Table 8: Summary of febrile syndromes in Ethiopia Disease *
Clinical presentation
Investigation Recommended Treatment
Remarks
Malaria
Acute onset of fever, chills, headache, hepatosplenomegaly
Thick and thin blood film
Coartem for uncomplicated falciparum malaria; Quinine for complicated falciparum malaria; Chloroquine for vivax malaria.
Severe manifestations (severe anaemia, altered mental state, hypotension, renal impairment, bleeding tendency, hypoglycaemia in pregnancy) should warrant admission. PI and NNRTI can reduce serum level of Coartem
Relapsing fever
Acute onset of fever, chills, headaches , epistaxis, hepatosplenomegaly
Blood film
Admit patient, establish IV line Procaine penicillin 400,000 units IM followed by doxycycline 100mg orally next day.
Typhus
Acute onset of fever, chills, headache , epistaxis, hepatosplenomegaly ; severe prostration if louse born
Doxycycline 100mg bid for seven days. Chloramphenicole 500mg qid for seven days.
Typhoid fever.
Acute onset of fever chills, headache, epistaxis, hepatosplenomegaly , often diarrhoea.
Leishmaniasis
Chronic fever, cachexia, anaemia, hepatosplenomegall y and patient from endemic `area.
MAC
Chronic fever, anaemia, cough, hepatosplenomegaly , hepatitis and diarrhoea.
High titer of Weil-Felix serology with clinical setting where patient has body louse or exposure to rat flea. Positive blood culture Four-fold rise in titer of anti body against somatic antigen of Widal test Spleen aspirate show amastigote on Wright or Giemsa stain DAT for presumptive diagnosis Culture of atypical mycobacteria from sputum or blood. CD4 < 50cells/ÂľL.
Observe for Jarish-Herxheimer reaction and manage by fluid replacement with normal saline solution. Digitalize if indicated. Delouse scalp, hair and clothes. Delouse scalp hair and clothes. Observe for complications such as renal impairment and stroke.
Ciprofloxacin 500mg bid for seven days
Check for renal function and substitute chloramphenicole if impaired.
SSG(pentostam 20mg/kg daily IM for 28 days Liposomal Amphotericin B or Miltefosine for resistant cases Clarithromycin 500 mg bid+ ethambutol 25 mg/kg daily Add rifabutin 300mg daily for severe symptoms
Recurrence and drug interaction with ART can create problem.
Rare in Ethiopia
* Refer to respiratory disease unit for treatment of TB and PCP and neurology unit for treatment of Cryptococcal meningitis.
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