Immunocompromised traveler Flashcards

1
Q

What are conditions that are identified as ‘disease without compromise’?

A

HIV CD4 >500
SOT/BMT >2y
Malignancy chemo>3m and in remission
Corticosteroids <20mg <2w
Autoimmune disease without treatment
MS with no exacerbation and no treatment

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2
Q

What are conditions that are identified as ‘limited compromise’?

A

HIV CD4 200-500
Complement deficiencies
Asplenia
Chronic renal or liver disease
MS with exacerbation and no treatment
Nutritional deficiencies

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3
Q

What are conditions that are identified as ‘severe compromised’

A

HIV CD4 <200
BMT/SOT <1y or on immunosuppressants
Active malignancy
CLL
Recent radiation
Aplastic anemia
Congenital immunodeficiency
Corticosteroids >20mg >2w
Thymus disorders
Drugs

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4
Q

Which drugs qualify a patient as ‘severe compromised’

A

Alkylating agent
Anti-metabolites
Chemotherapy
Immunomodulators
TNF blockers

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5
Q

What are the components of pre-travel consultation?

A
  1. Assess traveller’s health
  2. Assess disease exposure risk
  3. Administer vaccines
  4. Administer medical prophylaxis
  5. Medical care
  6. Counselling
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6
Q

What history is important for an immunocompromised traveller?

A

Conditions
Medications
Extremes of age
Immunisation history
Timelines (chemo, transplant)

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7
Q

How do you asses the risk of disease exposure?

A
  1. Countries
  2. Accomodation
  3. Peak seasons
  4. Food sources
  5. Activities
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8
Q

Which conditions can receive medical prophylaxis?

A

Traveller’s diarrhoea
Malaria
Leptospirosis
Post-splenectomy prophylaxis

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9
Q

What should you counsel a travelling patient on?

A
  1. Food and water safety
  2. