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A traveller returned from Southeast Asia

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As a rough rule if first symptoms came on more than 21 days after leaving an area ... Mite borne typhus. Fever, headache, usually rash. ... – PowerPoint PPT presentation

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Title: A traveller returned from Southeast Asia


1
A traveller returned from Southeast Asia
  • Glasgow, 2008
  • Chris Whitty, Hospital for Tropical Diseases

2
Question 1- where have you been?
3
(No Transcript)
4
Q2. When did you get back?
  • As a rough rule if first symptoms came on more
    than 21 days after leaving an area
  • -almost all tropical viruses (barring HIV) and
  • -most imported bacteria (eg typhoid) and
  • -some parasites
  • are ruled out.

5
Question 3. Is it malaria?
  • Nothing rules malaria in, nothing rules it out.
  • Except a test for malaria

6
Question 4. Do they have a rash?
  • Or other useful symptoms or signs such as
  • Jaundice
  • Cough
  • Diarrhoea
  • A palpable spleen

7
Southeast Asia- acute fever
  • Malaria variable. Often vivax.
  • Typhoid/paratyphoid relatively common
  • Dengue (generally a rash)

8
Melioidosis
  • High mortality
  • In adults- suspect with renal disease, diabetes,
    exposure in northeast Thailand
  • In children suspect with parotitis.
  • May be delayed presentation
  • Splenic abscesses highly suggestive

9
Question- where have you been?
10
Mite borne typhus
  • Fever, headache, usually rash.
  • Can be a serious disease (more so than classical
    typhus)
  • Eschar, or rash, from Laos suggestive, if jungle
    exposure.

11
  • 115 (27) of 427 adults with negative blood
    cultures admitted to Mahosot Hospital in
    Vientiane, Laos.
  • 63 cases of septicemic melioidosis and 206
    patients with other community-acquired
    septicemias were documented during a 1-y period
    in Ubon.
  • Malaria highly regional

12
STIs- always with us
  • Some go to SE Asia for sex, and many more take
    the risks (and partners) casually.
  • HIV, syphilis common problems.
  • AIDS presentations from SE Asia often different
    from Europe.

13
Fever and rash- consider
  • HIV seroconversion (or established AIDS)
  • Secondary syphilis
  • Dengue
  • Typhus (from Laos mainly)
  • Other arboviruses
  • Sunburn

14
Fever and jaundice
  • Malaria
  • Leptospirosis
  • Ascending cholangitis
  • Hepatitis- only if other causes excluded.

15
Time- late, or long
16
Fever that comes on gt21 days
  • Malaria
  • Amoebic liver abscess
  • TB
  • Brucellosis
  • Melioidosis
  • HIV and asscociated infections
  • (Katayama syndrome)

17
Chronic fevers
  • Consider funny bugs-
  • Malaria, TB, Brucellosis, HIV
  • Bugs in funny places
  • Abscess (inc melioidosis), endocarditis,
    osteomyelitis
  • Cancers, inc hepatoma
  • Rheumatological conditions

18
Worms- we are what we eat
19
Strongyloides
  • Penetrates the skin. In travelers associated with
    beach holidays.
  • More common in those working in muddy
    environments.

20
Rarer, in southeast Asia
21
The big risks
  • Malaria
  • HIV
  • RTA probably more commonly causes a serious
    outcome
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