|
|
| (25 intermediate revisions by 4 users not shown) |
| Line 1: |
Line 1: |
| ==Fever==
| | *[[Fever in traveler]] |
| # get incubation period- if > 1mo, dengue, rickettsia, viral hem fvr less likely
| | *[[Eosinophilic fever]] |
| # cbc c diff, thick smear, lft, ua, blood/ stool cx, cxr, serologies for specific viruses
| | *[[Traveler's diarrhea]] |
| | *[[Travel skin conditions]] |
| | *[[Parasitic diseases]] |
|
| |
|
| ===Malaria===
| |
| # most imp cause of fvr
| |
| # plasmodium falciparum can be rapidly fatal and needs to be ruled out soon
| |
| # p falciparum from sub Saharan Africa, 90% of pt have sx within 1 mo of return
| |
| # p vivax- Asia and Latin, 50% pt have sx within 1 mo- 2% up to 1 yr out
| |
| # chemoprophylaxsis does not guarantee protection
| |
| # usually have fvr, but 10- 40% may not
| |
| # fvr q 48- 72 hr pathognomic of vivax, ovale, malariae infc
| |
| # can also have ha, cough, gi sx
| |
| # check thick smear initially and if neg, repeat in 12- 24 hrs
| |
| # thrombocytopenia and splenomegaly common
| |
| # p falciparum unpredictable- admit and monitor for hypoglycemia
| |
| # iv meds if renal, resp failure, ams, sx, shock, anemia, p falcip rbc load >4% in nonimmune pt
| |
|
| |
|
| ===Dengue===
| | '''External Links''' |
| #aedes mosquito in urban area
| | * [https://wwwnc.cdc.gov/travel Center for Disease Control and Prevention - Travelers' Health] |
| # incubate for 4- 7d, influenza like prodrome, fvr, ha, myalgia, LN, rash
| | * [https://wwwnc.cdc.gov/travel/notices Center for Disease Control and Prevention - Travel Health Notices] |
| # dengue shock syndrome and hem fvr rare in travelers- usually in pt c prev infc
| |
| # leukopenia, thrombocytopenia
| |
| # dx by 4x increase in acute/ conv titres
| |
| | |
| ===Rickettsia/ Typhus===
| |
| # fvr, ha, myalgia
| |
| # xmitted by arthropods/ ticks
| |
| # painless eschar at inoculation site imp clue
| |
| # camping, hiking in grassy/ scrub area
| |
| # regional LN, rash, leukopenia, thrombocytopenia
| |
| # dx clinically
| |
| # tx c tetracycline
| |
| # confirm serologically
| |
| | |
| ===Leptospirosis===
| |
| # fvr, myalgia, ha, rash
| |
| # conjuntival suffusion characteristic but not common
| |
| # exp to fresh water while rafting, kayaking
| |
| # biphasic illness with meningitis, uveitis, transminitis, proteinuria, hematuria
| |
| # tx c pcn or tetra
| |
| # confirm by serology
| |
| | |
| ===Typhoid Fever===
| |
| # fvr, ha
| |
| # visiting friends in India, Phillipines Latin
| |
| # abd pain, constipation, -diarrhea rare
| |
| # leukopenia, thrombocytopenia, dry cough, LN
| |
| # insidious onset unlike dengue or rickettsia
| |
| # dx by blood cx for salmonella enterica serotype typhi
| |
| # serology unreliable
| |
| # tx empirically with flouroquinolone or 3rd gen cephal
| |
| # vaccine partially effecive and breakthrough infc possible
| |
| | |
| ===Hemorrhagic Fever===
| |
| # meningococcemia, malaria, leptospirosis, rickettsia- all treatable with abx
| |
| # also untreatable viruses- dengue, yellow fvr- but hem forms rarely seen in travelers
| |
| # also consider Ebola and Lassa fever- public health hazard
| |
| # h/o visit to rural area or contact with ill people in endemic area
| |
| # usually 3 wk after exposure
| |
| | |
| ==CNS Changes and Fever==
| |
| # malaria, tb, typhoid fvr, rickettsia, poliomyelitis, rabies, viral (Japanese/ West Nile/ tick borne) encephalitis
| |
| # meningococcal meningitis assoc with Haj to Mecca
| |
| # eosinophilic meningitis assoc c coccidiomycosis or angiostrongyliasis- rat lung worm to brain
