Chronic Diarrhea: Central America

4

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

5

What 5 vaccines are >90% effective?

What is the one vaccine that is 70% effective only?

>90%:
-Yellow fever
-hep A
-hep B
-meningococcal meningitis
-Japanese encephalitis


70%:
-Typhoid

6

What conditions have a short incubation period (21 days)?

Short:
-Dengue (3-5 d)***
-Typhus
-bacterial enteritis
-typhoid
-HIV
-SARS

Long:
-MALARIA*** (3 wks)
-viral hepatitis
-tuberculosis
-schistosomiasis

7

If a patient returns from the Tropics and has been back for >7 days and has fever what can we rule out?

Dengue

(3-5d incubation period)

8

What are examples for infections resulting from the following exposures:

-Freshwater wading, flooding

-Animal bites

-sexual contact

-unpasteurized dairy

-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

9

What are the 5 main infections seen after tropical travel?

-MALARIA
-Dengue fever
-Rickettsiosis
-Typhoid
-Mononucleosis

10

Where do most patients diagnosed with Malaria return from?

Subsaharan Africa

11

Where is most Typhoid from?

Indian subcontinent

12

Where is most Dengue from?

Caribbean and South East Asia

13

Fever from the tropics is _________ until proven otherwise?

Malaria

14

What mosquito transmits Plasmodium spp ?

the night-biting Anopheles mosquito

15

What are the two most common Malaria species (these 2 kill)?

1. falciparum (presents soon- KILLER)
2. vivax

16

What regions are falciparum and vivax milaria from?

-falciparum: Africa

-vivax: Asia

17

What are the thick and thin blood films used in Malaria helpful for in diagnosis?

-thick: sensitive, est. diagnosis

-thin: specific, for species identification

18

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)

19

What causes Dnegue?

Flavivrus (from day-biting Aedes mosquitoes)

20

Where is Dengue from usually?

Caribbean and SE Asia

21

What is the incubation period of Dengue?

3-5 days

22

What are the Sx of Dengue?

Fever, Headache (retroorbital pain), muscle and joint pain (50%)= break-bone fever, nausea/vomiting, rash, hemorrhagic manifestations

23

What is the most concerning complication of Dengue?

Hemorrhagic shock!

(severe manifestations usually seen in locals, while travelers have febrile illness)

24

How is Dengue diagnosed?

-leukopenia, thrombocytopenia

-inc IgM, 4x inc in IgG
-PCR testing

25

How is Dengue treated?

-fluid and electrolyte balance

-antipyretics

-avoid salicylates and NSAIDS

26

What causes Typhoid?

-Salmonella Typhi (bacterial infx, GN Bacillus )

27

How is Typhoid transmitted?

fecal-oral transmission

28

Where is Typhoid most commonly from?

South Asian peninsula (India)

29

What is often the only Sx of Typhoid?

Fever

30

How is Typhoid diagnosed?

blood culture: GRAM NEGATIVE ROD (BACILLUS)

31

What are the Rx for Typhoid?

-1st line: Ceftriaxone (IV)
-Azithromycin or Cefixime PO
-AVOID FLUOROQUINOLONES- resistant in S. Asia

32

What causes Rickettsiosis (Tick bite fever)?

R. africae, R.conorii from tick

33

Where is Ricketssiosis mostly frmo?

S Africa, India, Mediterranean

34

What are the Sx of Rickettsios?

fever, regional adenopathy, rash, tache noire (eschar)...self limited over 1-2 wks...mild illness usually

35

What is the hallmark of someone returning from African Safari with Rickettsiosis?

TACHE NOIRE= ESCHAR

36

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)

-Urinalysis (UTI)

-Chest x-ray (Pneumonia)

-Serology (dengue, ATBF)

37

What causes the following:

1. S. Asia trip, fever, GN Bacillus/bacteremia?

2. S Africa travel, cigarette burn lesion

3. Caribbean, SE Asia, fever within 3 days return, sore mm., better quick?

1. Typhoid

2. Rickettsia/ATBF

3. Dengue