Fever In The Returning Traveller Flashcards

Question

What diseases commonly present with resp illness?

Answer 1

Influenza H5N1 H7N9 | Mers

Answer 2

Bites of anopheles mosquito

Answer 3

Falciparum- can cause severe malaria, more than 1 million death pa, 3-4000000 infected Ovale and vivax- can cause relapsing malaria Malariae Knowelsi- Borneo, severe and rapidly fatal disease

Answer 4

``` Travel Rural more than urban Low standard of sleeping accommodation Lack of preventative measures Long duration of stay ```

Answer 5

UK imported- 2000 a year 75% falciparum Africa- more than 90% falciparum 200-300 cases of severe malaria in UK, mortality up to 8 % Resistance to chloroquine of falciparum almost universal

Answer 6

7 days-3 months post exposure | Fevers, myalgia, headache, shivers/rigours, GI tract problems

Answer 7

thick and thin Takes at least 1 hour to perform and interpret At least 3 negative films over 48 hours, malaria unlikely Need parasite count and stage to assess severity

Answer 8

Rapid, simple to perform and interpret 10-100 times less sensitive than thick film in best hands May be positive in previously treated malaria PCR most sensitive but not routinely available

Answer 9

Mild- parastaemia, no schizonts Temp- less than 39 degrees No complications Severe- parastaemia, schizonts, non ambulant, Complications- shock, renal failure, pulmonary oedema, severe anaemia (Hb

Answer 10

Quinine 600 mg tds po plus doxycycline 100 mg od po 7 days or clinda 450 mg tds if pregnant

Answer 11

Nausea, deafness, tinnitus Complete 7 days of rx Monitor blood glucose

Answer 12

Riamet- 4 tabs at 0, 8,24,36, 48, 60 hours | Malarone- 4 tabs od for 3 days

Answer 13

IV quinine 20mg/kg over 4 hours loading dose (omit if taking oral quinine derivative (chloroquine, mefloquine) 10mg/kg IV tds to follow Arrhythmogenic and causes hypoglycaemia Cardiac and BM monitoring mandatory

Answer 14

Derived from plants Used by Chinese herbalists for more than 2000 years Synthetic derivatives: artesunate water soluble, artemether lipid soluble Highly effective antimalarials with rapid parasite clearance Recommended in combo with other drugs

Answer 15

More effective and better tolerated than quinine Effective against parasite ring forms, faster reduction in parastaemia Potentially reduces sequestration Benefit greater with higher parasite load Recommended as 1st line for severe malaria, not licensed in UK

Answer 16

Chloroquine effective For vivax and ovale give primaquine to eradicate hypnozoites Check g6pd level before giving primaquine and it is contraindicated in pregnancy and breastfeeding

Answer 17

Awareness of risk Bite prevention Chemo prophylaxis Diagnose promptly

Answer 18

``` Salmonella typhi, paratyphi Gram negative bacilli, acid tolerant Spread by contaminated food, water, unsanitary conditions No animal reservoir Incubation period- 7-14 days ```

Answer 19

``` Fever, stepwise Relative bradycardia Abdominal pain and colic Constipation Cough Rose spots Leukopenia, borderline thrombocytopenia Mild transamintis chronic carriage important for spread and persistance ```

Answer 20

``` Isolate patient Blood and stool cultures Inform lab of risk Stool culture positive in 90% in 1st week of illness More than 3 blood cultures Bone marrow and aspirate most sensitive ```

Answer 21

Start IV ceft and gentamicin if shocked Discuss with id Notify public health

Answer 22

Transmitted by aedes aegyptii and aedes albopictus Mosquitos Day time biting and prevalent in urban areas Short incubation 1 week Myalgia, break one fever, retro orbital pain Sunburn like rash

Answer 23

Defevescence around day 4-5 | Complications may also develop at this time

Answer 24

Exclude malaria Serology for dengue fever plus or minus PCR Generally uncomplicated, supportive rx Refer to infection specialist