1/5. Case studies in international travelers.family physicians should be alert for unusual diseases in patients who are returning from foreign travel. malaria is a potentially fatal disease that can be acquired by travelers to certain areas of the world, primarily developing nations. Transmitted through the bite of the anopheles mosquito, malaria usually presents with fever and a vague systemic illness. The disease is diagnosed by demonstration of Plasmodium organisms on a specially prepared blood film. Travelers can also acquire amebic infections, which may cause dysentery or, in some instances, liver abscess. amebiasis is diagnosed by finding entamoeba histolytica cysts or trophozoites in the stool. Invasive amebic infections are generally treated with metronidazole followed by iodoquinol or paromomycin. Cutaneous larva migrans is acquired by skin contact with hookworm larvae in the soil. The infection is characterized by the development of itchy papules followed by serpiginous or linear streaks. Cutaneous larva migrans is treated with invermectin or albendazole. Case studies are presented.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/5. diagnosis of plasmodium vivax malaria complicated by abnormal neurological imaging.The number of patients presenting with malaria in the united states has increased. This is attributable to the growing ease and popularity of overseas travel. We present a 41-year-old man diagnosed with plasmodium vivax malaria after a 9-month symptom-free interval following return from an endemic area. The clinical picture was complicated by the results of neurological imaging that proved to be incidental and unrelated findings. Unfortunately, there are no pathognomonic signs or symptoms of malaria. The presenting complaints are often nonspecific and may be associated with a broad differential diagnosis. Thus, physicians must have a high index of suspicion and elicit a complete travel history to arrive at the correct diagnosis.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/5. fever of unknown origin.This is a case study of a 26-year-old Hispanic male who presented with an initial complaint of fevers, chills and generalized weakness for three weeks. Patient reported a classical history of diurnal fever with temperature spikes as high as 105.8F after returning from a trip to guatemala. His symptoms had waxed and waned for 3 weeks. This case study will focus on the initial presentation, value of complete history and physical exam, use of laboratory data and use of specialized diagnostic procedures in the outpatient setting. This case proves to be highly relevant to primary care in the context of treating patients with fevers of unknown etiology. Primary care physicians should be alert for unusual diseases in patients who are returning from foreign travel. malaria is a potentially fatal disease that can be acquired by travelers to certain areas of the world, primarily developing nations. Transmitted through the bite of the anopheles mosquito, malaria usually presents with fever and a vague systemic illness. The disease is diagnosed by demonstration of Plasmodium organisms on a specially prepared blood film. This case study speaks to the importance of prompt work up and treatment of fever of unknown origin that presents in an unusual clinical picture or that is not readily explainable.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/5. Imported malaria in pregnancy: report of four cases and review of management.malaria is a common infection worldwide. Increased travel by pregnant women makes it likely that physicians in the united states will see cases of malaria in this population. We observed four cases of malaria during pregnancy over an 8-month period at a general hospital in the united states. These cases illustrate the association between pregnancy and severe malaria in the mother and congenital infection in the newborn. We also noted delays in diagnosis because malaria was mistaken for other common illnesses. Therapy was complicated by concerns about the safety of antimalarial agents for the fetus and newborn as well as drug resistance. While chloroquine is safe for use in pregnancy, drug resistance is now common, especially when the etiologic organism is plasmodium falciparum. There are concerns about the safety of administering other antimalarial agents during pregnancy (e.g., mefloquine). Concerns about the safety and availability of these agents limit options for prophylaxis.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/5. A review of 79 patients with malaria seen at a military hospital in hawaii from 1979 to 1995.The goal of our study was to determine the epidemiological and clinical features of imported malaria seen at our military hospital in hawaii. We reviewed the records of malaria cases seen from January 1, 1979, to December 31, 1995, and compared our results with published reviews from civilian hospitals in north america. Seventy-nine patients were diagnosed with malaria by blood smears. All acquired malaria abroad, mostly in southeast asia. Sixty-seven percent of cases were vivax malaria, 22% were falciparum malaria, and 11% were caused by undetermined species. Common symptoms were fever (100%), alternate day fever (41%), rigors (91%), headache (59%), nausea (41%), fatigue (39%), dark urine (32%), and vomiting (31%). Ninety-one percent had fever during hospitalization, but 39% were afebrile on admission. splenomegaly was detected in 49% of cases. The white blood cell count was normal in 65%, low in 31%, and elevated in 4% of cases. Other laboratory findings were anemia (58%), thrombocytopenia (74%), and mild hyperbilirubinemia (64%). Military physicians initially considered the diagnosis of malaria in only 54% of patients. The epidemiological features of our patients differ from those described in the civilian hospitals. Most of our patients were nonimmune, U.S.-born, military personnel infected in southeast asia, whereas patients described in reviews from U.S. civilian hospitals were usually foreign-born civilians who were infected in africa or india. The clinical features of malaria, and the problems of initial misdiagnosis in our patients, were similar to those reported from civilian hospitals. Military physicians, like their civilian colleagues, need more training and experience in malaria.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |