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What 5 things are really important to ask in the history of returning traveller with fever?
- Travel history: where, dates, stay, activities, food and drink
- Insect bits
- Sexual, HIV exposure
- Vaccinations
- Malaria prophylaxis
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What type of organism is coccidiodes immitis? And where found?
- fungus
- soil in america mexico
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what problems does coccodiodes immitis cause?
Pneumonia
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What is Rx for coccodiodes?
Azoles or amphotericin
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Who gets worse infection with coccodiodes?
- Smoker
- Diabetic
- Immunosuppressed
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What incubation period does bacterial GE, dengue fever and tick typhus have?
< 1 week
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What is incubation period for malaria usually?
10-14 days
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What is incubation of typhoid?
7-14 d
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If you see anaemia in traveller what causes?
- Haemolysis: malaria or typhoid (so may be jaundiced)
- Blood loss: hookworm
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What do rose spots look like and indicate?
- Typhoid or paratyphoid
- (Pink spots on trunk)
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If a person is jaundiced, what may that indicate?
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What does an eschar indicate?
Tick typhus
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What may cause a petechial rash?
Haemorrhagic dengue fever
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What causes an urticarial rash?
- Loa loa if see with lymphoedema
- (type of filaria, african eye worm!)
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What do crusted ulcers healing by scarring indicate?
Cutaneous leishmaniasis
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Which test may you do if suspect wuchereria bancrofti (lymphatic filaria)?
Evening thick and thin blood films
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What investigation for typhoid?
Blood cultures
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Why may you do a hot stool or rectal scrape?
Amoebiasis
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If suspected schisto haematobium, what Ix and what time of day?
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Why may you want to do urine dip?
- Hb uria
- Blackwater fever – falciparum malaria
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What test is done for onchocerciasis?
Skin and eye snips
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Before giving quinine, what Ix needs to be done and why?
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What are 2 differentials for daytime insect bites?
- Dengue fever
- African trypanosomiasis
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What are 3 differentials for evening insect bites?
- Malaria
- Leishmaniasis
- Chagas disease= american trypanosomiasis
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Give 4 main causes of invasive travellers diarrhoea?
- Shigella
- E coli: EIEC, EAEC, EPEC
- Campylobacter
- Salmonella
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What are 2 main causes of non invasive travellers diarrhoea?
- Cholera
- ETEC – entero toxigenic e coli
- Both are watery stools
- Only give cipro to stop spread
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If you see haematemesis or malaena in a traveller – 2 differentials?
- VHF (lassa – west or ebola - central) – must isolate!
- DHF
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What are symptoms of infection with entamoeba histiolytica?
- ACUTE
- Bloody diarhoea
- Vomit
- Reduced appetite
- Low grade fever
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What is Rx of amoebic dysentry?
Metronidazole (or tinidazole)
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What are complicaitons of amoeba?
- Liver abscess – aspirate – anchovy sauce!
- Bowel ulceration, perforation, necorsis
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What are sypmtoms of liver abscess?
- Fever
- Hepatomegaly, RUQ pain, abnormal LFT
- Neutrophilia
- Raised hemidiaphragm
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Which test do you do to diagnose amoeba?
Serology
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What are symptoms of giardiasis?
- Chronic
- Watery explosive diarrhoea
- Steatorrhoea – malabsorption
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Which diarrhoea happens more in HIV pts?
Cryptosporidium parvum
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How do you diagnose cryptosporidium parvum?
- ZN stain on stool
- Tissue biopsy – red cysts
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What are main signs/symp of VHF?
- Fever
- Prostration
- Shock
- Organ failure
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What are the 2 types of VHF and where from in world?
- Lassa – west africa (nigeria)
- Ebola/marburg – central africa
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What spreads lassa fever?
Rat urine
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What is main aim of management of VHF?
Isolation
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What is katayama syndrome?
Acute schistosomiasis
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What are symptoms of katayama syndrome?
- Fever
- Headache
- Myalgia
- WHEEZE
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What is Rx of schisto?
Praziquantel and steroids
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What Ix do you do in schisto, why 2 different
- Faecal OCP – eggs of mansoni or japonicum
- Urine micro – haematobium
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Where is tyhpoid found – in world
- Poor areas, bad sanitation
- Street food vendors
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What type of fever does tyhpoid produce?
Enteric fever
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What is main difference between typhoid and paratyphoid?
Para is milder (main is para A)
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What are 3 main distinguishing features of enteric fever?
- Stepwise rising fever – above 40
- Relative bradycardia
- Rose spots
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Which test used to be done to detect tyhpoid but no longer is?
Widal test
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How is tyhpoid diagnosed?
- Blood/urine/stool culture
- Which salmonella causes gastroenteritis?
- Salmonella enteritidis
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What is the classical weekly pattern of enteric fever?
- Week1: fever, relative bradycardia, constipation (sometimes diarrhoea)
- Week2: signs - rose spots (maculopapular on trunk), hepatosplenomeg
- Week3: complicaitons - infect all organs – pericarditis, meningitis, pneumonia, cholecystitis…
- Week4: recuperation!
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What is first line Rx for tyhpoid?
- Ciprofloxacin but lots of resistance
- So Ceftriaxone 2g iv od after cultures sent
- Then azithromycin or cefixime PO 14 days
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What is the main sign of tick tyhpus? Describe?
- Eschar
- Ulcerated lesion with BLACK scar
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What is Rx for tick tyhpus?
- Doxycycline
- Not in children as tetracycline stain teeth and impair growth of bone and teeth
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What causes spread of dengue fever?
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What is special about the fever in dengue fever?
- Biphasic
- High for 5 days then may recurr to give 2nd peak
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What is another name for dengue fever?
- Breakbone fever
- As get muscle and joint pains
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What are skin features of dengue feveR?
Petechial rash or maculopapular
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What are 3 main features of dengue fever?
- Fever
- Rash – petechial
- Muscle and joint pain – breakbone disease
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What is different about FBC in dengue?
Low platelets
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Is dengue fever bacteruial or viral?
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How is dengue fever diagnosed?
Serology
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What is Rx for dengue fever?
Supportive Rx – ICU, blood products eg ffp
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What is main complication of dengue feveR?
- Dengue haemorrhagic fever
- Bleed skin gums GIT
- Get sepsis and shock
- Leads to: dengue shock syndrome
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What transmits african trypanosomiasis?
Tsetse fly
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What are 2 types of african tryp? Which is worse?
- East african – acute, fulminant course. Death in 1 yr
- West african – indolent subacute/chronic course
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What is main distinguishing feature of HAT?
Sleeping sickness
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What is the sign of lymphadenopathy in HAT?
Wintebottom sign
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What is Rx of HAT in stage 1 and 2?
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