Africa & the Middle East & Americas & Caribbean Flashcards
do you need cholera vaccine for safari-goers?
no - unless they are planning a side trip to work in a refugee camp or do humanitarian aid work in an affected country
what are some viral hemorrhagic fevers found in and around some game parks in sub-Saharan Africa?
Crimean-Congo hemorrhagic fever
Ebola virus disease
Lassa fever
Marburg virus disease
Rift Valley fever
Travelers who touch or come into proximity of bats (e.g., spelunking, visiting bat caves) are at greatest risk for .. which infection?
Ebola or Marburg virus
what are some Vectorborne diseases during safari-goers?
Chikungunya, Dengue, Zika - Aedes species (daytime biters);
Malaria - most caused by Plasmodium falciparum;
Rickettsial diseases - African tick-bite fever;
Trypanosomiasis (day-biting tsetse flies - Glossina species) - African trypanosomiasis;
West Nile - Culex species (more actve at dusk and dawn);
YF;
Viral hemorrhagic fevers
what is the risk of soil-waterborne infections in Egypt?
Schistosomiasis - avoid wading, swimming, or other contact with freshwater, icluding the Nile River and irrigation canals
what are some vectorborne diseases in Egypt?
Dengue, West Nile - rarely reported
what are some risks of animal bites and rabies in Egypt?
rabies endemic throughout - vaccine and IG available;
shark attackes rare in Red Sea
what are the vaccine requirement for Hajj in Saudi Arabia?
COVID 19
meningococcal (1 year old and up, vaccine within 3 years if polysaccharide vaccine or 5 years if conjugate vaccine) - 10 days before arrival;
polio (if coming from countries where the disease is reported - less than 6 weeks prior to departure)
YF (if arrive from YF endemic countries)
what vectorborne diseases are in Saudi Arabia?
Dengue and Malaria
- The cities of Jeddah, Mecca, Medina, Riyadh (the capital of KSA), and Ta’if have no malaria transmission, and prophylaxis against malaria is neither recommended nor required for pilgrims.
Is Middle East Respiratory Syndrome (MERS) risk in Saudi Arabia?
yes - outbreak in 2012
what are some enteric infections in South Africa?
Listeriosis (contaminated processed meat product outbreak in 2017-2018);
Traveler’s diarrhea;
Typhoid Fever
what are the risk of STI and HIV in South Africa?
largest # of HIV in the world - 19% among people aged 15-29 years;
antimicrobial-resistant gonorrhea (cipro resistance in 70-80%) –> dual tx azithrom + ceftriaxone recommended;
what are soil and waterborne infections in South Africa?
Schistosomiasis - Schistosoma haematobium is the dominant species, but S. mansoni occasionally has been detected
what is the malaria risk in South Africa?
Plasmodium falciparum - border with Zimbabwe and Mozambique in the Mopani and Vhembe Districts of Limpopo Province; in the Ehlanzeni District of Mpumalanga Province; and in the uMkhanyakude District of KwaZulu-Natal Province.
Kruger National Park spans 2 provinces, Mpumalanga and Limpopo, and is considered endemic for malaria with seasonal transmission.
what vectorborne infection other than malaria is at risk in South Africa?
Rickettsial diseases - African tick-bite fever is common
is viral hemorrhagic fever a risk in South Africa?
Yes only occupational disease rarely reported - in animal health workers, farmers, and hunters - Crimean-Congo hemorrhagic fever
what is enteric infections that is at risk in Tanzania?
Cholera - occur mostly during rainy season;
Giardiasis - high rate among young children;
TD;
Typhoid - prevalent - 580-1400 cases/100,000 persons;
75% of hospital deaths are due to … & … in Tanzania
pneumonia, tuberculosis
which soil/waterborne infections are at risk in Tanzania?
sSchistosomiasis - including Lake Tanganyika and Lake Victoria
what vectorborne diseases are at risk in Tanzania?
Dengue, Malaria (Chloroquine-resistant Plasmodium falcicum throughout Tanzania);
Trypanosomiasis - rare but reported in national parks;
YF - never been reported but low risk by WHO due to the risk in neighboring countries
which mountains are located in Tanzania?
Many travelers visit Tanzania for the opportunity to summit Mount Meru (4,566 m; 14,980 ft) or Mount Kilimanjaro (5,895 m; 19,340 ft), both located in northern Tanzania.
what are some fungi that are endemic to Brazil that cause respiratory infections (and more severe disease) by inhaling the spores of fungi?
Paracoccidioides;
Coccidioides;
Cryptococcus neoformans;
Histoplasma
Travelers should beware of bat guano in caves and use caution before disturbing soil, particularly if contaminated by bat or bird feces.
what is the concern of TB in Brazil?
