160 Infectious Disease and Foreign Travel Emergencies

COMMON IMPORTED DISEASES OF TR AVELLERS

oliguria, severe anaemia, hypoglycaemia, vomiting, acidosis or

respiratory distress, or if over 2% red cells are parasitized. Admit

these severe cases to the ICU

(a) give quinine 20 mg/kg up to 1.4 g infused over 4 h if

artesunate is not immediately available, with BP, blood sugar

and electrocardiographic monitoring.

(iii) Admit other less severe patients under the medical team when

falciparum malaria is even considered possible, and begin

treatment immediately – if necessary before definitive blood

results are available

(a) give those who can tolerate oral treatment artemether-

lumefantrine combination therapy.

2 Refer patients with other types of malaria (P. v iva x, P. ovale, P. malar iae and

P. knowlesi) to the medical team; some may be suitable for treatment as an

outpatient.

3 Ask a patient with two sets of negative thick and thin blood films, but a

suggestive history, to return for repeat malaria blood films in 48 h or earlier

if symptoms persist.

(i) Inform the GP of the possibility of malaria by fax and letter.

Typhoid

DIAGNOSIS

1 The incubation period is up to 3 weeks following travel to India, Latin

America, the Philippines and South-East Asia. There is an initial insidious

onset of fever, malaise, headache, anorexia, dry cough, and constipation in

the first week.

2 The illness then progresses to abdominal distension and pain associated

with diarrhoea, splenomegaly, a relative bradycardia, bronchitis, confusion

or coma.

(i) The characteristic crop of fine rose-pink macules on the trunk is

rare.

3 Send blood for FBC that may show a leucopenia with a relative lymphocyto-

sis. Send ELFTs and two sets of blood cultures in all suspected cases.

4 Request an MSU and a stool culture if diarrhoea is prominent.

(i) Blood cultures are positive in up to 90% in the first week.

(ii) Stool culture becomes positive in 75% and urine culture in 25%

in the second week.

Warning: do not diagnose the ’flu in a febrile patient without asking

! about recent foreign travel and considering malaria.