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16732642
Fever In Returning Traveler
Descripción
Mapa Mental sobre Fever In Returning Traveler, creado por Moza Almualla el 10/02/2019.
Mapa Mental por
Moza Almualla
, actualizado hace más de 1 año
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Menos
Creado por
Moza Almualla
hace más de 5 años
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Resumen del Recurso
Fever In Returning Traveler
Blood and Tissue Protozoa
Plasmodium species
Plasmodium vivax
Liver stages
Persistent hypnozoites, relapse
Microscopical features
Enlarged RBCs
Rings are big and coarse
Trophozoites have ameboid appearance
Gametocytes are round, oval and covering the surface of RBC
Schuffner's dots in RBC
Predominant areas (World wide)
RBCs invaded
Young immature erythrocytes
Plasmodium ovale
Tertian malaria
Microscopical features
Oval, jagged, enlarged RBCs
Schuffner's dots
Trophozoites have compact and irregular appearance
Schizonts have rosette shape
Gametocytes are round in shape
Liver stages
Persistent hypnozoites, relapse
Predominant areas (Tropical Africa)
RBCs invaded
Young immature erythrocytes
Plasmodium malariae
Quartan malaria
Microscopical features
RBCs are not enlarged
Parasite has bar and band appearance
Rosette schizonts
Ziemann dots
Round to oval shaped gametocytes
Liver stages
No persistent stage, recrudescence
Predominant areas (Subtropical and Temperate areas)
RBCs invaded
Mature erythrocytes
Complications
Nephrotic syndrome
Plasmodium falciparum
Malignant tertian malaria
Irregular fever, most severe and fetal
Microscopical features
Normal sized RBC
The rings are fine, small and multiple
Crescent shaped gametocytes
Maurer’s dots
Peripheral smear
Early ring stage and gametocytes stages
Liver stages
No persistent stage, recrudescence
Predominant areas
Tropical Africa, Asia, Latin America
RBCs invaded
All erythrocytes
Complications
Due to
Invades all erythrocytes
High parasitaemia
Rosetting
Sequestration
Ligands
Plasmodium falciparum erythrocyte membrane protein
Receptors
Placental binding receptor (Chondroitin sulfate A)
Endothelial cells receptors (CD36, ICAM-1, E-selectin)
Cytokines
TNF-a , IL1, IL6, Nitric oxide
Cerebral malaria
Severe anemia
Severe hypoglycemia
Blackwater fever
Hepatosplenomegaly
Nephrotic syndrome
Poor pregnancy outcome
Liver or spleen failure
Causes
Life Cycle
Toxoplasma species
Toxoplasmosis
Caused by Toxoplasma gondii
Intracellular parasite
Natural reservoir (Cat)
Immunocompenet
Asymptomatic or lymphadenopathy
Immunosuppressed
Severe symptoms: swollen glands, fever, seizures, headache, psychosis, and problems with vision, speech and movement
Congenital toxoplasmosis
Diagnosed by Antibody detection
IgG / IgM / PCR
Trypanosomes species
African trypanosomiasis
Two subspecies
Trypanosoma brucei gambiense
Single central nucleus and a single flagellum
Undulating membrane / Covered by glycoprotein
Trypanosoma brucei rhodesiense
Symptoms
Bite reaction
Parasitemia
Winterbottom’s sign
CNS involvement (Sleeping sickness)
Transmitted (Female tsetse fly)
American trypanosmiasis
Caused by Trypanosoma cruzi
Transmitted (kissing (riduvid) bug)
Causes
Chagas' disease
Chacoma
Chronic stages
Cardiomegaly
Megaesophagus
Megacolon
Babesiosis
Caused by Babesia microti
Intracellular parasite
Transmitted by (tick)
Enters the RBCs
Under microscope (Maltase cross form)
Causes
Tick fever (hemolytic anemia, jaundice, fever and hepatomegaly
Diagnosed by
Peripheral blood smear
Malaria
Epidemiology
219 million cases of malaria in 2017
African Region 2017
92% of malaria cases
93% of malaria deaths
5 countries accounted half of all malaria cases worldwide (2017)
