Fever in the returning traveller

Question 1

General approach

Answer 1

Travel history
Risk assess for highly infectious/life-threatening
Clinical exam
Danger signs
Malaria film

Question 2

Risk assessment

Answer 2

A
B
C
Screen for sepsis
Prevent transmissible infection

Question 3

Risk of transmission

Answer 3

Resp Symptoms
Vom + Diarr
Rash/skin infection/wound
Hospitalisation overseas
Haemorrhage
VHF risk

Question 4

Sub-Saharan Africa

Answer 4

Malaria
Dengue/Chikungunya
Rickettsiae
Enteric Fever (typhoid)
Acute schistosomiasis
Amoebic liver abscess
Meningococcus
Brucellosis
HIV

Question 5

Sub Saharan Africa main

Answer 5

Malaria
Dengue
Rickettsiae
Typhoid 
HIV
VHF (lassa, ebola)

Question 6

Viral haemorrhagic fever risk

Answer 6

Consider if- fever AND travel to endemic area <21days

Question 7

VHF initial management

Answer 7

Malaria film, clotted blood, EDTA blood
Isolation
Discuss with infectious diseases
Virologist
VHF PCR

Question 8

South + central asia

Answer 8

Dengue
Enteric fever
malaria
chikungunya
TB

Question 9

South east asia

Answer 9

Dengue 
enteric fever
chikungunya
malaria
leptospirosis

Question 10

Latin America + caribbean

Answer 10

Dengue/chik/zika
enteric fever
malaria

Question 11

Tick typhus

Answer 11

Bite

Question 12

Trypanosomiasis

Answer 12

Painful bite

Chancre

Question 13

Anthrax

Answer 13

Necrotic ulcer

Oedema

Question 14

Acute schistosomiasis

Answer 14

fresh/brackish water
2-12 weeks post exposure
Swimmer’s itch
eosinophilia

Question 15

Leptospirosis

Answer 15

Swimming/rafting in fresh water
<4wks exposure
Jaundice
conjunctival suffusion
liver/renal impairment

Question 16

Caves

Answer 16

Histoplasmosis
Rabies
Ebola

Question 17

Animal contact/bites

Answer 17

Rabies
Brucella
Q fever
VHF

Question 18

Unprotected sex

Answer 18

HIV
Syphilis
Viral hepatitis
Gonococcaemia
STi

Question 19

FBC- Lymphopenia

Answer 19

Viral
Dengue
Typhoid
HIV

Question 20

FBC- Low-normal WCC

Answer 20

Malaria
Viral
Typhoid
Rickettsial

Question 21

FBC- neutrophilia

Answer 21

Bacterial

Amoebic

Question 22

FBC- thrombocytopenia

Answer 22

Malaria
Dengue
Typhoid
Sepsis

Question 23

FBC- eosinophilia

Answer 23

Schisto
Fasciola
Filaria
Strongyloides
Allergy/drug reaction

Question 24

Malaria diagnosis

Answer 24

Thick and thin blood film

Rapid diagnostic tests detect Plasmodium spp. antigens

Question 25

Malaria + fluid

Answer 25

Cautious fluid resuscitation | 1-2ml/kg/hr

Question 26

Malaria treatment

Answer 26

IV artesunate IV quinine Oral therapy check blood film daily

Question 27

Malaria treatment- uncomplicated P falciparum

Answer 27

Malarone Riamet Quinine + oral therapy

Question 28

Malaria treatment- non falciparum

Answer 28

Chloroquine followed by primaquine | Check G6PD status

Question 29

Arbovirus infection

Answer 29

Febrile illness, haemorrhagic fever, encephalitis

Question 30

Dengue

Answer 30

3-14 incubation period Aedes spp. mosquitos Headache, myalgia, arthralgia, rash (initially erthyrodermic, then petechial)

Question 31

Dengue treatment

Answer 31

Simple analgesia- avoid NSAIDs | Fluid balance

Question 32

Chikungunya

Answer 32

Incubation 1-12 Fever + severe arthralgia PCR or IgM diagnosis Symptomatic relief, steroids

Question 33

Typhoid or Paratyphoid

Answer 33

Salmonella Typhi or Paratyphi Fever +++ GI bleeding, intestinal perforation + encephalopathy