Tuberculosis (TB) is prevalent in Brazil, but short-term travelers are not considered to be at high risk for infection unless visiting specific crowded environments. Before they leave the United States, consider TB testing for travelers who anticipate prolonged exposure to people known to have, or at high risk for having, TB (e.g., people in clinics, hospitals, prisons, homeless shelters).
what are some soil and waterborn infections at risk in Brazil?
Leptospirosis (outbreaks have occurred after heavy flooding in urban areas), Schistosomiasis
what are some vectorborne diseases at risk in Brazil?
chikungunya & dengue;
Leishmaniasis - cutaneous and visceral leishmaniasis are most common in the Amazon and northeast regions - sand fly bite at night;
lymphatic filariasis - only 4 cities located in the Recife Metropolitan Region (NE coast)
malaria
rickettsial disease - tickborne rickettsial diseases include febre maculosa and Brazilian spotted fever, which are caused by etiologic agents from the same genus Rickettsia that causes Rocky Mountain spotted fever in US;
trypanosomiasis/Chagas disease - mostly eliminated; but outbreaks have been associated with consuming food or beverages containing acai - an Amazonia fruit eaten throughout Brazil, and sugar cane juice (caldo de cana), contaminated with triatomines (the bloodsucking insects that transmit the etiologic agent of Chagas disease or their feces
YF - throughout the Amazon Basin and in forested regions along all major river basins in Brazil
Zika
what are some vectorborn diseases in Cusco & Machu Picchu?
Bartonellosis (Carrion disease) - bacterial infection transmitted by sand flies that causes hemolysis of infected red blood cells;
Chagas disease - endemic to semi-urban and rural areas in southern Peru;
Chikungunya, dengue, mayaro, zika;
Leishmaniasis;
Malaria, YF
what is the name of jungle vine in Cusco & Machu Picchu that can cause hallucinations and used in traditional rituals in S. America?
Ayahuasca
what are enteric infections in Dominican Republic?
Cholera only in certain area - vaccine not indicated;
TD;
Typhoid
what are soil/waterborne infections in Dominican Republic?
leptospirosis, schistosomiasis (almost eliminated)
what are vectorborne diseases in Dominican Republic?
dengue is widespread in the dominican republic (3964 cases and 38 deaths in 2020)
lymphatic filariasis - some smaller foci in the east and SW regions
malaria - only certain provinces
what are some toxic exposures in Dominican Republic?
methanol exposure!
what enteric infection is endemic in Peru?
Cyclospora cayetanensis - tx is trimethoprim-sulfamethoxazole;
Cryptosporidiosis;
Giardiasis;
Hep A;
TD - primarily enterotoxigenic E. coli strains;
typhoid fever - hyperendemic to Peru;
what respiratory infection is endemic to Peru?
TB - multidrug-resistant and extensively drug-resistant TB strains are frequently detected
what STI and HIV concern is there in Peru?
antimicrobial resistant strains of Chlamydia trachomatis and Neisseria gonorrhoeae are well described in Peru;
some strains of HIV are resistant to antiretroviral therapy
what are vectorborne diseases in Peru?
arboviruses - chikungunya, dengue, zika - outbreak occur frequently - day biting mosquitoes <2300m;
carrion disease - Bartonella bacilliformis, the cause of Oroya Fever and verruga peruana (together known as Carrion disease) - Lutzomyia sandflies - endemic to some areas in Ancash (Caraz), Cajamarca, and Cusco (Urubamba);
Leishmaniasis - cutaneous leishmaniasis, which manifests as chronic ulcers, is a parasitic infection transmitted by the bite of certain sandflies endemic to many valleys in the Andes and tropical Aamzon rainforest - traveler’s visiting the Manu National Park in Madre de Dios are at greatest risk;
malaria, yellow fever
what are enteric infections endmic to Mexico?
Giardia;
Taeniasis (tapeworm) - raw or undercooked beef or pork;
Cysticercosis - ingest larval cysts of Taenia solium excreted by human carriers (more serious) - undercooked vegetables;
TD;
Typhoid fever
what are respiratory infections endemic to Mexico?
Coccidioides - soil of NW Mexico;
histoplasma - central and SE regions;
Legionnaires’ disease;
TB (lower than in Africa, Asia, and Eastern Europe, but higher than US)
if someone was traveling Mexico, and has developed pneumonia within 14 days of coming back, what infection can you consider?
