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MCQs in Tropical Medicine

Rob Skelly DTM+H FRCP

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Answer 91 - Fever, diarrhoea and eosinophilia:

Fever, diarrhoea and eosinophilia in a returned traveller may be due to each of the following as the sole causative agent:
True a. Strongyloides stercoralis
False b. Aeromonas hydrophila
True c. Schistsoma mansoni
True d. Capillaria philippinensis

False e. Plasmodium falciparum

The combination of fever, diarrhoea and eosinophilia is suggestive of invasive helminthiasis:

Helminth infections
Helminth infection Additional prominent symptoms/ signs
Strongyloides stercoralis upper abdominal pain
Capillaria philippinensis chronic fatty diarrhoea
Fasciola hepatica hepatomegaly
Schistosoma mansoni hepatomegaly, urticaria
Schistosoma japonicum hepatomegaly, urticaria

The precise travel history may exclude some diagnoses.

Although there is no eosinophilia in malaria, it should be assumed that this is the cause of any fever in a returned traveller until proven otherwise. Not uncommonly multiple infections are acquired so the malaria patient, for example, may also have hookworm infection.

Aeromonas species may cause travellers' diarrhoea but not eosinophilia.

Copyright: Rob Skelly 2006