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Fever in the Tropics

Fever in the Tropics. Tom D. Thacher, MD Department of Family Medicine Mayo Clinic, Rochester, Minnesota thacher.thomas@mayo.edu. Malaria Hypertension Dyspepsia Pulmonary tuberculosis Medical examination. Upper respiratory infection Urinary tract infection HIV infection

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Fever in the Tropics

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  1. Fever in the Tropics Tom D. Thacher, MD Department of Family Medicine Mayo Clinic, Rochester, Minnesota thacher.thomas@mayo.edu

  2. Malaria Hypertension Dyspepsia Pulmonary tuberculosis Medical examination Upper respiratory infection Urinary tract infection HIV infection Diabetes mellitus PID Fever as a Symptom 1/3 of all presentations in primary care

  3. Learning Objectives • Syndromic Approach • 8 Febrile Syndromes

  4. Context of Fever • Age • Geography • Season • Duration of fever • Malnutrition • Immune status • Exposures

  5. Empiric treatment Syndromic Approach

  6. 8CommonFeverSyndromes • Fever alone • Neurologic • Abdominal • Pulmonary • Rash • Hemorrhage • Bone and joint • Gynecologic

  7. Which of these is NOT in the top five causes of death in children in tropical countries? • Measles • Pneumonia • Typhoid • HIV • Malaria

  8. 2/3 of allchild deaths

  9. Fever Alone • Malaria • Typhoid fever • HIV • Dengue • Leptospirosis • Rickettsia • Relapsing fever • Other viral illnesses

  10. Malaria Okie S. N Engl J Med 2008;358:2425-2428

  11. Plasmodium falciparum

  12. Symptoms of malaria • Headache • Pallor • Severe hemolytic anemia • Heart failure • Cerebral malaria – impaired mental status, convulsions, coma • Labored breathing • acidosis, heart failure • Splenomegaly

  13. Typhoid Fever

  14. Typhoid • Sustained high fever, headache • Apathy, psychosis • Constipation, abdominal pain • Splenomegaly • Positive blood culture www.worldortho.med.usyd.edu.au

  15. Dengue • Asia, So. America • Marked myalgia, eye pain • Rash • ↓ WBC, ↓ platelets

  16. Leptospirosis • Rash • Aseptic meningitis • Clue: conjunctival injection

  17. Rickettsia • Fever, headache, and myalgia • Clue: tick exposure, painless eschar • African tick-bite fever, scrub typhus

  18. Relapsing Fever

  19. 8CommonFeverSyndromes • Fever alone • Neurologic • Abdominal • Pulmonary • Rash • Hemorrhage • Bone and joint • Gynecologic

  20. Neurologic Syndromes Fever, headache, altered mental status, convulsions, coma • Cerebral malaria • Meningitis • Encephalitis • HIV

  21. African Meningitis Belt

  22. Encephalitis • Rabies • Japanese encephalitis • West Nile encephalitis • Trypanosomiasis (sleeping sickness)

  23. HIV • Chronic Meningitis: TB, cryptococcal • Toxoplasmosis • HIV dementia

  24. 8CommonFeverSyndromes • Fever alone • Neurologic • Abdominal • Pulmonary • Rash • Hemorrhage • Bone and joint • Gynecologic

  25. Abdominal Syndromes Fever, abdominal pain • Typhoid • Infectious colitis: shigella, E. coli, salmonella, campylobacter, ameba • Amebic liver abscess • Abdominal TB • Appendicitis, pyelonephritis • HIV

  26. 8CommonFeverSyndromes • Fever alone • Neurologic • Abdominal • Pulmonary • Rash • Hemorrhage • Bone and joint • Gynecologic

  27. Pulmonary Syndromes Fever, cough, dyspnea • Pneumonia • Tuberculosis • HIV

  28. IMCIIntegrated Management of Childhood Illness • Increased respiratory rate • ≥60 if age < 2 mos. • ≥50 if age 2-12 mos. • ≥40 if age 12 mos. to 5 years • Lower chest retractions

  29. 8CommonFeverSyndromes • Fever alone • Neurologic • Abdominal • Pulmonary • Rash • Hemorrhage • Bone and joint • Gynecologic

  30. Rash Syndromes Fever and skin rash • Measles • HIV • Dengue • Other viruses

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