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
- Malaria prophylaxis
What type of organism is coccidiodes immitis? And where found?
- soil in america mexico
what problems does coccodiodes immitis cause?
What is Rx for coccodiodes?
Azoles or amphotericin
Who gets worse infection with coccodiodes?
What incubation period does bacterial GE, dengue fever and tick typhus have?
< 1 week
What is incubation period for malaria usually?
What is incubation of typhoid?
If you see anaemia in traveller what causes?
- Haemolysis: malaria or typhoid (so may be jaundiced)
- Blood loss: hookworm
What do rose spots look like and indicate?
- Typhoid or paratyphoid
- (Pink spots on trunk)
If a person is jaundiced, what may that indicate?
What does an eschar indicate?
What may cause a petechial rash?
Haemorrhagic dengue fever
What causes an urticarial rash?
- Loa loa if see with lymphoedema
- (type of filaria, african eye worm!)
What do crusted ulcers healing by scarring indicate?
Which test may you do if suspect wuchereria bancrofti (lymphatic filaria)?
Evening thick and thin blood films
What investigation for typhoid?
Why may you do a hot stool or rectal scrape?
If suspected schisto haematobium, what Ix and what time of day?
Why may you want to do urine dip?
- Hb uria
- Blackwater fever – falciparum malaria
What test is done for onchocerciasis?
Skin and eye snips
Before giving quinine, what Ix needs to be done and why?
What are 2 differentials for daytime insect bites?
- Dengue fever
- African trypanosomiasis
What are 3 differentials for evening insect bites?
- Chagas disease= american trypanosomiasis
Give 4 main causes of invasive travellers diarrhoea?
- E coli: EIEC, EAEC, EPEC
What are 2 main causes of non invasive travellers diarrhoea?
- ETEC – entero toxigenic e coli
- Both are watery stools
- Only give cipro to stop spread
If you see haematemesis or malaena in a traveller – 2 differentials?
- VHF (lassa – west or ebola - central) – must isolate!
What are symptoms of infection with entamoeba histiolytica?
- Bloody diarhoea
- Reduced appetite
- Low grade fever
What is Rx of amoebic dysentry?
Metronidazole (or tinidazole)
What are complicaitons of amoeba?
- Liver abscess – aspirate – anchovy sauce!
- Bowel ulceration, perforation, necorsis
What are sypmtoms of liver abscess?
- Hepatomegaly, RUQ pain, abnormal LFT
- Raised hemidiaphragm
Which test do you do to diagnose amoeba?
What are symptoms of giardiasis?
- Watery explosive diarrhoea
- Steatorrhoea – malabsorption
Which diarrhoea happens more in HIV pts?
How do you diagnose cryptosporidium parvum?
- ZN stain on stool
- Tissue biopsy – red cysts
What are main signs/symp of VHF?
- Organ failure
What are the 2 types of VHF and where from in world?
- Lassa – west africa (nigeria)
- Ebola/marburg – central africa
What spreads lassa fever?
What is main aim of management of VHF?
What is katayama syndrome?
What are symptoms of katayama syndrome?
What is Rx of schisto?
Praziquantel and steroids
What Ix do you do in schisto, why 2 different
- Faecal OCP – eggs of mansoni or japonicum
- Urine micro – haematobium
Where is tyhpoid found – in world
- Poor areas, bad sanitation
- Street food vendors
What type of fever does tyhpoid produce?
What is main difference between typhoid and paratyphoid?
Para is milder (main is para A)
What are 3 main distinguishing features of enteric fever?
- Stepwise rising fever – above 40
- Relative bradycardia
- Rose spots
Which test used to be done to detect tyhpoid but no longer is?
How is tyhpoid diagnosed?
- Blood/urine/stool culture
- Which salmonella causes gastroenteritis?
- Salmonella enteritidis
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!
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
What is the main sign of tick tyhpus? Describe?
- Ulcerated lesion with BLACK scar
What is Rx for tick tyhpus?
- Not in children as tetracycline stain teeth and impair growth of bone and teeth
What causes spread of dengue fever?
What is special about the fever in dengue fever?
- High for 5 days then may recurr to give 2nd peak
What is another name for dengue fever?
- Breakbone fever
- As get muscle and joint pains
What are skin features of dengue feveR?
Petechial rash or maculopapular
What are 3 main features of dengue fever?
- Rash – petechial
- Muscle and joint pain – breakbone disease
What is different about FBC in dengue?
Is dengue fever bacteruial or viral?
How is dengue fever diagnosed?
What is Rx for dengue fever?
Supportive Rx – ICU, blood products eg ffp
What is main complication of dengue feveR?
- Dengue haemorrhagic fever
- Bleed skin gums GIT
- Get sepsis and shock
- Leads to: dengue shock syndrome
What transmits african trypanosomiasis?
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
What is main distinguishing feature of HAT?
What is the sign of lymphadenopathy in HAT?
What is Rx of HAT in stage 1 and 2?