Legionnaires’ disease
what type of travelers’ are at the risk of TB in Mexico?
long term >6 months travel;
health care settings, prisons, shelters, drug rehab centers;
extended or frequent visits home to spend time with friends and relativees;
eating unpasteurized dairy products
what are some soil/waterborne infections in Mexico?
cutaneous larva migrans - more remote beaches
what are some vectorborne diseases in Mexico?
arbovirus - chikungunya, dengue, zika;
Leishmaniasis - southern Mexico and along parts of both the Pacific and Gulf coasts;
rickettsial disease - tickborne Rocky Mountain spotted fever (dog tick, visiting grassy, brushy, or wooded areas, particularly in states along the US-Mexico border), fleaborne typhus
trypanosomiasis - Chagas disease - endemic throughout Mexico - 0.7 cases per 100,000 population - most along the Pacific Coast and the Gulf of Mexico, and in central and southern Mexico
what risks are there in Mexico from Scorpions, snakes, and other venomous wildlife?
scorpion- Centruoides genus (bark) scorpions along the Pacific Coast and in the central states of Durango, Guanajuato, State of Mexico, and Morelos;
bites from pit vipers (Agkistrodon, Bothrops, Crotalus spp)
stings from fire ants, bees, wasps
when is brown seaweed season in Mexico (Sargassum seaweed)?
April - August
what are some toxic exposure risks in Mexico?
Lead (pottery) & Mercury (skin-lightening creams)
is typhoid vaccine recommended in Jamaica?
No - only for those intending to venture outside the usual tourist areas or travel extensively in rural areas of the country, people travel for work in remote areas, visiting the island for extended periods
what is vectorborne diseases in Jamaica?
Chikungunya, Zika, Dengue - seasonal during the wet season between June and Nov
what is soil-waterborne infection in Jamaica?
leptospirosis
what are environmental risk in Jamaica in beach & ocean?
sting from lionfish spine;
Jamaican reef
what are some food poisonings in Jamaica?
acke fruit - Ackee fruit must be allowed to ripen fully before being eaten; the ripening process permits clearance of a naturally occurring, heat-stable toxin, hypoglycin A.
Ciguatera
which country has the highest murder rate in the Caribbean and Latin America in 2020-2021?
Jamaica
What enteric infections are endemic in Guatemala and Belize?
Giardiasis;
Taeniasis & Cysticercosis;
TD;
Typhoid fever;
is Guatemala and Belize low or moderate or high incidence countries for TB?
moderate
what are soil/waterborne infections in Guatemala and Belize?
cutaneous larva migrans (beaches or warm soil);
leptospirosis
what are vectorborne diseases in Guatemala and Belize?
Arboviruses - Chikung, dengue, zika;
Leishmaniasis - cutaneous leishmaniasis;
Malaria;
Rickettsial diseases - Rickettsia prowazekii, Rickettsia rickettsia, Rickettsia typhi, Rickettsia felis;
Trypanosomiasis (Chagas disease);
which countries still report rabies in dogs in the Americas?
Guatemala and Belize
what are some scorpions that are found in Guatemala and Belize?
striped bark scorpion (Centruroides spp.)
what are venomous snakes found in Guatemala and Belize?
coral snakes, pit vipers, neotropical rattlesnake
what are some venomous spiders in Guatemala and Belize?
Chilean recluse spider (Loxosceles laeta)
black widow spider (Latrodectus spp)
if you are stung by lionfish in Belize, what do you do?
hot water, analgesics, antihistamines, seek medical help
which country is one of the most seismically and volcanically active countries in the world?
Guatemala
what enteric infections can you likely get from Haiti?
Cholera;
TD;
Typhoid
what are some soil/waterborne infections in Haiti?
Helminths
what are some vectorborne diseases from Haiti?
arbovirus - dengue, chikununya, zika;
malaria - Chloroquine-sensitive P. falciparum - 70 cases / 100,000 annually - peak after rainy seasons March-May and Oct-Nov;
lymphatic filariasis
are there risk of Rabies in Haiti?
Yes - risk more than any other nation in the Americas
what are some food poisoning risk in Haiti?
Ciguatera fish poisoning - common;
avoid reef fish weighing >2.7kg or the filets of large fish
what is soil/waterborne infections in Brazil?
schistosomiasis - freshwater lakes and rivers
what are vectorborne diseases around Iguacu Falls?
chikung, deng, zika - urban and rural areas in the Iguacu Falls regions;
Leishmaniasis - sandflies - most common in Amazonian and northeast regions;
YF
is malaria a risk near Iguacu Falls?
no - but consider the entire itinerary (other regions of Brazil)
is YF a risk near Iguacu Falls?
yes - in monkeys and mosquitoes in the forested regions along the Iguacu and Parana rivers - all travelers should be vaccinated
