Paediatrics: Tropical infections

Tropical infections

Tropical infections may be present in any child returning from the tropics. A general review in the febrile child should follow the process discussed in the section on ‘Acute fever’.

Malaria

• Agent: Plasmodium falciparum (also P. vivax, P. ovale, P. malariae).

• Features: fever (often cyclical, though falciparum is not), diarrhoea, vomiting, flu-like symptoms, jaundice, anaemia, thrombocytopenia.

• Time course: onset usually occurs 7–10 days after inoculation, but may occur after a few months in children.

• Diagnosis: thick and thin blood film should be examined in all children with fever from infected area without prophylaxis. Repeat daily for 3 samples if there is a high index of suspicion.

• Treatment: artesunate is now the first line therapy for P. falciparum malaria, although not universally available in the UK. For other forms of malaria consult specialist advice.

Typhoid

• Agent: Salmonella typhi or paratyphi.

• Features: fever, headache, cough abdominal pain, myalgia followed by GI symptoms a week later. Splenomegaly, bradycardia, and rose-coloured spots on the trunk. Complications include GI perforation, myocarditis, hepatitis, and nephritis.

• Treatment: third generation cephalosporin or ciprofloxacin, adjust therapy following antimicrobial sensitivity testing.

Dengue fever

• Agent: viral infection spread by mosquitoes.

• Features: p infection produces a fine erythematous rash, myalgia, arthralgia, and high fever. s desquamation follows.

• Shock: Dengue shock occurs when a previously infected child has another infection with a different strain.

Viral haemorrhagic fevers

• Agents: Lassa, Marburg, Ebola, and other viruses.

• Features: highly contagious and often lethal.

Management: if suspected, strict isolation is required and specialist advice needed.