ill travelers

Question 1

top travel illnesses

Answer 1

diarrhea
vomiting
URI
fever

Question 2

top exposure areas for ill returned travelers

Answer 2

Asia 33%
sub-Saharan Africa 27%

3/4 of illness was due to
- GI 34%
- febrile illness 23%
- derm disorder 20%
- respiratory 11%

Question 3

top causes for GI, febrile, derm, resp by region

Answer 3

Sub-Saharan Africa
- falciparum
- Giardia
- Rickettsia

Latin America
- Dengue
- cutaneous larva migrans
- vivax
- giardia
- vivax
- influenza

Southeast Asia
- Dengue
- rabies PEP
- influenza
- cutaneous larva migrans
- campylobacter

Question 4

vaccine preventable disease travel health risks table

Answer 4

influenza
animal bites
latent TB
typhoid (SE Asia)
Tick borne ecaphalitis

Question 5

febrile systemic illness

Answer 5

1 malaria

dengue
typhoid/paratyphoid
mono
rickettsial
Hep A
leptospirosis

Question 6

relevant hx - host

Answer 6

age
underlying dz
past infections
vaccines, drugs, chemophroph
chronology of sxs

Question 7

relavent hx - destination

Answer 7

location
season
duration
accommodation
ID profile of area incl. outbreaks

Question 8

relevant hx: activities

Answer 8

food/drink
arthropod bites
repellents/bednets/screens
blood/body fluid exposure
- sex, shave, injection, dental work, med tx
animal contacts
water -fresh/salt, soil
caves

Question 9

fever + rash

Answer 9

deng, zika, chkga, measles, rickettsial, enteric, meningo coccemia, acute HIV, vesicular rash(mpox, rickettsia, varicella), drug

Question 10

African tick bite fever

Answer 10

Rickettsial africae
2nd only to malaria
sporadic, clusters in travelers
eschars - multiple
regional LAD
those with rash
- 51% mac-pap, 45% vesic, 4% purpuric

Question 11

measles

Answer 11

high fever 10 d after exp
rinorrhea, cough, Koplik spot - oral mucosa - rash comes later and fades after 5-6 days
complication- blindness, encephlts, diarrhea, resp,
US 2019 - 12,000 cases - majority attributed to travel

Question 12

fever + abd pain

Answer 12

invasive enteropathogens
- campylobacter, salmoneela, shigella

• enteric fever
• amebic or pyogenic liver abscess
• Heptitis
• 2022 covid

Question 13

fever + nl or low WBC

Answer 13

deng, chkgya, zika, HIV, malaria, Ricketsl, enteric fever, covid19

Question 14

fever + hemorrhage

Answer 14

deng, meningococcemia, lepto, rickettsl, YF
others- ebola, lassa, rimean congo, hanta rift val, marburg

Question 15

fever + arth/myalgia

Answer 15

CHIKUNGUNYA
deng, zika, ross river v, muscular sarcocystosis, trichinellosis(round worm), covid

Question 16

chikungunya

Answer 16

can cause impressive psoriasis flares and report of psoriatic arthritis.

Question 17

fever + eosinophilia

Answer 17

acute schisto
drug hypersensitivity
fascioliasis
sarcocystosis
trichenellosis
angiostrongyliasis
others

Question 18

fever + resp

Answer 18

flu
covid
legionnaires (cruise, hotel, spa)
MERS-CoV
Q fever (Coxiella burnetti)
Hemorrhagic pneumonia with leptospirosis
Fungal - coccidiomycosis- Mexico hotel construction, archeol dig
histoplasmosis - Mexico- trek through tunnel, spelunking

Question 19

fever + mental status change

Answer 19

cerebral malaria
JE, west nile
meningococcal, meningitis
rabies
Af. trypanosomiasis
Scrub typhus
Angiosrongyliasis
Tick borne enceph
acute HIV
Murray Valley enceph
Dengue, zika chkgna
covid 19

Question 20

fever and jaundice

Answer 20

acute viral hepatitis A,B,C,E
YF and other hemorragic fevers
severe malaria
leptospirosis
covid-19

Question 21

leptospirosis

Answer 21

zoonotic
global
spirochete in fresh water
inc 2-20 days

fever, HA, chills, myal, vom, jaundice, conjuctival suffusion

monsoons, flooding, fresh water snorkeling

Question 22

mononucleosis syndrome

Answer 22

febrile illness with prolonged fatigue, myalgia

CMV
EBV
Toxo
Acute HIV
Long Covid

Question 23

malaria

Answer 23

s/sx nonspecific
may be afebrile
parasites can be very few in peripheral smear
many labs lack expertise
severe dz: artesunate lic in US

Question 24

malaria dx

Answer 24

rapid dx test, microscopy, PCR
initial smear neg - REPEAT
request thick and thin urgent
- malaria?
- species?
- parasitemia(>=5% is severe)
- able to take oral meds

Question 25

dengue

Answer 25

favivirus
mosquito - Aedes
4 serotypes
urban and rural
most common febrile illness everywhere except SSA

Question 26

dengue

Answer 26

inc 4-7 d
fever, HA, retroorbital pain, myalgia
severe: vascular permeability/plasma leakage, hemoconcentration
- risk for sever increase ~ 100x with 2nd infection
- virulence may vary by genotype
fatalaty rate <1% with good care

Question 27

chikungunya

Answer 27

togaviridae, Alphavirus
mosquito: Aedes
3 lineages W Africa, East Central So Africa, Asian
dz burden: large sporadic outbreaks
arthritogenic “that which bends up”

Question 28

chikungunya

Answer 28

inc 3-7 (up to 12)
asymptomtic < 25%
- acute 0-3 wk fever, symmetrical polyarthralgia >80%, pain, myalgia, rash 35-65%
post acute 4-12 wks joint pain, longer in elderly
chronic > 12 wks in 15-50% symmetric arthritis/arthalgia
CFR0.01-0.1% - low with good care

Question 29

zika

Answer 29

flavivirus
Aedes
sexual, vertical, blood
sporadic outbreaks 2018 was last
clinical - most asx, rash, conjunctivitis, fever 2d, HA
arthralgia, myalgia up to 1 week
complications: neurologic (GBS, myelitis, meningoencephalitis, neuropathy), autoimmune congenital zika

Question 30

derm problems after travel

Answer 30

cutaneous larva migrans, insect bite, skin abscess, infected insect bite,
serpiginous lesions,

Question 31

cutaneous leishmaniasis

Answer 31

papule, nodule, painless ulcer with rolled edges.
other- multiple lesions
nodules; satellite lesions
plaques
nodular lymphangitis