| |
| # trypanosomiasis by tsetse fly- Africal sleeping sickness- red chancre at site of fly bite, fvr, ha, myalgia going to meningoencephalitis. May see trypansosomes in smear in acute phase
| |
| | |
| ==Resp Sx and Fever==
| |
| # consider strep pneumonia, influenza, mycoplasma, legionella, tb
| |
| # Q Fever- coxiella burnetti- fvr, pna, hepatitis and animal exposure
| |
| # Lofflers syn- pulm infiltrates, eosinophilia from transient migration of larval helminthes through lungs
| |
| # Cough also seen in malaria, typhoid fvr, scrub typhus, dengue
| |
| | |
| ==Sex/ Blood Exposure and Fever==
| |
| # can have fvr without genital findings- hiv, syphilis (treponema pallidum) cmv, ebv, hep B
| |
| # also from tattoo, piercing, share razor, blood xfsn
| |
| | |
| ==Eosinophilic Fever==
| |
| # >400 per cubic mm
| |
| # due to blood CA or allergy or helminthic infc
| |
| # hookworm, ascariasis, strongyloides, schistosomiasis, filariasis, visceral larva migrans, trichinosis, cocci
| |
| # eval with stool for O&P
| |
| # serology
| |
| # blood smear
| |
| # skin snips for microfilariae
| |
| | |
| ==Diarrhea==
| |
| # most respond to antibiotics or antimotility agents
| |
| # as duration of diarrhea increases, higher chance of parasitic cause
| |
| # giardia, cryptosporidiosis, entamoeba, cyclospora
| |
| # dysentery if stool bloody, fvr or wbc in stool- invasive inflamm enteropathy
| |
| # has abrupt onset, metastatic lesions, reactive arthopathies, or campylobacter assoc guillain barre- maybe flouroquinolone resis esp in SE Asia
| |
| # amoebic dysentery insidious and can get amoebic liver abscess
| |
| # if do not find infc cause of dysentery, eval pt for IBD or CA
| |
| # prolonged diarrhea and malabsorption- giardia or tropical sprue- does not respond to removal of gluten from diet- tx with tetra and folate
| |
| # also consider postinfectious disaccharidase deficiency or irritable bowel dz
| |
| # if diarrhea starts >1 mo after travel- not caused by travel
| |
| # tx regular travelers diarrhea with fluids, antimotility agents, abx- fluoro or macrolide
| |
| # tx invasive enteropathy- bloody/ fvr- same but no antimotility agents
| |
| # if bloody stool but no fvr, consider enterhemorrhagic E coli- do not give abx since will get hemolytic uremic syndrome in kids
| |
| #examine stool if diarrhea invasive, persistent, unresponsive to standard tx or immune compromised
| |
| # if persistent diarrhea, give empiric flouro or macrolide or consid metronidazole for giardia- most common parasite
| |
| # try lactose free diet
| |
| # chronic diarrhea usually self limited within 1 yr
| |
| | |
| ==Skin Conditions==
| |
| ===Papules===
| |
| # insect bites- cluster or linear distribution
| |
| # scabies- if sex active or backpacker
| |
| # seabathers eruption- confined to skin covered by swim suit- jellyfish larvae trapped under cloth
| |
| # cercarial dermatitis- skin exposed to freshwater schistosomes or coastal water clam diggers itch
| |
| | |
| ===Sub Q Swelling and Nodules===
| |
| # myasis- skin invaded by fly larvae- like boil but with central opening in which larvae may hide
| |
| # tungiasis
| |
| # loa loa
| |
| # trypanosomiasis
| |
| | |
| ===Ulcers===
| |
| # pyoderma/ ecthyma- secondary staph cellulitits post bite
| |
| # leishmaniasis
| |
| # mycobacterium marinum
| |
| | |
| ===Linear and Migratory Lesions===
| |
| # cutaneous larvae migrans- by soil contact with dog/ cat feces
| |
| # photodermatitis
| |
| | |
| ==Source==
| |
| Mistry
| |
|
| |
|
| [[Category:ID]] | | [[Category:ID]] |
| | [[Category:Tropical Medicine]] |
