ID-Travel Medicine

Question 1

How long can malaria incubate for?

Answer 1

12-35 days

Question 2

Describe the pathology of malaria, what are the symptoms?

Answer 2

Parasitemia of 5-10% causes clotting and infarcts in small blood vessels, capillary leakage and organ dysfunction.

Complications include altered mental status, seizures, liver failure, DIC, intravascular hemolysis, kidney insufficiency, hemoglobinuria, and hypoglycemia

Develop anemia and splenomegaly, elevated LFTs, and thrombocytopenia

Question 3

Malaria prophylaxis for chloroquine resistant P. falciparum?

Answer 3

atovaquone/proguanil (not for pregnancy)
mefloquin
doxycycline (not for pregnancy)

Question 4

Malaria prophylaxis for chloroquine sensitive P. falciparum?

Answer 4

chloroquine

hydroxychloroquine

Question 5

Malaria prophylaxis for areas endemic with P. vivax?

Answer 5

Primaquine (unless have G6PD)
chloroquine
hydroxychloroquine

Question 6

prophylaxis for vivax or ovale

Answer 6

primaquine

Question 7

What areas have… vivax? oval? falciparum? malariae? knowlesi?

Answer 7

vivax: topical and temperate areas
ovale: West Africa and southeast asia
malariae: tropical zones
falciparum: tropical and temperate zones
knowlesi: south and Southeast Asia

Question 8

What causes typhoid fever?

Answer 8

Salmonella enterica

Question 9

Incubation period and clinical symptoms of typhoid fever?

Answer 9

8-14 days. Fever, headache, arthralgia, pharyngitis, anorexia, abdominal pain and tenderness

Very high fevers to 104 can last for weeks
rose spots or blanching rash on body

hepatosplenomegaly, leukopenia, anemia, thrombocytopenia, abnormal liver chemistries

Question 10

how diagnose typhoid fever

Answer 10

blood cultures, stool cultures, urine, or bone marrow

Question 11

Treatment of typhoid fever

Answer 11

ceftriaxone, azithromycin, levo, cipro, moxi

Question 12

Do you give antibiotic prophylaxis for traveler’s diarrhea?

Answer 12

NO! it is effective but it is not given due to the potential for adverse effects. do consider ppx in people with inflammatory bowel disease, immunocompromised, or significant comorbidities

Question 13

What does prophylaxis include?

Answer 13

Bismuth 4x a day

cipro

Question 14

What can you use for treatment of travelers diarrhea?

Answer 14

Fluid is the mainstay and generally resolves in 3-5 days on it’s own without antibiotics, but you can give…

Bismuth
Cipro for 3 days

Question 15

Dengue fever, how is it transmitteD?

Answer 15

dengue virus, mosquitos!

Question 16

What are the clinical features of dengue fever?

Answer 16

incubation period of 4-7 days

febrile illness with frontal headache, retro-orbital pain, myalgia, arthralgia, and sometimes spontaneous bleeding (purpura, melena, conjunctival injection), you also get a rash with dermatographism.
Pathognomic is the lumbosacral pain! It’s called the breakbone pain… Dengue has the saddle fever!

Question 17

How do you vaccinate for hepatitis A?

Answer 17

give 1 month before travel, followed by a booster 6 to 12 months later

Question 18

If someone doesn’t have time, can you provide an accelerated vaccination schedule for Hep B?

Answer 18

Yes, bc otherwise it takes 6 months

Question 19

How does brucellosis occur?

Answer 19

unpasteurized dairy products or undercooked meat

Question 20

Clinical presentation of brucellosis?

Answer 20

Myalgias, athralgias, fatigue, headache, night sweats, depression is frequent

HSM and LAD on physical examination

can also get bone infection around the joints

Disease relapse can occur if undertreated or a small focal area of infection

Question 21

How do you diagnose brucellosis?

Answer 21

blood, bone marrow, body fluids, other tissue

Diagnostic is: 1:160, or a four fold increase from acute to convalescent titers

Question 22

How is brucellosis treated?

Answer 22

doxycycline, rifampin, streptomycin (or gentamicin!)

Question 23

How is yellow fever transmitted?

Answer 23

Aedes mosquito

Question 24

Clinical features of yellow fever and where is it common?

Answer 24

South America and sub Saharan Africa

fever, headache, myalgias, backache, can get jaundice hemorrhage and shock

Question 25

What are the travel recommendations for rabies?

Answer 25

Pre-exposure vaccine. Then if bitten they should get a post exposure vaccine

If previously unvaccinated then they should get the rabies toxin

Question 26

Leptospirosis–caused by?

Answer 26

urine and feces from rodents

Question 27

Clinical features of leptospirosis

Answer 27

fevers, headaches, myalgias (especially in the calf muscles and lower back), conjunctival injection, lower back pain, diarrhea, pharyngitis, pretibial rash

Question 28

Q fever–where get it? clinical features?

Answer 28

inhalation of aerosols from the infected placenta of cattle, goats, and sheep

self limited febrile illness but can get an atypical pneumonia

Middle East and Africa