FEVER IN RETURNED TRAVELLER - INFECTIOUS DISEASE

PromptImportant history in fever in returned traveller

ResponseTravel history - Where, uban/rurual, resort, air conditioning, duration. Animals/insects/water/food exposures
Prevention - Immunisations, Prophylaxis taken (Malaria), Mosquito protection, other exposures
Sexual history - sex workers, protection used
High risk activity - IVDU?
Fever history - Symptoms of current illness- symptom onset, cyclical fevers, rash, n/v/d, blood in stool, abdo pain, resp sx
Treatment history (self/MO)
General medical history

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PromptDifferential diagnosis of fever in returned traveler and investigations

ResponseTravel related

Malaria - Thick and thin films
Dengue fever - Serology for Dengue PCR
Typhoid - Blood/stool culture, serum for antibody testing
Ebola haemorrhagic virus - Serum PCR/Antigen testing

Region specific - Malaria, Dengue, other arboviruses (Barmah forrest, JEV)
High risk activities - STI, IVDU related

HIV seroconversion - HIV serology
Hepatitis - hepatitis serology

GIT - typhoid/paratyphoid, cholera, shigella, salmonella, E. Coli, Giardiasis
Viral hepatitis
Non exotic/Common infections - Viral/ RTI/Cellulitis

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PromptExamination findings in returned traveller and their common differential diagnoses

ResponseRash - Dengue, reckettsial infection, gonorrhoea, syphilis, brucellosis
Jaundice - hepatitis/leptospirosis
Lymphadenopathy - ricketsial infection, brucellosis, dengue
Hepatomegaly - Amoebiasis, hepatitis, leptosporidiosis
Petechiae - dengue, meningococcaemia
Meningism - Neisseria meningitidis, s. pneumoniae

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PromptInvestigations in returned traveller

ResponseFBC - ? malaria = anaemia
EUC - unwell/diarrhoea ? Deranged
LFT’s - ? Hepatitis
Blood culture
Malaria films - 3 sets. Thin and thick films
Falciparum antigen - 95% sensitive for PF

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