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Chapter: Paediatrics: Infectious diseases

Paediatrics: Tropical infections

Tropical infections may be present in any child returning from the tropics.

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’.




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.




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.


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