Emergency Medicine

Infectious Disease and Foreign Travel Emergencies 161

COMMON IMPORTED DISEASES OF TR AVELLERS

MANAGEMENT

1 Commence i.v. rehydration wit h norma l sa line or Hartmann’s.

2 Refer all suspected cases to the medical team for azithromycin 1 g i.v. or
orally daily for 7 days.
(i) Or give ciprofloxacin 400 mg i.v. 12-hourly or ciprofloxacin
500 mg b.d. orally for 7–10 days, if the infection was not acquired
in the Indian subcontinent or South-East Asia.

Dengue

DIAGNOSIS

1 Dengue occurs after a short 1-week incubation period from infection by one
of four serotypes of mosquito-borne f lavivirus, particularly in Central or
South America and South-East Asia.

2 There is abrupt fever, chills, retro-orbital or frontal headache, myalgia, back
pain, lymphadenopathy and rash.
(i) The initial rash is a transient, generalized, blanching macular
rash in the first 1–2 days.
(ii) A secondary maculopapular rash with areas of sparing occurs
lasting 1–5 days.
(iii) A later haemorrhagic rash may be associated with
thrombocytopenia.

3 Dengue haemorrhagic fever (DHF) and dengue shock syndrome occur in
repeat infections with a different serotype.

4 Send blood for FBC, coagulation profile, ELFTs, two sets of blood cultures
and dengue serology.

MANAGEMENT

1 Admit the patient under the medical team for supportive care with i.v. f luids
and antipyretic analgesics.

2 Admit patients with DHF or dengue shock syndrome to the ICU.

Typhus and spotted fevers

DIAGNOSIS

1 Typhus includes several diseases caused by Rickettsiae, such as epidemic and
murine (endemic) typhus.

2 Scrub typhus is one of the spotted fevers, and is caused by an acute bacterial
infection by Orientia tsutsugamushi, transmitted by trombiculid mites
(‘chiggers’). Foci of scrub typhus occur in South-East Asia, northern Japan
and northern Australia.

COMMON IMPORTED DISEASES OF

TRAVELLERS