1. Tropical Medicine; a whistle stop tour R Johnson MBBS MRCS DTM&H

2. Malaria 2 million fatalities per year Almost all P. falciparum “tropical” Stable vs unstable transmission; immunity Simple vs complicated

4. Life Cycle Infected female anopheline mosquito Sporozoites enter hepatocytes Hepatic shizont once mature ruptures and release merozoites into blood Erythrocytic trophozoites mature into shizonts and then precipitate sequestration Rupture to produce merozoites or gametocytes

6. Clinical Features The great pretender Fever, cough, muscle aches, diarrhoea, abdo pain, headache, seizures, haematuria Hypoglycaemia Anaemia; haemolysis and marrow suppression Splenomegaly Jaundice Cyclical nature of fever?

8. Diagnosis Thick and thin films Serology Buffy coats PCR

9. Treatment 1 Antipyretic Rehydration Blood transfusion Anti-convulsants Correcting hypoglycaemia Reducing acidaemia Antibiotics

10. Treatment 2 Chloroquine. Non-toxic, oral or IV Quinine. Toxic. Effective, oral or IV Mefloquine. Single dose due to long half life. Toxic. Negative inotrope. Fansidar. Resistance! Artemesinins. Effective, combination therapy

11. Prophylaxis Don’t get bitten Dependant on area Dependant on what you are doing Dependant on time spent in malarious area

12. Typhoid Salmonella typhi and paratyphi A, B, C Water bourne, oro-faecal Infect small bowel lymphatics, Bacteraemia, bone marrow, spleen, liver and gallbladder Secondary bacteraemia and invasion of bowel

13. Timeline Incubation 14 days (7-21) Week 1, non-specific illness with fever (intermittent), cough, diarrhoea or constipation Week 2, rose spots, constant fever, abdo pain. Very toxic Week 3, dehydation, metabolic mayhem. GI haemorrhage, multiple small bowel perforations Week 4, if reached, fever lysis and recovery. Other presentations; meningitis, pneumonia, renal failure Long-term sequelae; osteomyelitis, typhoid abscess, chronic carriage

15. Diagnosis Culture; blood, marrow, csf Serodiagnosis; Widal test

16. Treatment Chloramphenicol Amoxycillin or septrin as alternatives MDR Cefotaxime

17. Arboviruses Ecological description Three clinical syndromes –FAR –VHF –CNS Supportive care

18. Travellers diarrhoea Probably majority viral Bacterial Un-exposed normal flora Simple; 2 doses of cipro, 3 days of trimethoprim Blood = dystentery; –Ameobic, shigella, campylobacter, E. coli 157