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Infection > 13. Travel Related Infections > Flashcards

13. Travel Related Infections Flashcards

1
Q

What parts of the infection model are important to consider when suspecting a travel related infection

A

Time - both calendar and relative.

Place - recent.

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2
Q

What two bacterium sub-types are important to consider in your differential diagnosis with suspected travel-related infection more than you normally would?

A

Rickettsia

Spirochaete

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3
Q

Name two sub-types of parasites what are cause many travel related infections

A

Protozoa

Helminth

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4
Q

Why is the travel history important when suspecting a travel related infection?

A

Infection prevention - ward and lab.
Different strains of pathogen - are antigenically different, so impacts on protection/detection and antibiotic resistance.
Helps you to recognise imported diseases.

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5
Q

What are the 4 main questions you want to ask when you suspect a travel related infection? What other aspects of the travel history should you consider?

A 
Where have they been?
When did symptoms begin?
What are the symptom/signs?
How did they acquire it?
Other:
Unwell travel companions/contacts?
Vaccination history and preventative measures?
Recreational activities?
Healthcare exposure?
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6
Q

What are the 5 main species of plasmodium that cause malaria?

A 
Falciparum
Vivas
Ovale
Malariae
Knowlesii
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7
Q

What is the vector for malaria?

A

Female Anopheles mosquito

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8
Q

What is the commonest imported infection to the Uk?

A

Malaria

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9
Q

What species of plasmodium causes most cases of malaria from Africa?

A

Falciparum

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10
Q

What 2 species of plasmodium causes most malaria from India?

A

Vivax and ovale

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11
Q

In malaria, when would be abnormal in an FBC and biochemistry tests?

A 
FBC:
Low Hb
Low WCC
Low platelets
Biochemistry:
Raised urea
Raised creatinine
Raised bilirubin
Raised CRP
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12
Q

What is the minimum incubation period of malaria, and the maximum for P. falciparum and P. vivax/ovale?

A

Minimum 6 days.
P. falciparum up to 4 weeks.
P. vivax/ovale up to 1 year.

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13
Q

What symptoms or signs will a patient with malaria present with?

A

Is vague. May complain of fever chills and sweats in a cycle of every 3rd or 4th day, with few signs except fever with or without splenomegaly.

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14
Q

What percentage of parasites is needed for severe P. falciparum malaria?

A

> 2%

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15
Q

Give 3 examples of symptoms that severe malaria can cause

A 
Tachycardia/ hypotension/ arrhythmias.
Acute respiratory distress syndrome.
Diarrhoea/deranged LFT's/bilirubin.
Acute kidney injury.
Confusion/ fits/ cerebral malaria.
Low or normal WCC/ thrombocytopenia/ disseminated intravascular coagulation.
Metabolic acidosis/ hypoglycaemia.
Secondary infection.
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16
Q

How does malaria parasite reproduce in a human?

A

Mosquito feeds, malaria sporozoites enter into bloodstream, infect hepatocytes, develops into schizont, created lots of merozoites, rupture cell and enter blood stream.
Infect healthy RBCs, reproducing, rupturing cell releasing more merozoites.
Some of the infected cells develop into gametophytes, remain in bloodstream for several days, may be ingested by a mosquito in subsequent feeding.

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17
Q

What is the asexual reproductive cycle of the malaria parasite in mosquitos?

A

Gametophytes ingested by a mosquito from an infected human, into the gut, develop into sporozoites, migrate to salivary gland.

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18
Q

What tests would you do in a suspected case of malaria, or any travel related infection?

A

3 blood smears.
2 blood cultures.
FBC, U & Es, LFTs, glucose, coagulation.
Head CT if CNS symptoms.
CXR.
Serology/PCR based on travel history/symptoms.

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19
Q

What is the treatment for malaria caused by P. falciparum?

A

Artesunate or

Quinine + doxycycline.

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20
Q

What treatment would you give for malaria caused by P. vivax, ovale and malariae?

A

Chloroquine + primaquine or

Hypnozoites (liver stage).

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21
Q

Can malaria reoccur even once you have already had it?

A

Yes, malaria caused by P. vivax, ovale and malariae can all recur months-years later.

22
Q

What is the ABC for prevention of malaria?

