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Fever In Returning Traveler

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Mind Map on Fever In Returning Traveler, created by Moza Almualla on 10/02/2019.
Moza Almualla
Mind Map by Moza Almualla, updated more than 1 year ago
Moza Almualla
Created by Moza Almualla over 5 years ago
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Resource summary

Fever In Returning Traveler
  1. Blood and Tissue Protozoa
    1. Plasmodium species
      1. Plasmodium vivax
          1. Liver stages
            1. Persistent hypnozoites, relapse
            2. Microscopical features
              1. Enlarged RBCs
                1. Rings are big and coarse
                  1. Trophozoites have ameboid appearance
                    1. Gametocytes are round, oval and covering the surface of RBC
                      2. Schuffner's dots in RBC
                      3. Predominant areas (World wide)
                        1. RBCs invaded
                          1. Young immature erythrocytes
                        2. Plasmodium ovale
                          1. Tertian malaria
                            1. Microscopical features
                              1. Oval, jagged, enlarged RBCs
                                1. Schuffner's dots
                                  1. Trophozoites have compact and irregular appearance
                                    1. Schizonts have rosette shape
                                      1. Gametocytes are round in shape
                                      2. Liver stages
                                        1. Persistent hypnozoites, relapse
                                        2. Predominant areas (Tropical Africa)
                                          1. RBCs invaded
                                            1. Young immature erythrocytes
                                          2. Plasmodium malariae
                                            1. Quartan malaria
                                              1. Microscopical features
                                                1. RBCs are not enlarged
                                                  1. Parasite has bar and band appearance
                                                    1. Rosette schizonts
                                                      1. Ziemann dots
                                                        1. Round to oval shaped gametocytes
                                                        2. Liver stages
                                                          1. No persistent stage, recrudescence
                                                          2. Predominant areas (Subtropical and Temperate areas)
                                                            1. RBCs invaded
                                                              1. Mature erythrocytes
                                                              2. Complications
                                                                1. Nephrotic syndrome
                                                              3. Plasmodium falciparum
                                                                1. Malignant tertian malaria
                                                                  1. Irregular fever, most severe and fetal
                                                                  2. Microscopical features
                                                                    1. Normal sized RBC
                                                                      1. The rings are fine, small and multiple
                                                                        1. Crescent shaped gametocytes
                                                                          2. Maurer’s dots
                                                                            1. Peripheral smear
                                                                              1. Early ring stage and gametocytes stages
                                                                            2. Liver stages
                                                                              1. No persistent stage, recrudescence
                                                                              2. Predominant areas
                                                                                1. Tropical Africa, Asia, Latin America
                                                                                2. RBCs invaded
                                                                                  1. All erythrocytes
                                                                                  2. Complications
                                                                                    1. Due to
                                                                                      1. Invades all erythrocytes
                                                                                        1. High parasitaemia
                                                                                          1. Rosetting
                                                                                            1. Sequestration
                                                                                              1. Ligands
                                                                                                1. Plasmodium falciparum erythrocyte membrane protein
                                                                                                2. Receptors
                                                                                                  1. Placental binding receptor (Chondroitin sulfate A)
                                                                                                    1. Endothelial cells receptors (CD36, ICAM-1, E-selectin)
                                                                                                    2. Cytokines
                                                                                                      1. TNF-a , IL1, IL6, Nitric oxide
                                                                                                    3. Cerebral malaria
                                                                                                      1. Severe anemia
                                                                                                        1. Severe hypoglycemia
                                                                                                          1. Blackwater fever
                                                                                                            1. Hepatosplenomegaly
                                                                                                              1. Nephrotic syndrome
                                                                                                                1. Poor pregnancy outcome
                                                                                                                  1. Liver or spleen failure
                                                                                                                2. Causes
                                                                                                                  2. Life Cycle
                                                                                                                  3. Toxoplasma species
                                                                                                                    1. Toxoplasmosis
                                                                                                                      1. Caused by Toxoplasma gondii
                                                                                                                        1. Intracellular parasite
                                                                                                                          1. Natural reservoir (Cat)
                                                                                                                            1. Immunocompenet
                                                                                                                              1. Asymptomatic or lymphadenopathy
                                                                                                                              2. Immunosuppressed
                                                                                                                                1. Severe symptoms: swollen glands, fever, seizures, headache, psychosis, and problems with vision, speech and movement
                                                                                                                          2. Congenital toxoplasmosis
                                                                                                                            1. Diagnosed by Antibody detection
                                                                                                                              1. IgG / IgM / PCR
                                                                                                                          3. Trypanosomes species
                                                                                                                            1. African trypanosomiasis
                                                                                                                              1. Two subspecies
                                                                                                                                1. Trypanosoma brucei gambiense
                                                                                                                                  1. Single central nucleus and a single flagellum
                                                                                                                                    1. Undulating membrane / Covered by glycoprotein
                                                                                                                                    2. Trypanosoma brucei rhodesiense
                                                                                                                                      2. Symptoms
                                                                                                                                        1. Bite reaction
                                                                                                                                          1. Parasitemia
                                                                                                                                            1. Winterbottom’s sign
                                                                                                                                              1. CNS involvement (Sleeping sickness)
                                                                                                                                              2. Transmitted (Female tsetse fly)
                                                                                                                                              3. American trypanosmiasis
                                                                                                                                                1. Caused by Trypanosoma cruzi
                                                                                                                                                  1. Transmitted (kissing (riduvid) bug)
                                                                                                                                                    1. Causes
                                                                                                                                                      1. Chagas' disease
                                                                                                                                                        1. Chacoma
                                                                                                                                                        2. Chronic stages
                                                                                                                                                          1. Cardiomegaly
                                                                                                                                                            1. Megaesophagus
                                                                                                                                                              1. Megacolon
                                                                                                                                                      2. Babesiosis
                                                                                                                                                        1. Caused by Babesia microti
                                                                                                                                                          1. Intracellular parasite
                                                                                                                                                            1. Transmitted by (tick)
                                                                                                                                                              1. Enters the RBCs
                                                                                                                                                                1. Under microscope (Maltase cross form)
                                                                                                                                                              3. Causes
                                                                                                                                                                1. Tick fever (hemolytic anemia, jaundice, fever and hepatomegaly
                                                                                                                                                                2. Diagnosed by
                                                                                                                                                                  1. Peripheral blood smear
                                                                                                                                                              4. Malaria
                                                                                                                                                                1. Epidemiology
                                                                                                                                                                  1. 219 million cases of malaria in 2017
                                                                                                                                                                    1. African Region 2017
                                                                                                                                                                      1. 92% of malaria cases
                                                                                                                                                                        1. 93% of malaria deaths
                                                                                                                                                                        2. 5 countries accounted half of all malaria cases worldwide (2017)
                                                                                                                                                                          1. Nigeria (25%)
                                                                                                                                                                            1. Democratic Republic of the Congo (11%)
                                                                                                                                                                              1. Mozambique (5%)
                                                                                                                                                                                1. India (4%)
                                                                                                                                                                                  1. Uganda (4%)
                                                                                                                                                                                  3. Risk factors
                                                                                                                                                                                    1. Area of malaria
                                                                                                                                                                                      1. Bite from infected mosquito
                                                                                                                                                                                        1. Age (Young and old)
                                                                                                                                                                                          1. Travelers
                                                                                                                                                                                            1. Immune system deficiency
                                                                                                                                                                                              1. Pregnancy
                                                                                                                                                                                                1. Newborns (Transmission from the mother)
                                                                                                                                                                                                2. Blood transfusion
                                                                                                                                                                                                  1. Poverty
                                                                                                                                                                                                    1. Lack of knowledge
                                                                                                                                                                                                      1. No access to health care centers
                                                                                                                                                                                                        1. Environmental factors
                                                                                                                                                                                                          1. No protective clothing
                                                                                                                                                                                                            1. Exposed sleeping accommodations
                                                                                                                                                                                                              1. Lack of insect repellent
                                                                                                                                                                                                                1. No precautions and prophylaxis
                                                                                                                                                                                                              2. Clinical manifestation
                                                                                                                                                                                                                1. Prodromal Symptoms
                                                                                                                                                                                                                  1. Non-specific flu-like symptoms (anorexia, muscle pain, headaches)
                                                                                                                                                                                                                  2. Clinical Infection
                                                                                                                                                                                                                    1. Febrile attacks (Malarial paroxysms)
                                                                                                                                                                                                                      1. Three successive stages
                                                                                                                                                                                                                        1. Sweating stage (2 to 4 hours)
                                                                                                                                                                                                                          1. Fever drops rapidly and the patient sweats
                                                                                                                                                                                                                          2. Hot stage (2 to 6 hours)
                                                                                                                                                                                                                            1. Fever (41°C), flushed, dry burning skin, throbbing headache, nausea and vomiting
                                                                                                                                                                                                                            2. Cold stage (15 to 60 minutes)
