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Probability diagnosis

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Malaria

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Viral respiratory illness (e.g. influenza)

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Bacterial pneumonia

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Hepatitis (may be subclinical)

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Gastroenteritis/diarrhoeal illness

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Dengue

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Serious disorders not to be missed

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Malaria

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Tuberculosis

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Typhoid

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Viral haemorrhagic diseases (e.g. Ebola, Lassa)

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Encephalitis

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Meningococcal meningitis

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Melioidosis

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Amoebiasis (liver abscess)

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HIV seroconversion illness

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Pitfalls (often missed)

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Ascending cholangitis

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Infective endocarditis

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Cytomegalovirus

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Epstein--Barr virus (glandular fever)

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Dengue fever

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Lyme disease

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Bronchopneumonia

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Ross River fever

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Rarities:

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  • chikungunya

  • Legionnaire disease

  • schistosomiasis

  • African trypanosomiasis

  • typhus

  • Rift Valley fever

  • spotted fever

  • yellow fever

  • other haemorrhagic fevers

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Masquerades checklist

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Drugs (reaction to antimalarials)

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Urinary tract infection

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Key history

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Ask about itinerary, length of stay, exposure to mosquitoes and possible contact with infectious diseases. Associated symptoms, especially diarrhoea, abdominal pain, rash and other skin lesions. Past history, prophylaxis (incl.immunisation) and drug history (incl. antimalarial therapy).

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Key examination

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  • General features

  • Vital signs

  • Neck for neck stiffness

  • Skin and lymph node sites

  • Respiratory and cardiovascular examination

  • Abdominal examination, especially liver and spleen

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Key investigations

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  • FBE (?eosinophils)

  • ESR

  • Blood culture

  • Urine MC

  • Stool MC

  • LFTs

  • Thick and thin blood films

  • New malaria test

  • Dengue serology

  • CXR

  • Tubercular skin test and interferon gamma release assay (for suspected TB)

  • Specific tests for suspected diseases, e.g. Ebola, influenza

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Diagnostic tips

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  • All fever in a returned traveller is malaria until proved otherwise.

  • Three causes of a dry cough (in the absence of chest signs) are malaria, typhoid and amoebic liver abscess.

  • Be vigilant for meningitis and encephalitis.

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