Fever in returning traveller.txt

  1. 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
  2. What type of organism is coccidiodes immitis? And where found?
    • fungus
    • soil in america mexico
  3. what problems does coccodiodes immitis cause?
  4. What is Rx for coccodiodes?
    Azoles or amphotericin
  5. Who gets worse infection with coccodiodes?
    • Smoker
    • Diabetic
    • Immunosuppressed
  6. What incubation period does bacterial GE, dengue fever and tick typhus have?
    < 1 week
  7. What is incubation period for malaria usually?
    10-14 days
  8. What is incubation of typhoid?
    7-14 d
  9. If you see anaemia in traveller what causes?
    • Haemolysis: malaria or typhoid (so may be jaundiced)
    • Blood loss: hookworm
  10. What do rose spots look like and indicate?
    • Typhoid or paratyphoid
    • (Pink spots on trunk)
  11. If a person is jaundiced, what may that indicate?
    • Malaria
    • Hepatitis
  12. What does an eschar indicate?
    Tick typhus
  13. What may cause a petechial rash?
    Haemorrhagic dengue fever
  14. What causes an urticarial rash?
    • Loa loa if see with lymphoedema
    • (type of filaria, african eye worm!)
  15. What do crusted ulcers healing by scarring indicate?
    Cutaneous leishmaniasis
  16. Which test may you do if suspect wuchereria bancrofti (lymphatic filaria)?
    Evening thick and thin blood films
  17. What investigation for typhoid?
    Blood cultures
  18. Why may you do a hot stool or rectal scrape?
  19. If suspected schisto haematobium, what Ix and what time of day?
    • Urine OCP
    • Midday
  20. Why may you want to do urine dip?
    • Hb uria
    • Blackwater fever – falciparum malaria
  21. What test is done for onchocerciasis?
    Skin and eye snips
  22. Before giving quinine, what Ix needs to be done and why?
    • ECG
    • Long QT
  23. What are 2 differentials for daytime insect bites?
    • Dengue fever
    • African trypanosomiasis
  24. What are 3 differentials for evening insect bites?
    • Malaria
    • Leishmaniasis
    • Chagas disease= american trypanosomiasis
  25. Give 4 main causes of invasive travellers diarrhoea?
    • Shigella
    • E coli: EIEC, EAEC, EPEC
    • Campylobacter
    • Salmonella
  26. 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
  27. If you see haematemesis or malaena in a traveller – 2 differentials?
    • VHF (lassa – west or ebola - central) – must isolate!
    • DHF
  28. What are symptoms of infection with entamoeba histiolytica?
    • ACUTE
    • Bloody diarhoea
    • Vomit
    • Reduced appetite
    • Low grade fever
  29. What is Rx of amoebic dysentry?
    Metronidazole (or tinidazole)
  30. What are complicaitons of amoeba?
    • Liver abscess – aspirate – anchovy sauce!
    • Bowel ulceration, perforation, necorsis
  31. What are sypmtoms of liver abscess?
    • Fever
    • Hepatomegaly, RUQ pain, abnormal LFT
    • Neutrophilia
    • Raised hemidiaphragm
  32. Which test do you do to diagnose amoeba?
  33. What are symptoms of giardiasis?
    • Chronic
    • Watery explosive diarrhoea
    • Steatorrhoea – malabsorption
  34. Who gets isospora belli?
    • HIV
    • Severe dirrhoea
    • Malab
  35. Which diarrhoea happens more in HIV pts?
    Cryptosporidium parvum
  36. How do you diagnose cryptosporidium parvum?
    • ZN stain on stool
    • Tissue biopsy – red cysts
  37. What are main signs/symp of VHF?
    • Fever
    • Prostration
    • Shock
    • Organ failure
  38. What are the 2 types of VHF and where from in world?
    • Lassa – west africa (nigeria)
    • Ebola/marburg – central africa
  39. What spreads lassa fever?
    Rat urine
  40. What is main aim of management of VHF?
  41. What is katayama syndrome?
    Acute schistosomiasis
  42. What are symptoms of katayama syndrome?
    • Fever
    • Headache
    • Myalgia
    • WHEEZE
  43. What is Rx of schisto?
    Praziquantel and steroids
  44. What Ix do you do in schisto, why 2 different
    • Faecal OCP – eggs of mansoni or japonicum
    • Urine micro – haematobium
  45. Where is tyhpoid found – in world
    • Poor areas, bad sanitation
    • Street food vendors
  46. What type of fever does tyhpoid produce?
    Enteric fever
  47. What is main difference between typhoid and paratyphoid?
    Para is milder (main is para A)
  48. What are 3 main distinguishing features of enteric fever?
    • Stepwise rising fever – above 40
    • Relative bradycardia
    • Rose spots
  49. Which test used to be done to detect tyhpoid but no longer is?
    Widal test
  50. How is tyhpoid diagnosed?
    • Blood/urine/stool culture
    • Which salmonella causes gastroenteritis?
    • Salmonella enteritidis
  51. 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!
  52. 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
  53. What is the main sign of tick tyhpus? Describe?
    • Eschar
    • Ulcerated lesion with BLACK scar
  54. What is Rx for tick tyhpus?
    • Doxycycline
    • Not in children as tetracycline stain teeth and impair growth of bone and teeth
  55. What causes spread of dengue fever?
    • Mosquitos
    • Daytime
  56. What is special about the fever in dengue fever?
    • Biphasic
    • High for 5 days then may recurr to give 2nd peak
  57. What is another name for dengue fever?
    • Breakbone fever
    • As get muscle and joint pains
  58. What are skin features of dengue feveR?
    Petechial rash or maculopapular
  59. What are 3 main features of dengue fever?
    • Fever
    • Rash – petechial
    • Muscle and joint pain – breakbone disease
  60. What is different about FBC in dengue?
    Low platelets
  61. Is dengue fever bacteruial or viral?
    • Viral
    • Flavivirus
  62. How is dengue fever diagnosed?
  63. What is Rx for dengue fever?
    Supportive Rx – ICU, blood products eg ffp
  64. What is main complication of dengue feveR?
    • Dengue haemorrhagic fever
    • Bleed skin gums GIT
    • Get sepsis and shock
    • Leads to: dengue shock syndrome
  65. What transmits african trypanosomiasis?
    Tsetse fly
  66. 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
  67. What is main distinguishing feature of HAT?
    Sleeping sickness
  68. What is the sign of lymphadenopathy in HAT?
    Wintebottom sign
  69. What is Rx of HAT in stage 1 and 2?
    • 1: Sumarin
    • 2: melarsoprol
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Fever in returning traveller.txt