                                                                                                                                                                                                                              1. Intense cold and strong shivering
                                                                                                                                                                                                                            3. Periodic Febrile Response
                                                                                                                                                                                                                              1. Caused by
                                                                                                                                                                                                                                1. Rupture of mature schizonts in all types of malaria
                                                                                                                                                                                                                                  1. P.malariae, fever happens every 72 hours
                                                                                                                                                                                                                                    1. Quartan malaria
                                                                                                                                                                                                                                    2. P.falciparum, fever may occur every 48 hours, however it is usually irregular and shows no distinct periodicity
                                                                                                                                                                                                                                      1. P.vivax and P.ovale malaria, schizonts mature every 48 hours
                                                                                                                                                                                                                                        1. Tertian malaria
                                                                                                                                                                                                                                2. Fever
                                                                                                                                                                                                                                  1. Chills
                                                                                                                                                                                                                                    1. Headache
                                                                                                                                                                                                                                      1. Myalgia
                                                                                                                                                                                                                                        1. Nausea, vomiting, diarrhea
                                                                                                                                                                                                                                          1. Abdominal pain
                                                                                                                                                                                                                                            1. Cough
                                                                                                                                                                                                                                              1. Hepatomegaly
                                                                                                                                                                                                                                                1. Splenomegaly
                                                                                                                                                                                                                                                  1. Anemia
                                                                                                                                                                                                                                                2. Pathogenesis
                                                                                                                                                                                                                                                  2. Invistigations
                                                                                                                                                                                                                                                    1. Thick smear microscope (Gold standard)
                                                                                                                                                                                                                                                      1. Detects parasites
                                                                                                                                                                                                                                                      2. Rapid Ag test (Most popular screening test)
                                                                                                                                                                                                                                                        1. Detects parasite specific antigen
                                                                                                                                                                                                                                                        2. Rapid Ab test
                                                                                                                                                                                                                                                          1. Detects antibodies to malaria parasites
                                                                                                                                                                                                                                                          2. ELISA Ab test
                                                                                                                                                                                                                                                            1. Detects antibodies to malaria infection
                                                                                                                                                                                                                                                            2. Molecular method (Very sensitive and expensive)
                                                                                                                                                                                                                                                              1. Detects the malaria gene
                                                                                                                                                                                                                                                            3. Managment
                                                                                                                                                                                                                                                              1. Treated appropriately > Prognosis is excellent
                                                                                                                                                                                                                                                                1. Uncomplicated malaria > improvement within 48 hours after treatment
                                                                                                                                                                                                                                                                  1. Fever free after 96 hours
                                                                                                                                                                                                                                                                  2. P,falciparum > Untreated > Poor prognosis
                                                                                                                                                                                                                                                                  3. Drugs
                                                                                                                                                                                                                                                                    1. Chloroquine
                                                                                                                                                                                                                                                                      1. P.vivax and P.ovale
                                                                                                                                                                                                                                                                        1. Prophylaxis and treatment in areas without resistant P.falciparum
                                                                                                                                                                                                                                                                          1. Adverse effects
                                                                                                                                                                                                                                                                            1. GI distress / skin rash / headache / retinal dysfunction (high dose)
                                                                                                                                                                                                                                                                          2. Quinine