A

Assess risk.
Bite prevention.
Chemoprophylaxsis.

23
Q

Which area of the world do most UK travel-related cases of typhoid and paratyphoid come from?

A

Asia

24
Q

What is the mechanism of infection of typhoid and paratyphoid (enteric fever)?

A

Faecal-oral from contaminated food or water

25
Q

What is the bacterial cause of typhoid and paratyphoid (enteric fever)?

A

Salmonella typhi or salmonella paratyphi (A, B or C)

26
Q

What type of bacteria is salmonella paratyphi?

A

Enterobacteriaceae, so aerobic gram-negative bacillus

27
Q

What are the virulence factors of salmonella causing typhoid?

A

Low infectious done.
Survives gastric acid.
Fibrillation adhere to epithelium over ileal lymphoid tissue (peyer’s patches).
Reside within macrophages in the liver, spleen and bone marrow.

28
Q

What is seen on blood tests and biochemical tests in typhoid?

A

Low Hb, low WCC (esp lymphopenia), normal U+E, raised CRP, raised LFTs, normal CXR and AXR, mild splenomegaly seen on USS, use blood and faecal culture to confirm bacteria, as serology isn’t reliable.

29
Q

What is the incubation period of typhoid?

A

7-14 days

30
Q

What are the symptoms of typhoid? What complications can it lead to?

A

Fever, headache, abdominal discomfort, constipation, dry cough, bradycardia, rose spots. Is bacteraemia, so can cause sepsis and septic shock, also intestinal haemorrhage and perforation.

31
Q

Which is milder, typhoid or paratyphoid?

A

Paratyphoid

32
Q

What is typhoid normally treated with?

A

IV ceftriaxone or azithromycin for 7-14 days

33
Q

Give 2 ways to prevent typhoid

A

Food and water hygiene precautions.
Typhoid vaccine for high-risk travel and lab personnel (either vi capsular polysaccharide antigen or live attenuated vaccine).

34
Q

What other infections can salmonella cause that are non-typhoidal?

A

Food-poisoning. Eg salmonella typhimurium, salmonella enteritis. Cause diarrhoea, fever, vomiting, abdominal pain. Is generally self-limiting but bacteraemia and deep-seated infections may occur.

35
Q

What is dengue fever spread by?

A

Mosquitos - arbovirus

36
Q

What regions of the world is dengue fever most common?

A

Sub and tropical regions eg Africa, Asia

37
Q

How many serotypes of dengue fever is there?

A

4

38
Q

What are the symptoms of classic dengue fever (first infection)?

A

Lasts 1-5 days.
Improves 3-4 days after rash.
Asymptomatic to severe febrile illness.

39
Q

What is the treatment for dengue fever?

A

Supportive treatment only

40
Q

What happen on reinfection with a different serotypes of dengue fever?

A

Is much more severe - can cause dengue haemorrhagic fever (leaking of capillaries) and dengue shock syndrome.

41
Q

What is typically seen as signs, on blood test results and biochemical tests in dengue fever?

A

Macular rash, fever, low platelet count, slightly low WCC, high ALT. Severe myalgia, headache, negative cultures, CXR normal, dengue PCR positive and dengue serology (IgM) positive.

42
Q

What is the cause of Ebola?

A

Filovirus

43
Q

What are the signs and symptoms of Ebola?

A

Flu-like illness - vomiting, diarrhoea, headaches, confusion, rash. Internal/external bleeding 5-7 days.

44
Q

How is Ebola spread?

A

Direct contact with body fluids

45
Q

What is the treatment for Ebola?

A

Zmapp (monoclonal abs) and antivirals

46
Q

How is Zika virus spread?

A

Arbovirus (flavivirus) spread by the Aedes mosquito. Also sexual transmission.

47
Q

Where is Zika virus prevalent?

A

Americas, Caribbean, Pacific

48
Q

What are the symptoms on Zika virus?

A

Few people get symptoms which are mild and dengue-like. Causes congenital microcephaly and foetal loss.

49
Q

What is the treatment and preventative measures against Zika virus?

A

No treatment.
No vaccine.
Use condoms and mosquito nets.

50
Q

Where would you look for information about potential outbreaks of infections in certain areas?

A

CDC

Infection (14 decks)

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