What are some common conditions you should consider for fever in a return traveller?
- Time course <21 day incubation period: - 2/3 of malaria (falciparum) within 2 weeks - Dengue fever (break bone fever) - can be haemorrhagic - Enteric fever (thyphoid and parathyphoid) - systemic unwellness + abdo pain - treat with fluoroquinolones. - Rickettsial - spotted/thyphus fevers (ticks) mell >21 day incubation period - Malaria (p. vivax >6weeks) - TB - Acute viral hepatitis
What is the difference between complicated vs uncomplicated malaria?
- >2% parasite count - Too sick to sit upright or take medications - Parasitemia % >5% or in areas of high transmission >10% (different cut off because of baseline) - Cerebral - GCS drops, encephalopathy ○ At risk § Young/old § Post splenectomy § Comorbidities ○ Mortality is high untreated, treated 15-20% - ARDS, metabolic collapse, haemoglobinuria (blackwater fever), hepatic failure, severe anaemia, hypoglycemia and splenic rupture. Uncomplicated: - Swinging/cyclical fever (duration of fever free period) or random times - Tachycardia, tachpnoea - Headache, cough, anorexia, arthralgias/myalgias - Nonsepcific - Can have anaemia and thrombocytopenia - Mild coagulopathy - Elevation in urea and creatinine - Palpable spleen - Elevated bilirubin and jaundice - Investigations + for thick and thin <0.1
What is the treatment of malaria?
Treatment varies: Uncomplicated: - resistance to chloroquine (few areas, Haiti, Middle east and central america) - 2 drugs if not those regions: ○ Artemisinin combination therapies Complicated: - IV for 24 hours artesumate plus normal course of oral artemesinin - Paracetamol for pain
What is preventative advice for malaria?
- Pretravel consultation (avoid bites, light colours, repellant with Deet, fan or aircon) - Malrone - Proquanil - most expensive - Middle - methloqine - nightmares - Doxycycline - 2 days before and 4 weeks after (sun burns)