                                                                                                                                                                                                                                                                            1. Treatment of multidrug-resistant malaria
                                                                                                                                                                                                                                                                              1. Adverse effects
                                                                                                                                                                                                                                                                                1. Cinchonism / hemolysis in G6PD deficiency / Blackwater fever / hypoglycemia
                                                                                                                                                                                                                                                                              2. Primaquine
                                                                                                                                                                                                                                                                                1. Eradication of liver stages of P.vivax and P.ovale
                                                                                                                                                                                                                                                                                  1. Adverse effects
                                                                                                                                                                                                                                                                                    1. GI distress / methemoglobinemia / hemolysis in G6PD deficiency
                                                                                                                                                                                                                                                                                  2. Atovaquone-proguanil (Malarone)
                                                                                                                                                                                                                                                                                      1. Adverse effects
                                                                                                                                                                                                                                                                                        1. GI distress / headache / rash hemolysis / folate deficiency
                                                                                                                                                                                                                                                                                      2. Mefloquine
                                                                                                                                                                                                                                                                                        1. Prophylaxis and treatment of multidrug-resistant P.falciparum
                                                                                                                                                                                                                                                                                          1. Adverse effects
                                                                                                                                                                                                                                                                                            1. GI distress / rash / headache / cardiac conduction defects and neurologic symptoms (high dose)
                                                                                                                                                                                                                                                                                          2. Artemisinins
                                                                                                                                                                                                                                                                                            1. Standard of care for all chloroquine-resistant malaria
                                                                                                                                                                                                                                                                                              1. Adverse effects
                                                                                                                                                                                                                                                                                                1. GI distress / rare neutropenia / anemia / allergic reactions / QT prolongation
                                                                                                                                                                                                                                                                                              2. Pyrimethamine
                                                                                                                                                                                                                                                                                                1. Not used alone for P. falciparum
                                                                                                                                                                                                                                                                                                  1. Adverse effects
                                                                                                                                                                                                                                                                                                    1. Megaloblastic anemia
                                                                                                                                                                                                                                                                                              3. Prevention and Control
                                                                                                                                                                                                                                                                                                1. Prevent mosquito breeding
                                                                                                                                                                                                                                                                                                  1. Drain potential breeding sites
                                                                                                                                                                                                                                                                                                    1. Outdoor insecticide spraying
                                                                                                                                                                                                                                                                                                      1. Chemical & biological larvicides
                                                                                                                                                                                                                                                                                                        1. Male sterilisation of mosquitoes
                                                                                                                                                                                                                                                                                                        2. Avoid mosquito bites
                                                                                                                                                                                                                                                                                                          1. Site dwellings away from breeding sites
                                                                                                                                                                                                                                                                                                            1. Protective clothing
                                                                                                                                                                                                                                                                                                              1. Insect repellants (DEET based)
                                                                                                                                                                                                                                                                                                                1. Use of insecticide treated bed net (ITN)
                                                                                                                                                                                                                                                                                                                  1. Residual indoor insecticide spraying
                                                                                                                                                                                                                                                                                                                  2. Early diagnosis
                                                                                                                                                                                                                                                                                                                    1. Intermittent preventive treatment (IPT) in pregnancy
                                                                                                                                                                                                                                                                                                                      1. Chemoprophylaxis in non-immune travellers

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