Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Clinical 2 - Antibiotics > 13 - Travel Infections > Flashcards

13 - Travel Infections Flashcards

1
Q

What 2 infections are we focusing on?

A

1) Traveller’s diarrhea

2) Malaria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

_____ is the biggest cause of GI illnesses in travellers

A

Giardia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

VFR

A

visiting friends and relatives

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Why are VFR traveller’s more likely to get sick?

A

-they believe that if they used to live there, they won’t get sick when they go back

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are numerator factors?

A

-traveller has returned home before S & S develop, mild symptoms may not be reported, multiple locations visited making it difficult to know where disease was contracted

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are denominator factors?

A

Knowing the # of travellers to a specific location may be difficult to know accurately

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is TD (traveller’s diarrhea) ?

A
  • Diarrhea associated with travel
  • Most predictable travel-related illness
  • Affects 30-70% of travellers, depending on destination and season
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Mild (acute) TD

A
  • diarrhea that is tolerable
  • it is not distressing (no blood in stool or fever)
  • does not interfere with planned activities
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Moderate (acute) TD

A

-diarrhea that is distressing or interferes with planned activities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Severe (acute) TD

A
  • diarrhea that is incapacitating or completely prevents planned activities
  • all dysentery is considered severe
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Describe the etiology of TD

A

-Contaminated food and/or water

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

_____ are the most common cause of TD (80-90%)

A

Bacteria (most commonly E. coli)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

____ pathogens are the 2nd most common cause of TD

A

Viral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Bacterial and viral TD present with a sudden onset of bothersome symptoms - such as ?

A
  • mild cramps
  • urgent loose stools
  • severe abdominal pain
  • fever
  • vomiting
  • bloody diarrhea
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

With ______, vomiting may be more prominent

A

norovirus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Untreated bacterial diarrhea usually lasts ____ days

A

3-7

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Viral diarrhea generally lasts ____ days

A

2-3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

_____ pathogens are the least common cause of TD (less than 5%)

A

Protozoal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

____ is the main protozoal pathogen found in TD

A

Giardia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Protozoal pathogens:

Incubation period is generally ____ weeks and may persist for weeks to months if not treated

A

1-2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Low risk areas for TD include ?

A
  • US
  • Canada
  • Australia
  • New Zealand
  • Japan
  • Northern and Western Europe
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Intermediate risk areas for TD include ?

A
  • Eastern Europe
  • South Africa
  • some Caribbean islands
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

High risk areas for TD include ?

A
  • Asia
  • Middle east
  • Africa
  • Mexico
  • Central and South American
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Low risk area incidence rate

A

8%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Intermediate risk area incidence rate

A

8-20%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

High risk area incidence rate

A

> 20%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What are some patient related risk factors for TD ?

A
  • TD occurs equally in male and female travellers and is more common in young adult travellers than in older travellers
  • Very young travellers are at high risk of severe and/or prolonged TD
  • The highest risk is observed with patients with immunocompromised conditions, achlorhydria, IBD, and people with chronic debilitating medical conditions
  • More common in travellers from low TD risk (ex. Canada) travelling to moderate or high risk countries (ex. Mexico)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What are the destination related risk factors for acquiring TD ?

A
  • Environments in warmer climates where access to modern pluming is low, the amount of stool contamination in the environment will be higher and more accessible to flies
  • Inadequate electric capacity may lead to frequent blackouts and poor fridge function
  • Lack of safe water
  • Handwashing may not be social norm
  • Risk regions (ex. Mexico, Africa, South America, etc.)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What foods are considered higher risk for TD ?

A
  • raw or undercooked food such as meat, fish, shellfish
  • salads, uncooked vegetables, unpasteurized fruit juices, unpasteurized milk or cheese
  • raw fruits that are eaten unpeeled (such as berries)
  • Food/bev from street vendors
  • Tap water (including fountain drinks or ice made from tap water)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What is the saying to remember to prevent TD ?

A

boil it, peel it, cook it, or forget it !!!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What is the safest way to feed an infant < 6 months ?

