CME : Your SA Journal of CPD - Volume 23, Issue 3, 2005
Volume 23, Issue 3, 2005
Source: CME : Your SA Journal of CPD 23, pp 113 –119 (2005)More Less
Any patient presenting with fever and a history of travel to a malaria area within the preceding 6 months should be regarded as having falciparum malaria until proven otherwise. <br>Falciparum malaria is a medical emergency. <br>Malaria cannot be diagnosed on clinical grounds, and its suspicion demands urgent investigation. <br>A negative blood smear or rapid antigen test does not rule out the diagnosis of malaria. <br>It is negligent to advise against chemoprophylaxis for most malarious destinations, especially in sub-Saharan Africa. <br>Currently available efficacious chemoprophylactic agents are mefloquine, doxycycline, and atovaquone-proguanil. <br>Chloroquine and azithromycin are best avoided as antimalarials. <br>Personal protection measures against mosquito bites should be recommended in addition to, but not instead of, chemoprophylaxis.
Author Robert WeissSource: CME : Your SA Journal of CPD 23, pp 121 –125 (2005)More Less
Many conditions that are not frequently seen in a particular country may present as a result of increased international travel. <br>Appropriate investigations and consultation with experts may be needed in order to make the correct diagnosis and provide correct management. <br>Climate-related disorders include both heat- and cold-related disorders. <br>Allergic disorders are commonly seen, owing to their sudden onset and distressing nature. Infectious disorders represent one of the biggest challenges, particularly as HIV may change the typical nature of these conditions. <br>Exotic conditions such as unusual viral exanthems, deep fungal infections, atypical rickettsial diseases and Lyme disease must be considered depending on the country of origin. <br>Infestations with worms or protozoa are uncommon and are related to the country of origin. <br>Arthropod bites may result in many different skin manifestations.
Author Gary MaartensSource: CME : Your SA Journal of CPD 23, pp 126 –129 (2005)More Less
The population of people living with acquired immune deficiency is burgeoning. <br>Immune compromised patients should be stable on therapy and receive routine prophylaxis against opportunistic infections before travel. <br>Assessment of the level of immune compromise is essential before immunisation. <br>Severely immune-suppressed patients must not be given live vaccines - an official waiver letter should be issued for countries requiring yellow fever vaccination. <br>Severely immune-suppressed patients respond poorly to active immunisation - where possible passive immunisation should be given. <br>Enteric pathogens that are invasive or associated with chronic diarrhoea can cause severe morbidity in immunecompromised patients. <br>Many countries discriminate against HIV-infected travellers.
Source: CME : Your SA Journal of CPD 23, pp 130 –132 (2005)More Less
All travellers undertaking extensive, long-haul air travel (particularly those with the risk factors outlined in Table I) need to be warned of the risks of DVT and VTE and advised of appropriate preventive measures. <br>All travellers should be aware of the signs and symptoms of DVT / VTE and of the need to seek medical advice should they develop them, in order to help prevent progression of a DVT to a VTE. <br>The risks of screening for those at possible 'risk' for DVT / VTE should be weighed up against the risks of DVT / VTE itself. <br>When DVT is suspected and confirmed by ultrasound in one leg, the possible diagnosis of bilateral DVT and the need for bilateral ultrasound scanning of the legs need to be considered, particularly in symptomatic travellers undertaking long-haul air travel.
Source: CME : Your SA Journal of CPD 23, pp 133 –138 (2005)More Less
Thorough history of illness and travel movements is essential. <br>Ask about existing medical conditions. <br>Focus initially on diagnosing infections that are dangerous for patient and community. <br>Skin lesions are important clues to many travel-related infections. <br>Malaria must always be considered in a traveller with fever and flu-like symptoms. <br>Tick bite fever is common in travellers in Africa, and the typical rash may be absent. <br>Fever, rash and arthritis is suggestive of arboviral infections. <br>Fever and eosinophilia is commonly due to acute schistosomiasis (Katayama fever). <br>Full blood count, blood smear examination, and liver function tests are obligatory initial investigations. <br>Getting a diagnosis before treatment is ideal, but must be balanced against the need to treat severe illness.