Brainscape's Knowledge GenomeTM

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


See full index

Kat's Pathology > Fever in the Returning Traveller > Flashcards

Fever in the Returning Traveller Flashcards

1
Q

What percentage of people who travel from the industrialised world to the developing world report some illness associated with their travel?

A

Between 20-70%

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

What percentage of people who travel from the industrialised world to the developing world become ill enough to seek medical attention either during or immediately after travelling?

A

1-5%

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

What percentage of people who travel from the industrialised world to the developing world require medical evaluation?

A

0.01-0.1%

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

What percentage of people who travel from the industrialised world to the developing world die from an illness acquired from their travels?

A

1/100,000

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

What are some key questions to ask when taking a travel history? (5)

A

Where did you go - details?
Timing - travel, symptoms?
Why did you go?
What did you do? Activities/interactions.
What pre-travel vaccines/malaria prophylaxis did you take?

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

What is the deadliest vector-born disease?

A

Malaria.

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

What are the two deadliest infections worldwide?

A

HIV

TB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the most common diagnosis in a returning traveller with a fever?

A

Malaria.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the vectors for malaria? (2)

A

Mosquitos.

Humans.

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

What are the life cycle stages of malaria in the mosquito? (4)

A
  1. Parasite is sucked up from human vector by mosquito.
  2. Oocysts develop in the mosquito gut wall.
  3. Sporozoites develop in the oocyst.
  4. Sporozoites migrate to the mosquito salivary glands, where it re-enters the human host.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the life cycle stages of malaria in the human host? (4)

A
  1. Sporozoites injected with the mosquito bite.
  2. Liver stage.
  3. Red blood cell stage.
  4. Gametocytes produced, which can then be taken up by mosquitos again.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the causative parasite of malaria?

A

P. falciparum. (can be rapidly fatal)

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

How quickly do symptoms of p. falciparum develop after contracting malaria.

A

Symptoms usually appear within 1 month, but can also be much later.

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

Where is p.falciparum malaria most prevalent.

A

Africa.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are some more indolent malaria species. (3)

A

P.vivax.
P.ovale.
P.malariae.

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

Where are the more indolent species of malaria more prevalent? (2)

A

South America.

Asia.

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

How quickly do symptoms develop after contracting a more indolent form of malaria? (2)

A

Only half of patients develop symptoms within 1 month of returning from travel.
Symptoms can manifest >1 year after return.

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

What is a key features of p.vivax and ovale malaria?

A

Hypnozoites.

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

What are the typical clinical features of malaria? (4)

A

History of fevers/rigors.
Other non-specific symptoms.
Thrombocytopaenia.
Sequestration in organs.

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

What is the most common cause of complicated malaria?

A

P. falciparum.

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

What are the clinical features of complicated malaria? (9)

A 
>5% parasitaemia. 
Confusion/coma. 
Oligoanuric AKI. 
Jaundice (Bilirubin>50mg/dL)
Anaemia (Hb<5g/dL) 
ARDS. 
Severe hypoglycaemia. 
Acidosis. 
Shock.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are the clinical tests to detect malaria infection? (3)

A

Thick smear.
Thin swear.
Rapid antigen tests.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What does the thick smear look for when screening for malaria?

A

Screens for any parasites in the blood (sensitive)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What does the thin smear look for when screening for malaria?

A

To identify the species and quality parasitaemia.

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

What is more effective at detecting malaria - thick smear or the rapid antigen test?

A

Thick smear.

You need 100 versus 5 parasites/microL in the blood)

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

What is the most important thing to remember when screening for malaria?

A

Do not delay treatment if there is any indication that a patient has malaria.

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

In what setting in falciparum malaria treated?

A

Always admit to hospital.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What drug regimen is most commonly used to treat falciparum malaria?

A

Quinine 600mg TDS PO (unless vomiting) + doxycycline 100mg OD (or clinidamycin 450mg TDS if pregnant) PO for 7 days.

Observe until improving and parasitaemia falls.
Always give advice RE prevention and prophylaxis.
Inquire RE travel companions.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What is are two alternative drug regimen for treatment malaria? (2)

A

Co-artem (Riamet) - 4 tablets at 0, 8, 24, 36, 48 and 60 hours.

Atovaquone-proguanil (Malarone) - 4 tablets OD for 3 days.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What are the side effects of the classic drug regimen to treat malaria? (Quinine, doxycycline) (3)

A

Nausea.
Deafness.
Tinnutus (cinchonism)

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

What must be monitored for the duration of malaria treatment?

A

Blood glucose.

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

Is severe falciparum malaria a medical emergency?

A

Yes

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

How do you treat severe falciparum malaria? (2)

A

First-line: IV Artesunate.

Second-line: IV Quinine.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What must be monitored with IV artesunate for severe falciparum malaria?

A

BM monitoring required.

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

What must be monitored with IV quinine treatment for severe falciparum malaria? (2)

A

Cardiac and BM monitoring.

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

What are some adverse effects of IV quinine? (2)

A

Arrhythmogenic.

Causes hypoglycaemia.

37
Q

How is non-falciparum malaria usually treated?

A

Chloroquine.

38
Q

What is given to treat p.vivax and p.ovale malaria infection? (2)

A

Chloroquine.

Primaquine (to eradicate hypnozoites)

39
Q

What must be checked before commencing primaquine treatment for non-falciparum malaria?

A

G6PD levels.

40
Q

In what group of people is primaquine contra-indicated? (2)

A

Pregnant.

Breast-feeding.

41
Q

What are the principles of malaria prevention? (4)

A

ABCD.

A- awareness of risk - avoid malarious areas, avoid going out from dusk until dawn.
B - bite prevention - repellents, nets, clothing.
C - chemoprophylaxis - seek expert guidance.
D - diagnose prompt and treat without delay.

