1.Describe the abnormalities

severe sepsis in returning traveller- hypotension, tachycardia, fever

Aneamia, thrombocytopaenia, normal white cell count with high lymphocytes in setting of sepsis (decrease in two cell lines)

Mild hyponatraemia, moderate pre renal failure ( Urea increase >> Creatinine)

Moderate reduction in HCO3 – acidaemia, unwell patient

2. Give 5 suitable differential diagnosis

Malaria

Dengue

Diarrhoeal illness – bacterial: typhoid/ paratyphoid, cholera, E coli

Respiratory – especially atypical (Mycoplasma, Legionella, TB)

Genito Urinary – Gonorrhoea, UTI, Bilharzia

Other – Hepatitis, Giardia, Rabies

(MUST HAVE – Malaria, Dengue and 3 others)

3. What is the single most likely diagnosis?

Malaria

4. What are your emergent principles?

RESUSCITATION – as per surviving sepsis, ABC approach, fluids, broad spectrum antibiotics, seek and treat hypoglycaemia

Investigations – septic screen (CXR, Urine, blood cultures), malaria – thick and thin films, Dengue serology, stool MCS and parasites

ICU and Infectious disease consultation

5. List 3 complications

ARDS and respiratory failure

Cerebral Malaria

Coagulopathy

Renal failure

hypoglycaemia