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15 - Travel Related Infections Flashcards

1
Q

Which parts of the infection model are most significant when looking at travel infections?

A
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2
Q

Why is travel history so important and what questions should be asked?

A
  • Any unwell travel companions /contacts?
  • Pre-travel vaccinations / preventative measures?
  • Healthcare exposure?
  • Where have they been?
  • When did the symptoms begin?
  • What are the symptom/signs?
  • How did they acquire it?
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3
Q

Identify some common regions which are associated with travel-related infections

A

- Sub-saharan Africa

- S.E .Asia

- S / C America

  • N. Africa
  • M. East S / C Asia
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4
Q

Identify and describe the different incubation periods for travel-related infections

A
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5
Q

What are some typical symptoms of travel-related infections?

A
  • Jaundice
  • Eosinophillia
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6
Q

What are some activities that lead people to get travel related infections?

A
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7
Q

Draw a table of the important features of a travel history.

A
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8
Q

What are some risk factors whilst travelling that can lead to infections, and what infections do they most commonly cause?

A
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9
Q

What is malaria?

A
  • Malaria is a mosquito-borne infectious disease, typically transmitted through an animal vector – an infected female Anopheles mosquito
  • It is the commonest imported disease in the UK
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10
Q

Which species of the Plasmodium parasite cause malaria in humans?

A
  • Plasmodium falciparum (75% – mainly Africa)
  • Plasmodium vivax (~20% – mainly India)
  • Plasmodium ovale (~20% – mainly India)
  • Plasmodium malariae
  • Plasmodium knowlesii
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11
Q

What is the distribution of malaria like across the world?

A
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12
Q

How does a patient with malaria present when it is only mild?

A

- History – fever, chills & sweats (cycle every 3rd or 4th day)

- Examination – often few signs except fever (± splenomegaly)

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13
Q

What is the incubation period for malaria?

A
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14
Q

What are some symptoms of severe falciparum malaria?

A

- CVS – tachycardia, hypotension, arrhythmias

- Resp – ARDS

- GI – diarrhoea, bilirubin, deranged LFT

- CNS – confusion, fits, cerebral malaria

  • Blood – thrombocytopenia, DIC

- Renal - AKI

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15
Q

What is the brief life cycle of the malaria parasite?

A
  • Mosquito gut to salivary gland
  • Human liver to erythrocytic to mosquito gut
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16
Q

What are the clinical investigations for malaria?

A
  • CXR
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17
Q

What is the treatment for malaria?

18
Q

How can you prevent malaria?

19
Q

What is Enteric fever?

A
  • Mainly in Asia (India) as poor sanitation
  • Also S.America and Africa
20
Q

What are the organisms that cause enteric fever?

A
  • Typhoid fever: Salmonella typhi
  • Paratyphoid fever: Salmonella paratyphi A, B or C

Enterobacteriaceae that are aerobic gram-negative bacillus

21
Q

What is the virulence of salmonella bacteria?

A
  • Low infectious dose
  • Survives gastric acid
  • Fimbriae adhere to epithelium over ileal lymphoid tissue (Peyer’s patches) → RE system / blood
  • Reside within macrophages (liver/ spleen/ bone marrow)
22
Q

What are the signs and symptoms of enteric fever and what is the incubation period?

A
  • 7-14 days (paratyphoid generally milder symptoms)

  • Bacteraemia & sepsis
  • Fever
  • Headache
  • Constipation
  • Dry cough
  • Relative bradycardia
  • Abdominal discomfort
23
Q

What are the complications of typhoid fever?

A
  • Intestinal haemorrhage
  • Intestinal perforation
  • 10% mortality (untreated)
24
Q

What are the investigations for enteric fever?

25
What is the treatment for enteric fever?
- Multi drug resistant (including penicillins) **- Fluoroquinolones** (e.g. ciprofloxacin) may work, but increasing resistance - Usually, IV **ceftriaxone (cephalosporin) / azithromycin** **(macrolide)** for 7-14 days
26
How do cephalosporins and macrolides work?
**Macrolides:** inhibit protein synthesis **Cephalosporins:** mode of action as other β-lactam antibiotics (such as penicillins), but are less susceptible to β-lactamases. Cephalosporins disrupt the synthesis of the peptidoglycan layer forming the bacterial cell wall.
27
How can enteric fever be prevented?
- Food & water hygiene precautions - Typhoid vaccine (high-risk travel & lab personnel) - Capsular polysaccharide antigen or live attenuated vaccine
28
What are some non-typhoidal salmonella infections?
- Food poisoning, e.g *S.typhimurium and S.enteritidis* - Diarrhoea, fever, vomiting, abdominal pain - Mainly affect immunocompromised and develop into enteric fever in these patients a lot
29
What is Dengue fever?
**- Dengue fever** is a mosquito-borne tropical disease caused by the dengue virus - It is commonest arbovirus and has 4 serotypes
30
What are the high risk areas for Dengue fever?
- Africa - Asia - Indian SC
31
How does Dengue fever present?
First infection ranges from asymptomatic to non-specific febrile illness: - Lasts 1-5 days - Improves 3-4 days after rash
32
When you see a fever and rash together after travel, what diagnoses should you be thinking about?
- Childhood viruses – measles, rubella, parvovirus - Infectious mononucleosis (EBV / CMV) - Acute HIV infection - Rickettsia (spotted fever)
33
How can Dengue fever be treated?
- Supportive treatment (no vaccine as it can cause the disease itself)
34
When can complications of dengue fever arise?
- Reinfection with different serotype and this can cause an ***antibody dependent enhancement*** - Dengue haemorrhagic fever - Dengue shock syndrome
35
What is myiasis?
- Fly larva in bite wounds
36
What are some examples of notifiable diseases to public health?
37
What are some emerging diseases in the UK as a consequence of travel?
**- Influenza pandemics** **- Novel coronaviruses:** I. SARS II. MERS
38
What is viral haemorrhagic fever?
39
What is Ebola and where are the high risk areas?
- **Viral haemorrhagic fever** caused by a **filovirus**, spread by direct contact with body fluids - It presents with flu-like symptoms (+ vomiting, diarrhoea, headaches, confusion, rash) as well as internal/external bleeding at 5-7 days - Nigeria, Guinea, Liberia, Sierra Leone
40
What is the treatment for Ebola?
- Antivirals - Zmapp (monoclonal antibodies) - Vaccine under development
41
What is Zika virus?
- Arbovirus (**flavivirus**) transmitted through the Aedes mosquito & through sexual contact - It presents with mild dengue-like symptoms (only in 20%) and causes congenital microcephaly and/or foetal loss - NO TREATMENT OR VACCINE - High risk in america, caribbean and pacific
42
In general what tests can you do for someone who is displaying signs of a travel related infection?
***_THINK ABOUT INCUBATION PERIODS_***

Infection (18 decks)

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