FeverintheTropics-GlobalMissionsHealthConference.docVIP

Fever in the Tropics Tom D. Thacher, MD thacher.thomas@mayo.edu Learning Objectives To understand the syndromic approach to fever in the tropics To identify common causes of 8 febrile syndromes Disease burden Infectious disease is a larger proportion of disease burden in developing countries Chronic, non-communicable disease is a greater burden in developed countries (epidemiological transition) Africa has the greatest proportion of infectious disease burden Context of fever Age – child/adult Geography – region of the world, elevation Season – rainy/dry Duration of fever – acute/chronic Malnutrition – cause or consequence of infection Immune status – immunizations, HIV Exposures – insect vectors, water source, HIV, TB Syndromic approach Framework to a differential diagnosis in the absence of laboratory and imaging Combination of clinical symptoms associated with fever Not an etiological approach Based on clinical symptoms and clinical judgment rather than diagnostic tests Empiric treatment for the most likely infections that fit the clinical syndrome Diagnosis often confirmed by response to treatment Common fever syndromes Under 5 mortality is 20% in African children Five febrile diseases account for 2/3 of child deaths in Afric Malaria Pneumonia Diarrhea HIV Measles Fever Alone Malaria 40% of world’s population at risk Greatest killer of children in endemic regions Most severe in children, pregnant women, travellers Repeated infections lead to partial immunity Blood smear or rapid diagnostic tests for confirmation Clinical manifestations Headache Pallor – due to severe hemolytic anemia High output heart failure Cerebral malaria – impaired mental status, convulsions, coma Labored breathing – acidosis, heart failure Splenomegaly – spleen rate used to assess endemicity Typhoid fever Salmonella typhi ingested in contaminated water or food Consider after failure of antimalarial treatment or negative blood film for malaria parasites Symptoms Sustained high fever 1 week