Mi - Imported Fevers Flashcards by Lottie Barot

components of a good travel history (6)

where did you go - inc stop overs / rural vs urban / exact location
when did you go - inc sx onset
why did you go - holiday / VFR (visiting friends and relatives)
what did you do - activities / interactions
pre travel vaccines / malaria prophylaxis

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what is the incubation period of malaria

months

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what is the incubation period of viral haemorrhage fever

3 to 21 days

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what can exposure to tic bite put you at risk of

CCHF (VHF)
Lyme disease

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what can exposure to animal bites put you at risk of

CCHF (VHF)
MERS
rabies

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what can being on a cruise put you at risk of

Legionnaires (zircon)
norovirus

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what can freshwater activities put you at risk of

schistosomiasis
leptospirosis

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what can sexual contact put you at risk of

HIV
hep
PID

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what tropical diseases can you get from food /water

hep E
cholera

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what travel activity type puts you at greater risk of tropical diseases and why

visiting friends and relatives (VFR)
less likely to adhere to prophylaxis and more likely to do weird activities / eat weird foods

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54M fever, headache, rigors. UK national but visited Lagos 1 week ago VFR. Already had amoxicillin from GP but not helped. Dx?

malaria

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what can cerebral malaria present with

confusion

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Ix for malaria

FBC
CRP
U&Es
HIV
blood film - thick and thin
malaria rapid diagnostic test
blood parasitaemia

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what does malaria look like on blood film

‘headphones’ - 2 dots on one cell

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what Ix can show if malaria is severe or not

parasitaemia in blood

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who carries the biggest mortality burden of malaria

<5 y/o African children

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Africa has ___% of all malaria cases

95%

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how many strains of malaria are there

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what strain of malaria are 75% of cases

plasmodium falciparum

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where does p.falciparim invade in the body

RBCs

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what strain are 20% of malaria cases

p.vivax

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main stages of malaria lifecycle

mosquito stage
human stage - liver then RBC stage

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in which stage is asexual reproduction of malaria

RBC stage

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what features are part of a malaria risk assessment

geography
altitude - lower risk at high altitude
preg
urban vs rural - inc accommodation

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how can malaria be prevented

repellents nets prophylaxis

name 2 drugs that can be used as malaria prophylaxis

malarone mefloquine

when do people present post bite with malaria

10 to 15 days usually but can be months

what stage does vivax have that means people can present at any time

hypnozoite stage

what type of fevers do you usually get in malaria

cyclical or spiking

what is the malaria paroxysm

chills, high fevers and sweats

what 10 features indicate malaria is severe

high parasitaemia change in conciousness respiratory distress circulatory collapse metabolic acidosis renal or hepatic failure coagulopathy / DIC severe anaemia / intravascular haemolysis hypoglycaemia schizont on film

what is a schizont

multiple malaria dots on 1 cyst

what is classified as high parasitaemia in malaria

>2% or >5% in non imm

what is the purpose of the thick vs thin film in malaria

thick = see presence of any parasites thin = see the species of malaria present

what are the rapid malaria detection kits

lateral flow like test that you blob blood on and see if 1 or 2 lines become present

name 2 brands of rapid malaria detection kits

Paracheck-Pf OptiMAL-IT

Tx of non falciparum malaria

3d oral tabs chloroquine and 14d primaquine

what do you need to check before starting primaquine and why

G6PD - if deficient, get severe haemolysis

Tx for mild falciparum malaria

ACT / macarons

Tx for severe falciparum malaria

IV artesanate

3 features that make malaria mild

not vomitting parasitaemia <2% ambulatory

what advice is given to patients regarding taking ACT

eat with a high fat meal to improve absorption

3 additional Mx components of severe malaria

correct any hypoglycaemia cautious fluids daily parasitaemia then PO follow on with ACT

why should fluids only be given cautiously in severe malaria

avoid pulmonary oedema

side effects of artesemate

delayed haaemolysis

side effects of quinine

cinchonism arrhythmias hyperinsulinaemia

what is cinchonism

tinnitus and dizziness - specific in quinine OD

53M from Thailand, had visited Thailand 5/7 before Sx PC: fever, headache, arthralgia, rash No malaria prophylaxis O/E: conjunctival injection, sunburn rash which can leave a palm print on skin Dx?

Dengue fever

what transmits dengue

aedes aegypti mosquito

how many serotypes of dengue are there

what type of virus is dengue

flavivirus

if you recover from 1 type of dengue, what is your prognosis RE reinfections

lifelong immunity from that type can get cross reactivity with other types

where does dengue replicate and where does it migrate to

replicates in midgut migrates to salivary glands

2 risk factors for Dengue in terms of travel

day time > night time urban > rural

recovery time from dengue usually

1-2 weeks

incubation period of dengue

4-7 days

5 classic Sx of dengue

high fever retrorbital headache myalgia / arthralgia sunburn rash nausea and vomitting

what complication can occur once the fever has subsided in dengue

haemorrhage sx eg shock / haemetemesis / organ impairment

when should serology be done for dengue

after 5-7 days to get IgG/M

33F PC: fever, constipation, dry cough, abdominal pain, vacant expression Been to India 2/52 ago. O/E: high temp, normal HR, normal platelets, raised CRP Clear CXR, clear ECG Spiking fevers Culture shows gram - rods on day 3, which are flagellated. Dx?

salmonella typhi

would expect HR to be high if spiking a fever so this is worrying

'Himalayan peak temperatures'

malaria and dengue cause a low platelet count

classic with salmonella typhi

what are some salmonella typhi resistant to

cipro

how is salmonella typhi diagnosed

blood / BM / stool culture

how is salmonella typhi transmitted

faeco-oral route

is there an animal reservoir for salmonella typhi

how is salmonella typhi prevented

hand hygiene vaccine

salmonella typhi is ___x more likely in ____

10x in indian subcontinent

features of salmonella typhi fever

gradual, high, prolonged fever

other sx of salmonella typhi

rose spots (rare) headache constipation dry cough

3 stages of salmonella typhi sx

1 = fever with low / inappropriately normal HR 2 = extreme fatigue, delirium 3 = intestinal haemorrhage, encephalitis, resp complications

Mx of salmonella typhi

oral rehydration solution IV ceftriaxone follow on with oral azithromycin

what is the pre ABx fatality of salmonella typhi

10-20%

Mi - Imported Fevers Flashcards

(75 cards)