A

breastfeed exclusively

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What if an infant is formula fed ?

A

formula should be reconstituted with hot water at a temp of > 70

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

List 3 non-Rx options for prevention

A
  • Bismuth subsalicylate
  • Probiotics
  • Dukoral
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Bismuth Subsalicylate:

dose ?

A

524 mg PO QID

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Bismuth Subsalicylate:

Safe for prevention for up to a ______ period

A

3 week

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Bismuth Subsalicylate:

Disadvantages?

A
  • inconvenient dosing
  • possible salicylate toxicity
  • cannot be used in anyone under 18 or pregnant women
37
Q

Bismuth Subsalicylate:

Drug interactions ?

A
  • salicylates
  • blood thinners
  • meds used in GOUT (methotrexate)
38
Q

Bismuth Subsalicylate:

Caution in ppl with ?

A

renal impairement

39
Q

Bismuth Subsalicylate:

__% reduction in TD from studies done in travellers to Mexico

A

50%

40
Q

Probiotics (Lactobacillus GG and Saccharomyces boulardii):

Effective in prevention of TD?

A
  • studies are inconclusive

- insufficient evidence to recommend use

41
Q

Dukoral:

Describe it

A
  • Oral, inactivated TD and cholera vaccine
  • No Rx required
  • 2 doses, separated by 1 week and is effective 1 week after the 2nd dose.
  • Protection against TD lasts for 3 months.
  • A booster every 5 years will remain protection
42
Q

Dukoral:

Indicated for ?

A

children 2 yrs and up and adults who want protection from E. coli and/or cholera

43
Q

Dukoral:

Effective?

A

effectiveness not been documented

44
Q

Dukoral:

Safe ?

A

yes

45
Q

Dukoral:

Price ?

A

around $100

46
Q

Dukoral:

Who do you think would be interested ?

A

backpackers, immunocompromised, ppl with IBS, ppl with low acid production

47
Q

When is it appropriate to use antibiotics as prophylaxis for TD ?

A
  • Patients at high-risk for serious infections or complications such as immunocompromised patients
  • Travellers who are travelling for a short period of time who can tolerate any down time (diplomats high level athletes, professionals presenting at a conference)
48
Q

What antibiotics are used as prophylaxis in TD ?

A

FQ’s

Cipro or Levo

49
Q

Goals of treatment of TD ?

A
  • Prevent dehydration and replace fluids (oral rehydration therapy)
  • Decrease duration and severity of symptoms
  • Minimize impact of travel
50
Q

List 3 agents that can be used to treat TD

A

1) Loperamide
2) BSS
3) Antibiotics

51
Q

Loperamide for TD:

Describe it

A
  • symptomatic relief
  • useful adjust to antibiotics
  • antimotility and antisecretory properties
  • not recommended for patients with blood in the stools or those with a fever if used alone
52
Q

Loperamide for TD:

Dose for adults

A

4 mg stat then 2mg after each loose stool (max 16 mg/day)

53
Q

Loperamide for TD:

Dose for ages 3-5

A

1-2 mg PO initially, then 1-2 mg after each loose stool

max 3 mg daily

54
Q

Loperamide for TD:

Dose for ages 5-8

A

1-2 mg PO initially, then 1-2 mg after each loose stool

max 4 mg daily

55
Q

Loperamide for TD:

Dose for ages 8-12

A

1-2 mg PO initially, then 1-2 mg after each loose stool

max 6 mg daily

56
Q

BSS for TD:

dose

A

524 mg q30 mins

Max 8 doses/day

57
Q

Antibiotics for TD:

If prophylactic antibiotics were used and TD occurs, can you repeat treatment with the same antibiotic ?

A

No - a different AB needs to be used for treatment

58
Q

Antibiotics for TD:

2 first line options ?

A

Cipro

Levo

59
Q

Antibiotics for TD:

Dose of Cipro

A

500 mg BID x 3 days
or
750 mg QD x 1 dose

60
Q

Antibiotics for TD:

Dose of Levo

A

500 mg QD x 3 days
or
1000 mg QD x 1 dose

61
Q

Antibiotics for TD:

Who might Azithromycin be preferred in?

