The ASM/ACTM Parasitology & Tropical Medicine Masterclass earlier this month was an excellent opportunity to catch up with leading experts in the field. The MicroGnome brings you a series of snapshots highlighting the weekend’s teaching. The edited highlights will be presented at the next QEIIMC Tropical Medicine Breakfast:

• Introduction to faecal parasite examination (Lynne Garcia)
• Blood parasites (Lynne Garcia)
• Molecular methods in parasitology (Jaco Verweij)
• Medical Entomology (Richard Russell)
• Clinical cases of parasitic infections (clinical centres around Australia)

Clinical Case of the Febrile Returned Traveller

Ms A, a 23 year old aid worker who has just returned after half a year overseas. She spent six months on aid work in the Amazon region and had a two week holiday in Mozambique on her way home. She took no travel health precautions before or during her travel.

She developed fever and profuse diarrhoea on her last day in Mozambique, and went straight from the airport to the Emergency Department.

On initial examination she was alert and oriented, but unwell and dehydrated with a pulse of 120 and a blood pressure of 90/60. She had diffuse abdominal tenderness and a mildly enlarged spleen. Her chest was clear.

Q1. What is your differential diagnosis?

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The initial investigations were:

• Hb  100
• WCC  8.6
• Plts  25
• Na  135
• K  4.8
• Ur  13.7
• Cr 149
• Stool microscopy – no parasites seen

These blood investigations produced this result.

Q2. What are these investigations ?

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Q3. What is the result?

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Q4. What other widely available investigation would give a rapid confirmatory result?

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Q5. What treatment would you commence?

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The patient had a very stormy course.

• she was given 8L iv crystalloid in the first 24h, iv artesunate (SAS Category A, requiring informed consent), and exchange transfusion (6 units packed cells)
• despite this, she deteriorated and went into multiple organ systems failure and DIC, requiring 29 days in intensive care
• she was discharged from hospital, having lost 8/10 toes to necrosis

Additional resources

• other clinical problems
• malaria revision
• malaria files
• seafood poisoning & toxins

The next Tropical Medicine Breakfast at SCGH will see a change of form and content. Be prepared for some challenging clinical cases from the head of Infectious Diseases & Tropical Medicine, Dr Ronan Murray.

As the cases will be presented as unseen clinical problems, no material will appear in advance, other than the units that can already be found here at the Micrognome and on the Priobe Net site (see below). We recommend reading these notes if you want to earn your breakfast next Tuesday. The session is at 07:30 and will run until 08:30hr, on Tuesday 8th June in the ED Seminar Room, Sir Charles Gairdner Hospital.

Tropical medicine learning support at MicroGnome:

• malaria 1
• malaria 2
• malaria 3
• malaria 4
• arbovirus infections 1
• arbovirus infections 2
• neglected bacterial diseases 1
• neglected bacterial diseases 2

Tropical medicine resources at the Priobe Net:

• Plasmodium (malaria)
• Arboviruses
• Melioidosis

Beware!  We had little warning. The Stafinator is here; scourge of staphylococci, decoloniser par excellence. If it needs antibacterial armour, he’ll put the tanks on the streets. If you have an exotic microbe lurking under cover, he’ll be onto your case. And as for the Resistance, he’ll be only too HAPI to make life difficult for them.

Crazy bug hunters are skeptical.  Fascinellas are laying low. The μgnome is quaking in his boots.