Fever in the returning traveller from SE Asia Michael McGowan

Colouring in game

Malaria Malaria is the most common cause of fever in the returning traveller (around 21% of 7000 patients at a Geosentinel site over 10y). SE Asia is the second most common area in which Malaria is contracted.

Only Singapore and Brunei do not have endemic areas within their borders

Anopheles mosquito

Symptoms High fevers, chills, rigors & sweats 8-15days after infection Can be up to 3 months after return Headaches, abdo pain, arthalgia, diarrhoea, vomting Jaundice, pallor Hepatosplenomegaly in chronic infection Severe anaemia with haemolysis Confusion, fits, coma with cerebral malaria ATN, pulmonary oedema, hypoglycaemia

Treatment Prophylaxis – Protective clothing, insect repellents, bed nets with impregnated insecticide – Chemoprophylaxis – chloroquine, mefloquine, atovaquone, doxycycline etc. – Check the yellow book/CDC app

Dengue fever 390million infections worldwide every year 96million produce illness Children much less symptomatic than adults (53% vs 86%) Classic dengue – headache, fever, retro- orbital pain, muscle & joint pains (Breakbone fever) DHF – Bleeding occurs in majority of children (68%) and in rare cases is life threatening

DHF criteria So you can have dengue fever and haemorrhage but not have dengue haemorrhagic fever

Investigation & treatment DENV1-4 RT PCR Platelets, haematocrit, AST can be useful Look for “warning signs” Fever – Paracetamol Plasma leakage – Fluids (IV/oral) Bleeding – blood products

Prevention Reducing breeding sites Night nets are of little use Vaccine is being developed Vaccine shows better efficacy against DENV-3&4 than 1&2 Travellers to SE Asia are unlikely to get DHF Previous DF confers long term immunity to that serologic type but only short term immunity for the other 3