'Break-bone fever'
What a fantastically descriptive term for Dengue fever. We've had a few cases of this recently from Thailand and Indonesia and thats exactly how the poor erstwhile holiday makers described their symptoms....terrible fevers, myalgia, aching joints and intolerable malaise. One poor 2nd year medical student was so incapacitated by it that he went all vasovagal and fainted on his Dad in an Underground train. Worst case of green around the gills we've seen so far, especially when he was told he had to be admitted and had an armful of blood taken and an IV put up.... Some are more stoical...like the Bostonian hedge Fund analyst who had come straight from work with symptoms that would have flattened most people and was aghast when told that she needed to stay in hospital overnight on account of the subprime market doing a nose dive and that she needed to be there to monitor the situation! She was so funny - she had literally taken every precaution against biting bugs she could think of (sprays, creams, electronic plug things, bednets, long trousers - not a burqua mind!) 
and still got the lurgy....all taken with great humour - atta girl! So far no one has had the haemorrhagic version (thankfully) which happens when you get more than one strain of Dengue at once.
and still got the lurgy....all taken with great humour - atta girl! So far no one has had the haemorrhagic version (thankfully) which happens when you get more than one strain of Dengue at once. Oh yes, and as you can see Dengue is an epidemic in Central America as if I didn't have enough flies to worry about!
Typhoid is on the up if clinic diagnoses are anything to go by. It can be really nasty too....within 4 weeks 20% are dead from multiorgan failure and/or massive GI haemorrhage if untreated. 
Mostly it seems to be folks back from visiting India. So......if any of you guys are out in India and you start getting terrible but remitting fevers, constipation rather than the squits, no energy to do anything and a bad headache then you might have it...especially if you develop 'rose spots' the next week when the fevers don't subside and you feel even worse. Oh, and you have super infectious poo and can give it to everyone else! Typhoid Mary did this very effectively in the 1900's and killed loads of people - she had to be bunged in the clink to stop the epidemic.
As far as causes of fever go it has to said that Malaria has not been high on the list of eventual diagnoses in the emergency clinic. We've only had two vivax cases which is a bit disappointing! The last chap had come back to clinic after 6 months of no symptoms with a re-emergence of fevers that he had developed after travelling through Thailand, Vietnam, Cambodia and India (where he had to be hospitalised due to a temp of 104 degrees and lost most of his platelets) but had had a negative malaria blood film on his return in March. He was given a bollocking by the SHO who then had to then turn the other cheek when P. vivax parasites were found again this time..... Apparently the Indians had recommended 6 months of chloroquine to clear it but the drugs made his liver and one testicle (!) so painful he stopped it. After the obligatory G6PD test we gave him some primaquine and so hopefully he's cured now.
Mostly it seems to be folks back from visiting India. So......if any of you guys are out in India and you start getting terrible but remitting fevers, constipation rather than the squits, no energy to do anything and a bad headache then you might have it...especially if you develop 'rose spots' the next week when the fevers don't subside and you feel even worse. Oh, and you have super infectious poo and can give it to everyone else! Typhoid Mary did this very effectively in the 1900's and killed loads of people - she had to be bunged in the clink to stop the epidemic.As far as causes of fever go it has to said that Malaria has not been high on the list of eventual diagnoses in the emergency clinic. We've only had two vivax cases which is a bit disappointing! The last chap had come back to clinic after 6 months of no symptoms with a re-emergence of fevers that he had developed after travelling through Thailand, Vietnam, Cambodia and India (where he had to be hospitalised due to a temp of 104 degrees and lost most of his platelets) but had had a negative malaria blood film on his return in March. He was given a bollocking by the SHO who then had to then turn the other cheek when P. vivax parasites were found again this time..... Apparently the Indians had recommended 6 months of chloroquine to clear it but the drugs made his liver and one testicle (!) so painful he stopped it. After the obligatory G6PD test we gave him some primaquine and so hopefully he's cured now.
The advice for malarial prophylaxis has undergone a bit of a revolution recently. The boss of the Travel Clinic Dr Behrens has just published a paper in ...yes you've guessed it...'Malaria'...that rubbishes the idea of taking prophylaxis in predominently P.vivax regions (ie. most of India and Central America) as it's not common, fatal, the drugs are unpleasant and possibly even not very effective at protecting against it (compared to P. falciparum). Excellent. Better go somewhere where I can use up my Mefloquine next year then!
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