PBL SEMINAR . FEVER IN A RETURNED TRAVELLER. OUR PATIENT CASE. Our patient is Jenny Randall , a 23 y.o. female student who presents to her local doctor with cough and fever having recently returned from a 3 week holiday. IMPORTANT. What’s common is common The diagnosis is
FEVER IN A RETURNED TRAVELLER
Our patient is Jenny Randall, a 23 y.o. female student who presents to her local doctor with cough and fever having recently returned from a 3 week holiday
until proven otherwise.
Definition: In adults: T>38.3 for>3 weeks with no known origin despite appropriate Ix.
With these history and examination findings, Jenny was sent home with a suspected viral URTI.
The next day, Jenny re-presents with continuing fevers, having taken her own temperature measuring 36.9 that morning.
Typical malarial fever patterns
- not necessarily useful diagnostically
THE BIG FOUR
STRAINS OF MALARIA
1) MOSQUITO VECTOR
3) ERYTHROCYTIC PHASE
Most countries in the tropics
Who is the most vulnerable?
Treatment alters slightly in severe malaria, and the primary treatment is a different artemesinin derivative
CNS: cerebral malaria
Renal: blackwater fever: haemoglobinuria + haemolysis + renal failure, uraemia (acute tubular necrosis)
Blood: severe anaemia (haemolysis, dyserythropoiesis, splenomegaly with sequestration and folate depletion)
Respiratory: acute respiratory distress syndrome (ARDS)
Metabolic: hyperglycaemia, metabolic acidosis
GI: diarrhoea, jaundice, splenic rupture haemorrhage
Other: shock/hypotension (especially with secondary bacterial infection), hyperpyrexia
- recognised by a decreased conscious state not a headache
- causes 80% of deaths from Malaria and will kill 15- 20% of the people who have it even with treatment
Non-cardiogenic Pulmonary Oedema
- caused by overhydration, increased permeability of pulmonary vessels in response to the infection or by the clogging of pulmonary microcirculation by infected red cells
- 50% mortality
- caused by dehydration, increased blood viscosity and the products of haemolysis
- adequate rehydration needed
Criteria for a poor prognosis:
The species of Malaria:
The number of parasites:
>5% of RBCs
HOW TO TAKE A HISTORY IN A RETURNED TRAVELLER
COUNSELLING A PROSPECTIVE TRAVELLER