Global health, tropical and travel medicine. Flashcards
Place with the highest 1 week risk of travellers diarrhoea?
India - 54%
Key things to assess when your patient is travelling abroad?
When are they going. - how long for vaccinations, is it rainy season?
Where are they going.
What are they doing. - Healthcare? Aid agency? Duration? Access to healthcare?
Past Medical history. Drug interactions, safe to travel?
ABCD of malaria advice?
A - Awareness of Risk: Fever for up to 6 months after returning could be malaria.
B - Bite avoidance: DEET, Nets, Dusk till dawn, long sleeved clothing.
C - Chemoprophylaxis - Duration pre, post and during, S/Es and cost
D - Diagnose early
Malaria prophylaxis choices?
Malarone (Atovaquone + Proguanil)
- 1 tablet a day, good S/E profile
- 1 day before, 1 week afterwards
Doxycycline
- 1 Tablet a day
- 20% risk of photosensitivity
- 1 week before 4 weeks after return. (cheap)
Mefloquine
- 1 tablet a week
- Neuropsychiatric S/Es
- 3 weeks before 4 weeks when returning (cheap)
Legally required vaccine for Saudi Arabia?
Meningococcal vaccine
What are the most common types of illness following travel?
GI illness - 34%
Systemic febrile illness - 23.3%
Dermatological - 19.5%
Where are systemic febrile illnesses most likely caused from?
Sub-saharan africa
Where is acute diarrhoea most likely caused from?
SC asia
Pathogenesis of Giardia bacteria?
Causes inflammatory process by attaching to enterocytes in the jejunum - acute diarrhoea
Most common bacterial causes of acute diarrhoea?
Campylobacter
Whats more common parasitic/viral/bacterial infection causing diarrhoea?
Parasitic more common presentation.
Most likely cause of fever presentation?
Malaria
Difference in Vivax and falciparum malaria?
Falciparum a bit worse generally
What is cutanea larva migrans? Where is it most likely caught from?
Infection from hookworms from cats/dogs. Won’t get further than skin as man is not desired host. Most likely caught from Caribbean - C. America
Risks for travellers who are visiting friends and family?
Unlikely to seek pre-travel advice and so more likely to acquire a vaccine preventable illness
62% of falciparum occurred amongst travellers visiting friends and relatives
Which group of Travellers get respiratory illness commonlly
Business travellers
Which group of travellers are most likely to become ill abroad?
Tourists.
Investigations you should do for returning unwell travellers?
Blood culture. Malaria blood test. HIV test Urine/stool culture throat swab
Standard: FBC, U+Es, CRP, LFTs, CXR
Most common cause of parasitic diarrhoea?
Giardia
Clinical features of falciparum malaria?
Fevers, rigors, vomiting, headache, arthralgia, malaise (cough, diarrhoea)
Fevers are usually daily or continuous
Commonly presents within 4 weeks of return from endemic area but can be delayed for much longer
What species of mosquito cause malaria
Female anopheles mosquitos
Serious complications of malaria?
AKI
Cerebal Malaria
Pulmonary oedema
Alkolosis/acidosis
Types of malaria testing?
Blood film - look for it
Antigen testing
Treatment of falciparum malaria?
Non severe:
PO (oral): Malarone
PO: Co-artem
Severe:
IV artesunate
Where are you most likely to see flaciparum and where are you most likely to see vivax?
Falciparum - sub saharan Africa
Vivax South and South east asia
Vivax malaria diagnosis?
Blood film only (antigen not sensitive) need several
Vivax malaria treatment?
PO Chloroquinine
Followed by primaquine to eliminate liver (hypnozoite) stage
Pattern of Fever in vivax malaria?
Every 3 days there is a peak of fever
How many cases of imported malaria were reported in 2015?
1500
What proportion of falciparum and vivax caused imported malaria?
Falciparum - 75%
Vivax - 15%
Ebola infection management?
IV zmapp - monoclonal antibodies
Blood transfusion
LFTs in ebola infection?
Derranged
Clinical presenting signs and symptoms of ebola?
Fever Headache Weakness Dizziness Diarrhoea Abdo pain etc...
What is MERS
Middle eastern respiratory syndrome
Caused by a virus
> 85% in saudi arabia
Treatment of MERS?
Oseltamivir
Extracorporeal membrane oxygenation
Treatment of Avian flu?
Oseltamivir
Maximum incubation period for MERS?
14 days
