Yellow fever — DTM&H MCQ

Correct answer: D — Yellow fever

The correct answer is D, Yellow fever. This unvaccinated traveller from the Amazon basin (an endemic region) has the classic triad of fever, jaundice and albuminuria together with relative bradycardia (Faget sign), which is a highly specific combination for yellow fever, reflecting hepatic necrosis, renal involvement and direct viral effects on cardiac conduction despite high fever. Two negative malaria films make falciparum malaria unlikely, and the absence of prior vaccination in an Amazon traveller is a key epidemiological clue, since yellow fever vaccine is routinely recommended before travel to endemic South American and sub-Saharan African areas. Albuminuria is a constant and distinguishing feature that helps separate yellow fever from other causes of febrile jaundice in returning travellers. Why the other options are wrong: B. Dengue without warning signs: Dengue causes fever and can cause mild transaminitis but does not typically cause marked jaundice, albuminuria or relative bradycardia; tachycardia, not bradycardia, is usual. A. Acute hepatitis A alone: Hepatitis A causes jaundice but not albuminuria, relative bradycardia or the acute systemic toxicity described, and incubation and exposure pattern do not fit as tightly as yellow fever. C. Leptospirosis without renal involvement: The option explicitly excludes renal involvement, but this patient has albuminuria, and leptospirosis (Weil disease) typically causes tachycardia with conjunctival suffusion and myalgia rather than the bradycardia described. E. Crimean-Congo haemorrhagic fever: This is transmitted by ticks in Africa, the Balkans, Middle East and Asia, not the Amazon, and presents with haemorrhagic features rather than the jaundice-albuminuria-bradycardia triad. Key point: In an unvaccinated traveller from an endemic area, fever with jaundice, albuminuria and relative bradycardia (Faget sign) is classic for yellow fever and should trigger urgent public health notification.

Reference: TravelHealthPro (NaTHNaC), Yellow Fever factsheet, National Travel Health Network and Centre, UK, https://travelhealthpro.org.uk/factsheet/26/yellow-fever