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Fever in Returned Traveller — SCE Infectious Diseases MCQ

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HardTravel Medicine & VaccinationFever in Returned TravellerSCE Infectious Diseases

A returning traveller has fever, jaundice and tender hepatomegaly. Three properly timed expert malaria films are negative and ultrasound shows no abscess. What is the next diagnostic priority?

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Correct answer: AInvestigate acute viral hepatitis and other causes of febrile jaundice

The best answer is “Investigate acute viral hepatitis and other causes of febrile jaundice”. Three high-quality negative films make malaria unlikely, so HAV, HEV, leptospirosis, dengue, yellow fever and other exposure-led diagnoses need targeted testing rather than indefinite repetition of one test. Malaria chemoprophylaxis is selected by destination, resistance, contraindications, interactions, pregnancy and previous neuropsychiatric adverse effects. Sustained virological response markedly reduces liver events and can permit fibrosis regression, but patients with established cirrhosis retain hepatocellular-carcinoma risk and need surveillance.

Reference: UK malaria prevention guidelines for travellers: https://www.gov.uk/government/publications/malaria-prevention-guidelines-for-travellers-from-the-uk EASL recommendations on treatment of hepatitis C: https://easl.eu/publication/easl-recommendations-on-treatment-of-hepatitis-c/