No regimen is 100% effective.

42
Q

What are some important causes of fever in travellers returning from Sub-Saharan Africa? (2)

A

Malaria.

Diarrhoea, bacterial Schistosomiasis.

43
Q

What are some important causes of fever in travellers returning from Southeast Asia? (3)

A

Malaria.
Dengue.
Typhoid.

44
Q

What is the causative organisms in dengue? (fever + systemic symptoms) (2)

A

Aedes mosquito.

Flavivirus.

45
Q

What are the typical symptoms of dengue? (4)

A

Fever.
Headache.
Myalgia.
Rash present in 50%

46
Q

How long is the incubation period in dengue?

A

Short.

47
Q

Is dengue predominantly an urban or a rural disease?

A

Urban disease.

48
Q

What is the natural history of dengue?

A

Usually mild, self-limited illness.

49
Q

Who is susceptible to DHF and shock following dengue infection?

A

Occurs in those previously infected with a different dengue serotype - rare in travellers.

50
Q

What is the treatment for dengue?

A

No specific antiviral treatment available.

51
Q

What are the three phases of dengue infection? (3)

A 
Febrile phase (0-4 days). 
Critical phase (days 3-7) - potential clinical issues: shock, bleeding, organ impairment. 
Recovery phase (by day 6-7): IgG and IgM antibodies present in blood.
52
Q

What are the potential complications of dengue during the critical phase? (3)

A

Shock.
Bleeding.
Organ impairment.

53
Q

What two physiological processes occur to combat dengue fever? (2)

A

Inflammatory host response.

Capillary leakage.

54
Q

How many cases of dengue occur in the UK every year?

A

Approximately 340 cases/year.

55
Q

What are the principles of management of dengue? (4)

A

Exclude malaria as a cause.
Serology for dengue fever (+/- PCR).
In uncomplicated - supportive treatment.
Refer to infectious diseases.

56
Q

What is enteric fever also know as?

A

Typhoid.

57
Q

What is typhoid caused by? (2)

A

Salmonella typhi

Paratyphi

58
Q

Where are you most likely to contract typhoid fever?

A

Indian subcontinent. (10 times more likely to catch it there)

59
Q

What does the vaccine for typhoid cover?

A

S.typhi, does not protect against s. paratyphoid.

60
Q

What are the clinical features of typhoid fever? (5)

A 
Insidious onset. 
High prolonged fever. 
Headache. 
Rose spots (rare) 
Low/normal WCC.
61
Q

What are the principles of management of typhoid fever? (6)

A 
Isolate patient. 
Blood cultures. 
Bone marrow cultures. 
Antibiotic treatment. 
Discuss with ID. 
Public health considerations (notifiable disease).
62
Q

What is the antibiotic of choice for the treatment of typhoid fever?

A

IV Ceftriaxone. (however, there is a large regional variability)

63
Q

What are the causes of mononucleosis? (3)

A

EBV
CMV
HIV

64
Q

What is the clinical presentation of mononucleosis? (2)

A

Tonsillar enlargement with exudates.

Fever.

65
Q

What is seen in the blood of a patient with mononucleosis?

A

Atypical lymphocytosis.

66
Q

How is mononucleosis diagnosed?

A

Monospot. (IgM+EBV/CMV)

67
Q

What are the colloquial names for mononucleosis? (2)

A

Glandular fever.

Kissing disease.

68
Q

What is the clinical presentation of rickettsial disease? (4)

A

Fever.
Headache.
Myalgia
+/- Eschar.

69
Q

What is the pathology of rickettsial disease?

A

Obligate intracellular bacteria which invade endothelial cells, causing vasculitis.

70
Q

What is the second most common febrile illness in returning travellers from Africa?

A

Rickettsial disease.

71
Q

What is the vector for Rickettsial disease?

A

Arthropod vectors - ticks, lice, mites.

72
Q

What are some subtypes of rickettsial disease? (3)

A

Spotted fevers: RMSF, MSF, African tick bite fever.
Typhus: epidemic (lice) and endemic (murine).
Scrub typhus (chiggers): o.tsutsugamushi.

73
Q

How is rickettsial disease diagnosed? (2)

A

Acute and convalescent serology.

74
Q

What is the treatment for rickettsial disease?

A

Doxycycline.

75
Q

What increases the likelihood of a parasitic/protozoan cause of diarrhoea?

A

Longer duration.

76
Q

What are the most common causes of diarrhoea in returning travellers?

A

Bacterial/viral.

77
Q

What type of organism is responsible for diarrhoea in travellers returning from SE Asia?

A

Bacteria.

78
Q

What type of organism is responsible for diarrhoea in travellers returning from Sub-Saharan Africa/Central Asia?

A

Parasites.

79
Q

What are the two protozoa most commonly associated with diarrhoea in returning travellers? (2)

A

Giardia lamblia.

Entamoeba histolytica.

80
Q

What does girardia lambda cause?

A

Malabsorption.

81
Q

What does entamoeba histolytica cause? (2)

A

Dystentery.

Liver cysts.

82
Q

What is an uncommon cause of diarrhoea in returning travellers?

A

Helminths.

83
Q

What blood finding is most common in patients with parasitic infections.

A

Eosinophilia.

84
Q

What organism is responsible for katakana fever?

A

Schiztosomiasis.

85
Q

Where is schistosomiasis prevalent?

A

Sub-Saharan Africa.

86
Q

Where are you most at risk of schistosomiasis infection?

A

Fresh/costal water.

87
Q

What is another common infection in returning travellers?

A

Acute hepatitis.

88
Q

What are the most important infectious diagnoses to be aware of? (4)

A

Malaria.
HIV.
Menigococcal disease.
Viral haemorrhage fever.

Kat's Pathology (105 decks)

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