A

certain patients (allergies, pregnancy, children and breastfeeding) and regions because of resistance

62
Q

Antibiotics for TD:

Dose of Azithro for adults

A

500mg QD x 3 days
or
1000mg x 1 dose

63
Q

Antibiotics for TD:

Dose of Azithro for children

A

5-10 mg/kg QD x 3 days

max daily = 500 mg

64
Q

Antibiotics for TD:

When might SMP-TMX be considered?

A

It is 3rd line due to resistance and should only be considered if other options are CI and there region is known to NOT exhibit resistance

65
Q

Antibiotics for TD:

Dose of TMP-SMX for adults

A

800/160mg BID x 3 days
or
1600/320 mg x 1 dose

66
Q

Antibiotics for TD:

Dose of TMP-SMX for children

A

20-25 mg/kg SMX
4-5 mg/kg TMP

BID x 3 days

67
Q

Describe the therapy of mild TD

A
  • Antibiotic treatment not recommended

- Loperamide or BSS may be considered

68
Q

Describe the therapy of moderate TD

A
  • Antibiotics may be used

- Loperamide may be used as adjunctive therapy or monotherapy

69
Q

When would you not use Loperamide as monotherapy ?

A

if there’s fever or blood in the stools

70
Q

Describe the therapy for severe TD

A
  • Antibiotics should be used

- Azithromycin is preferred

71
Q

What important non-pharm advice for TD ?

A

Be cautious about what he’s eating and drinking, hand hygiene is also important

72
Q

What non-Rx items are available to prevent TD?

A
  • BSS
  • Dukoral

**loperamide is to treat, not to prevent

73
Q

Is Azithromycin safe in pregnancy ?

A

yes

74
Q

Malaria:

Human disease caused by ___ protozoan parasites of the genus “Plasmodium”

A

5

75
Q

Malaria:

Symptoms ?

A
  • fever
  • flu-like symptoms
  • chills
  • headache
  • myalgias
  • malaise
76
Q

Malaria:

Uncomplicated disease may be associated with ?

A
  • anemia

- jaundice

77
Q

Malaria:

In severe disease, may have ?

A

seizures, mental confusion, kidney failure, acute respiratory distress, syndrome, coma and death may occur

78
Q

Malaria:

Symptoms can develop as early as ____ days after initial exposure

A

7 days

usually > 14 days

79
Q

Malaria:

The parasite is transmitted by the bite of an infected female ______ mosquito

A

Anopheles

80
Q

Malaria:

Anopheles female mosquitos must take a blood meal to develop her eggs and she hunts from ?

A

dusk until dawn

81
Q

Dusk til dawn feeds normally bite when?

A

at night

82
Q

Malaria:

Transmission may rarely occur by ?

A

blood transfusion, organ transplantation, needle sharing or congenitally from mother to fetus

83
Q

Antimalarial medications:

Do these medications stop a person from becoming infected?

A

NO - these meds do NOT stop a person from becoming infected with the parasites that cause the disease, but rather eliminate the parasites during their different life cycles either in the liver or in the RBC

84
Q

_____ or _____ may remain dormant in the body for months of years after initial infection

A

P. vivax

P. ovale

85
Q

Infections caused by ______ are the most likely to progress to severe, potentially fatal forms therefore when the decision is being made on which antimalarial medicine to choose, the main focus is on providing protection against _______

(same word)

A

P. falciparum

86
Q

Non-pharms to dealing with malaria

A
  • window and door screens
  • loose fitting and long-sleeved shirts and long pants in light colors
  • mosquito repellent
  • pyrethrin insecticides
  • bed nets, preferably treated with permethrin
87
Q

When do you refer malaria?

A
  • ASAP

- malaria can be fatal

88
Q

Read malaria prevention notes

A

okay

Clinical 2 - Antibiotics (14 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions