1 / 32

Fever of traveler return from tropical area (1)

HKCEM College Tutorial. Fever of traveler return from tropical area (1). Author Dr. Poon Kin Ming Oct, 2013. A case. 50/M, smoker, GPH C/O fever for 5 days Also has sore throat, cough, myalgia, poor appetite, chills, headache SOB, chest pain –ve

ilori
Download Presentation

Fever of traveler return from tropical area (1)

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. HKCEM College Tutorial Fever of traveler return from tropical area (1) Author Dr. Poon Kin Ming Oct, 2013

  2. A case • 50/M, smoker, GPH • C/O fever for 5 days • Also has sore throat, cough, myalgia, poor appetite, chills, headache • SOB, chest pain –ve • Seen GP once and just partial improvement • Recalled travel history to Thailand 10 days ago for a trip • Vitals stable

  3. What would you like to ask more in the history ?

  4. History • TOCC What does it stand for ? - Others symptoms ? • Chemoprophylaxis or vaccination before the trip • Mosquito bite / insect bite /animal contact • Onset of fever : Incubation period • Fever pattern

  5. On further history • Travel : Thailand for 4 days, noted fever 2 days after back to HK • Occupation : teacher • Contact / cluster –ve • No chemoprophylaxis or vaccination before the trip • Mosquito bite +

  6. Physical exam: • Alert, responsive • Temp 38.1C, Jaundice & pallor –ve • BP118/55mmHg, Pulse 88/min • RR 16/min , SpO2 98% on RA • Chest clear & no heart murmur • Pharynx congested + • A 1cm lymph node over L side of the neck • Maculopapular skin rash over the body, petechiae –ve • Neck stiffness –ve • Liver & spleen not palpable • Multiple joints pain but calf soft

  7. Measles-like skin rash • The rash consists of macular lesions that are red and usually 2–10 mm in diameter but may be confluent in places • Morbilliform refers to a rash that looks like measles http://upload.wikimedia.org/wikipedia/commons/9/91/Denguerash.JPG

  8. Patient with fever after return from tropical region • What is your differential diagnosis in general ?

  9. Diagnosis • Infectious diseases esp. tropical illness • Autoimmune diseases • Malignancy

  10. Infectious diseases that should not be missed

  11. What is tropical region?

  12. Continent visited

  13. Incubation periods

  14. Fever pattern

  15. Physical signs

  16. Clinical diagnosis • Dengue fever, • Infectious mononucleosis, • Influenza, • Rickettial infection, • Malaria, • Typhoid fever • Other non-infectious causes e.g. malignancy, auto-immune

  17. Patient’s progress – fever pattern

  18. Investigation • WCC : 3.9 (N : 4.5 -11x 10 9 /L) Differential count : neutropenia & lymphopenia • HGB :14.9 (N : 14 – 17.5 x 10 9/ L ) • Platelet : 100 (N: 150 – 450 x 10 9/ L) • INR normal • APTT prolonged to 42.1 sec • R/LFT normal • Malaria parasite –ve

  19. Progress – lab. result

  20. Dengue fever 登革熱 • A viral disease transmitted by the infected mosquito, Aedes aegypti (埃及伊蚊) • In HK, most abundant species is Aedes albopictus (白紋伊蚊) • 4 dengue virus serotypes • Most common serotype in HK is type 1 • A statutory notifiable diseases in HK • About 3-17 cases per year

  21. Aedes Aegypti 埃及伊蚊 www.giron.co.cu/es/noticia/social/lucha-contra-el-aedes-aegypti-alertas-en-todo-momento

  22. Dengue fever • Incubation period of dengue infection is 4 to 7 days • Fever usually lasts for 5 to 7 days • Another name : break bone fever • Clinical presentation ranges from non- specific febrile illness to severe life threatening conditions such as dengue hemorrhagic fever (DHF) & dengue shock syndrome (DSS)

  23. Dengue Hemorrhagic fever http://www.niaid.nih.gov/SiteCollectionImages/topics/denguefever/michaelRossmannStory.JPG

  24. Dengue fever 登革熱 • Dengue hemorrhagic fever (DHF) : Dengue fever + Hemorrhagic tendency + Plasma leakage (>20%) • Dengue shock syndrome : (DSS) DHF + shock + rapid pulse with narrow pulse pressure < 20mmHg

  25. Pathophysiology of DHF & DSS • Rarely occurs in primary infection as host develops life long immunity only against specific serotype • In secondary infection with another serotype, the a/b at primary infection cross reacts & forms complexes with viral antigen, which enhances the phagocytosis by mononuclear cells. • The virus replicates inside the cells, which release the vasoactive immune mediators causing DHF & DSS

  26. http://mednews.com/wp-content/uploads/dengue-virus-296x300.jpghttp://mednews.com/wp-content/uploads/dengue-virus-296x300.jpg

  27. Treatment • Mainly supportive • Steroid & antiviral agents not effective • Paracetamol as antipyretic agent • Avoid aspirin as worry of Rye’s syndrome • No vaccine available • Vector (mosquito) control

  28. Summary • Tropical infection, especially the Dengue fever, Malaria, Rickettsial diseases& Typhoid & Paratyphoid • Protection against the vector (mosquito) • Chemoprophylaxis against malaria before the trip

  29. Summary • Exclusion of life threatening infection or diseases with public health risk (e.g. measles, rubella) is the priority • Life threatening infections include Falciparum malaria, dengue haemorrhagic fever/ dengue shock syndrome, leptospirosis, infective endocarditis and meningoccocaemia.

  30. Any questions ?

More Related