Fever in the Tropics

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Fever in the Tropics

• Tom D. Thacher, MD
• Department of Family Medicine
• Mayo Clinic, Rochester, Minnesota
• thacher.thomas_at_mayo.edu

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Fever as a Symptom

• Malaria
• Hypertension
• Dyspepsia
• Pulmonary tuberculosis
• Medical examination

• Upper respiratory infection
• Urinary tract infection
• HIV infection
• Diabetes mellitus
• PID

1/3 of all presentations in primary care
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Learning Objectives

• Syndromic Approach
• 8 Febrile Syndromes

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Context of Fever

• Age
• Geography
• Season
• Duration of fever
• Malnutrition
• Immune status
• Exposures

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Empiric treatment

• Syndromic Approach

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8CommonFeverSyndromes

• Fever alone
• Neurologic
• Abdominal
• Pulmonary
• Rash
• Hemorrhage
• Bone and joint
• Gynecologic

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Which of these is NOT in the top five causes of
death in children in tropical countries?

• Measles
• Pneumonia
• Typhoid
• HIV
• Malaria

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2/3 of allchild deaths
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Fever Alone

• Malaria
• Typhoid fever
• HIV
• Dengue
• Leptospirosis
• Rickettsia
• Relapsing fever
• Other viral illnesses

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Malaria
Okie S. N Engl J Med 20083582425-2428
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Plasmodium falciparum
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Symptoms of malaria

• Headache
• Pallor
• Severe hemolytic anemia
• Heart failure
• Cerebral malaria impaired mental status,
  convulsions, coma
• Labored breathing
• acidosis, heart failure
• Splenomegaly

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Typhoid Fever
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Typhoid

• Sustained high fever, headache
• Apathy, psychosis
• Constipation, abdominal pain
• Splenomegaly
• Positive blood culture

www.worldortho.med.usyd.edu.au
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Dengue

• Asia, So. America
• Marked myalgia, eye pain
• Rash
• ? WBC, ? platelets

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Leptospirosis

• Rash
• Aseptic meningitis
• Clue conjunctival injection

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Rickettsia

• Fever, headache, and myalgia
• Clue tick exposure, painless eschar
• African tick-bite fever, scrub typhus

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Relapsing Fever
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8CommonFeverSyndromes

• Fever alone
• Neurologic
• Abdominal
• Pulmonary
• Rash
• Hemorrhage
• Bone and joint
• Gynecologic

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Neurologic Syndromes

• Fever, headache, altered mental status,
  convulsions, coma
• Cerebral malaria
• Meningitis
• Encephalitis
• HIV

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African Meningitis Belt
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Encephalitis

• Rabies
• Japanese encephalitis
• West Nile encephalitis
• Trypanosomiasis (sleeping sickness)

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HIV

• Chronic Meningitis TB, cryptococcal
• Toxoplasmosis
• HIV dementia

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8CommonFeverSyndromes

• Fever alone
• Neurologic
• Abdominal
• Pulmonary
• Rash
• Hemorrhage
• Bone and joint
• Gynecologic

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Abdominal Syndromes

• Fever, abdominal pain
• Typhoid
• Infectious colitis shigella, E. coli,
  salmonella, campylobacter, ameba
• Amebic liver abscess
• Abdominal TB
• Appendicitis, pyelonephritis
• HIV

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8CommonFeverSyndromes

• Fever alone
• Neurologic
• Abdominal
• Pulmonary
• Rash
• Hemorrhage
• Bone and joint
• Gynecologic

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Pulmonary Syndromes

• Fever, cough, dyspnea
• Pneumonia
• Tuberculosis
• HIV

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IMCIIntegrated Management of Childhood Illness

• Increased respiratory rate
• 60 if age lt 2 mos.
• 50 if age 2-12 mos.
• 40 if age 12 mos. to 5 years
• Lower chest retractions

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8CommonFeverSyndromes

• Fever alone
• Neurologic
• Abdominal
• Pulmonary
• Rash
• Hemorrhage
• Bone and joint
• Gynecologic

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Rash Syndromes

• Fever and skin rash
• Measles
• HIV
• Dengue
• Other viruses

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8CommonFeverSyndromes

• Fever alone
• Neurologic
• Abdominal
• Pulmonary
• Rash
• Hemorrhage
• Bone and joint
• Gynecologic

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Hemorrhagic Syndromes

• Hematemesis, melena, epistaxis, petechiae,
  purpura, puncture site bleeding
• Ebola, Lassa, Marburg
• Yellow fever
• Dengue
• Relapsing fever

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8CommonFeverSyndromes

• Fever alone
• Neurologic
• Abdominal
• Pulmonary
• Rash
• Hemorrhage
• Bone and joint
• Gynecologic

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Musculoskeletal Syndromes

• Fever with joint or bone pain
• Sickle cell disease
• Septic arthritis
• Osteomyelitis
• Pyomyositis
• Rheumatic fever

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8CommonFeverSyndromes

• Fever alone
• Neurologic
• Abdominal
• Pulmonary
• Rash
• Hemorrhage
• Bone and joint
• Gynecologic

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Gynecologic Syndromes

• Fever, pelvic pain, vaginal discharge
• PID
• Tubo-ovarian abscess
• Postpartum endometritis
• Septic abortion

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Treatment Limiting Factors

• Self treatment with OTC antibiotics
• Limited spectrum of antibiotics
• No health insurance
• Counterfeit drugs and adulteration

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What is the deadliest animal in Africa?
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no-pest.com
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no-pest.com
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20,000 deaths per year
news.nationalgeographic.com
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800,000 deaths per year