• Causes range from mild viral infections to potentially fatal cerebral malaria (Table 12.5) and meningococcal septicaemia.

• The common serious causes are malaria, typhoid, hepatitis (especially A and B), dengue fever and amoebiasis.

• Most deaths from malaria have occurred after at least 3 or 4 days of symptoms that may be mild. Death can occur within 24 hours. Factors responsible for death from malaria include delayed presentation, missed or delayed diagnosis (most cases), no chemoprophylaxis and old age.

• Refer immediately to a specialist unit if the patient is unwell.

• Be vigilant for meningitis and encephalitis.

• Be vigilant for amoebiasis—can present with a toxic megacolon, especially if antimotility drugs given.

First line screening tests o full blood examination and ESR o thick and thin films o liver function tests o urine for micro and culture

• Refer immediately if malaria is proven or if fever persists after a further 24 hours.

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