Nigeria (25%)
Democratic Republic of the Congo (11%)
Mozambique (5%)
India (4%)
Uganda (4%)
Risk factors
Area of malaria
Bite from infected mosquito
Age (Young and old)
Travelers
Immune system deficiency
Pregnancy
Newborns (Transmission from the mother)
Blood transfusion
Poverty
Lack of knowledge
No access to health care centers
Environmental factors
No protective clothing
Exposed sleeping accommodations
Lack of insect repellent
No precautions and prophylaxis
Clinical manifestation
Prodromal Symptoms
Non-specific flu-like symptoms (anorexia, muscle pain, headaches)
Clinical Infection
Febrile attacks (Malarial paroxysms)
Three successive stages
Sweating stage (2 to 4 hours)
Fever drops rapidly and the patient sweats
Hot stage (2 to 6 hours)
Fever (41°C), flushed, dry burning skin, throbbing headache, nausea and vomiting
Cold stage (15 to 60 minutes)
Intense cold and strong shivering
Periodic Febrile Response
Caused by
Rupture of mature schizonts in all types of malaria
P.malariae, fever happens every 72 hours
Quartan malaria
P.falciparum, fever may occur every 48 hours, however it is usually irregular and shows no distinct periodicity
P.vivax and P.ovale malaria, schizonts mature every 48 hours
Tertian malaria
Fever
Chills
Headache
Myalgia
Nausea, vomiting, diarrhea
Abdominal pain
Cough
Hepatomegaly
Splenomegaly
Anemia
Pathogenesis
Invistigations
Thick smear microscope (Gold standard)
Detects parasites
Rapid Ag test (Most popular screening test)
Detects parasite specific antigen
Rapid Ab test
Detects antibodies to malaria parasites
ELISA Ab test
Detects antibodies to malaria infection
Molecular method (Very sensitive and expensive)
Detects the malaria gene
Managment
Treated appropriately > Prognosis is excellent
Uncomplicated malaria > improvement within 48 hours after treatment
Fever free after 96 hours
P,falciparum > Untreated > Poor prognosis
Drugs
Chloroquine
P.vivax and P.ovale
Prophylaxis and treatment in areas without resistant P.falciparum
Adverse effects
GI distress / skin rash / headache / retinal dysfunction (high dose)
Quinine
Treatment of multidrug-resistant malaria
Adverse effects
Cinchonism / hemolysis in G6PD deficiency / Blackwater fever / hypoglycemia
Primaquine
Eradication of liver stages of P.vivax and P.ovale
Adverse effects
GI distress / methemoglobinemia / hemolysis in G6PD deficiency
Atovaquone-proguanil (Malarone)
Adverse effects
GI distress / headache / rash hemolysis / folate deficiency
Mefloquine
Prophylaxis and treatment of multidrug-resistant P.falciparum
Adverse effects
GI distress / rash / headache / cardiac conduction defects and neurologic symptoms (high dose)
Artemisinins
Standard of care for all chloroquine-resistant malaria
Adverse effects
GI distress / rare neutropenia / anemia / allergic reactions / QT prolongation
Pyrimethamine
Not used alone for P. falciparum
Adverse effects
Megaloblastic anemia
Prevention and Control
Prevent mosquito breeding
Drain potential breeding sites
Outdoor insecticide spraying
Chemical & biological larvicides
Male sterilisation of mosquitoes
Avoid mosquito bites
Site dwellings away from breeding sites
Protective clothing
Insect repellants (DEET based)
Use of insecticide treated bed net (ITN)
Residual indoor insecticide spraying
Early diagnosis
Intermittent preventive treatment (IPT) in pregnancy
Chemoprophylaxis in non-immune travellers
Recursos multimedia adjuntos
Viva (binary/octet-stream)
Ovale (binary/octet-stream)
Malarie (binary/octet-stream)
Falci (binary/octet-stream)
Vbgfd (binary/octet-stream)
Oijuhghjk (binary/octet-stream)
Oighjk (binary/octet-stream)
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