Makindo Medical Notes

Related Subjects: |Fever in a traveller |Malaria Falciparum |Malaria Non Falciparum |Viral Haemorrhagic Fevers (VHF) |Lassa fever |Dengue |Marburg virus disease |AIDS HIV |Yellow fever |Ebola Virus |Leptospirosis | Crimean-Congo haemorrhagic fever |African Trypanosomiasis (Sleeping sickness) |American Trypanosomiasis (Chagas Disease) |Incubation Periods |Notifiable Diseases UK

Fever is defined as a body temperature over 38°C. Any patient who was in a malarial area within the past 3 months who presents with flu-like or more symptoms must be assumed to have falciparum malaria until proven otherwise. Needs urgent thick and thin films. Urgent treatment saves lives. Hours matter and patients can be dead by the time of the post take ward round so always ask about foreign travel and look for malaria if any doubts. Non-falciparum malaria can present up to 1 year after infection but falciparum rare after 3 months.

Key questions

• Malaria is the most common specific diagnosis in febrile returning travellers and must be excluded using peripheral blood smear testing for the malarial parasite
• To protect yourself and prevent an outbreak, always ask yourself does this patient need to be isolated?
• Consider the possibility of antimicrobial resistance if a patient with fever has recently travelled to Africa, Asia, or the Middle East, particularly if they were hospitalised

Important causes

• Malaria, dengue, enteric fever (typhoid and paratyphoid fevers)
• Rickettsial infections
• Ebola virus disease and Middle East respiratory syndrome (MERS).
• HIV seroconversion
• Schistosomiasis, leptospirosis

Systemic febrile illness with initial nonspecific symptoms

• Malaria, Arboviral infections (dengue, Zika, chikungunya)
• Typhoid fever, Rickettsia, spotted fevers, East African trypanosomiasis
• Acute HIV infection, Leptospirosis, Viral haemorrhagic fevers

Fever with central nervous system involvement

• Malaria, Meningococcal meningitis
• Arboviral encephalitis (e.g. Japanese encephalitis virus, West Nile virus)
• East African trypanosomiasis, Angiostrongyliasis, Rabies

Fever with respiratory symptoms

• Influenza, Bacterial pneumonia
• Acute histoplasmosis or coccidioidomycosis
• Legionella pneumonia, Acute Q fever
• Malaria, Tularemia, Pneumonic plague
• Middle East respiratory syndrome (MERS)

Fever and skin rash

• Arboviral infection (dengue, chikungunya, Zika)
• Measles, Varicella, Rickettsia, spotted fevers
• Typhoid fever, Parvovirus B19
• Mononucleosis (Epstein-Barr virus, cytomegalovirus)
• Acute HIV infection

Incubation period <14 days

• Malaria
• Arboviral infection (dengue, chikungunya, Zika, etc.)
• Rickettsia, spotted fevers
• Legionella
• Meningococcal disease
• Relapsing fever
• Middle East respiratory syndrome (MERS)

Incubation period 1-4 weeks

• Malaria, Leptospirosis, Enteric fever
• Acute HIV
• Mononucleosis: Epstein-Barr virus (EBV), cytomegalovirus (CMV)
• Bartonellosis
• Melioidosis
• Ebola virus disease, Lassa fever
• African trypanosomiasis

Incubation period several weeks to months

• Malaria, Acute schistosomiasis syndrome
• Amoebic liver abscess
• Hepatitis A and E
• Tuberculosis, Brucellosis
• Acute Q fever
• Visceral leishmaniasis
• Filariasis, Rabies

Suggested Tests

• FBC, DWCC, U&E, LFTs, Blood glucose
• Malaria: rapid antigen test and thick and thin malaria films which should be repeated after 12-24 hrs
• Aerobic and anaerobic blood cultures
• Urine microscopy and culture, Stool culture
• CXR, Abdominal USS
• HIV test, Serology as needed, Pregnancy test