Parasitology Masterclass

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:

Fever, diarrhoea & international travel

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?

  • infectious enterocolitis: ETEC, Salmonella, Campylobacter, Shigella.
  • malaria
  • dengue
  • typhoid
  • pelvic inflammatory disease
  • appendicitis

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 ?

Thick film to detect malaria parasites (Plasmodium species), and thin film to identify which species

Q3. What is the result?

Plasmodium falciparum, high level parasitaemia

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

Rapid HRP-2 card test for Plasmodium falciparum

Q5. What treatment would you commence?

  1. basic resuscitation comes first
  2. then intravenous antimalarial agent, preferably artesunate

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

Clinical challenges in tropical medicine

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:

Tropical medicine resources at the Priobe Net:

The Stafinator has landed

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.