- A forestry worker from Cameroon contracts fever. He has not been feeling well for 4 days. On physical examination you notice a generalised rash and a small painless ulcer with a black crust on the right groin. What do you think?
- A Cambodian refugee returns from Thailand to his native region. He clears away the vegetation that has enveloped his old house. A few days later he develops fever and rash and his general condition is poor. There is neck stiffness. You notice no chancre. Which rickettsiosis should be considered? Which other bacterium might be responsible?
- Some men are sitting in a room to play poker. The house cat has just given birth to 4 small kittens. A few weeks later the men develop fever, cough and abnormal liver function tests. Any connection you can think of?
- One of the former card players has persistent fever and on auscultation has a heart murmur. This murmur was not present on a previous check-up. Explanation?
- In a refugee camp in Ethiopia there is an epidemic of fever, bleeding tendency, digital gangrene and high mortality. What do you think?
- On examination of the patients in the above-mentioned camp you find no painfully enlarged, fluctuating lymph nodes. Thick smears show no Borrelia. The patients often exhibit a centrifugal rash. What do you do?
- In Brazil a 30-year-old woman develops high fever. She has muscle pain, is confused and her eyes are red. Spots appear on the palms of her hands and forearms. The following day the spots have generalised. Septicaemia is suspected and IV treatment with high dose ampicillin is instituted. Her general condition deteriorates rapidly and she dies 4 days later. Which rickettsiosis might have caused this and how could the woman have been infected? What do you think about the choice of antibiotic?
- A four-year-old child in Benin develops fever and rash. The eyes are red, the child is hoarse, coughs and is miserable. The rash began on the head and spread in the following 2-3 days over the whole of the body. The child is very severely ill. On the 5th day, the rash begins to disappear, after which desquamation of the skin occurs. The child has white spots on the cornea, as a result of which it is practically blind in the left eye. What has happened?
- Are vets at increased risk of Q fever? Leptospirosis? Brucellosis? Amoebic dysentery?
- Somewhere in the field in the rural north-east of Brazil. The six-year-old daughter of the schoolmaster is brought to your house in an emergency. She has fever and an extensive rash. Her general condition is poor. You have yourself vaccinated her one month previously against measles. You hesitate between meningococcal sepsis and RMSF. You have no laboratory (which test could reliably be useful here?). Do you choose penicillin, chloroquine, metronidazole, tetracycline, co-trimoxazole or chloramphenicol as treatment?
- Ghana. What is meant by the term "African tick fever"? Any comments on this?
