162 Infectious Disease and Foreign Travel Emergencies
COMMON IMPORTED DISEASES OF TR AVELLERS(i) Other tick-borne spotted fevers include Rocky Mountain and
Mediterranean.
3 Infection is characterized by high fevers, headache, lymphadenopathy and a
fine vasculitic maculopapular rash, with a characteristic black eschar at the
site of the original chigger bite in scrub typhus.
4 Potential complications include pneumonitis, encephalitis and myocarditis,
which usually occur in the late phase of the illness.
5 Send blood for FBC, coagulation profile, ELFTs, blood cultures and serology.
(i) Leucopenia and deranged LFTs are common in the early phase of
infection.
6 Scrub typhus can be confirmed by PCR assay on ethylenediaminetetraacetic
acid (EDTA) blood in its early stages, or serological tests in the later or
convalescent stage.MANAGEMENT
1 Give doxycycline 100 mg orally b.d. for 7–10 days.
2 Refer the patient to an infectious disease specialist for exclusion of additional
travel-related infections, and follow up.Helminth infections
DIAGNOSIS
1 Schistosomiasis (bilharzia) caused by fresh-water trematodes (flukes) rarely
presents acutely, but should be suspected in cases from endemic areas such as
Africa, South America, the Middle East and Asia presenting with fever and
diarrhoea associated with eosinophilia (Katayama fever).
(i) Chronic infection may present up to years later with painless
terminal haematuria or obstructive uropathy, portal or
pulmonary hypertension and seizures.
2 Roundworm infection (ascariasis) is discovered when the adult worm is
passed in the stool, although occasionally allergic pneumonitis, abdominal
pain, diarrhoea or urticaria occur.
3 Ta p e wo r m infection usually presents with lassitude, weight loss and anaemia
or with disease-specific complications such as seizures in cysticercosis, and
mass effects in hydatid disease (Echinococcus).MANAGEMENT
1 Discuss your suspicions with an infectious disease specialist and take advice
about which laboratory tests are indicated.