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.
• 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.
• Agents: Lassa, Marburg, Ebola, and other viruses.
• Features: highly contagious and often lethal.
Management: if suspected, strict isolation is required and specialist advice needed.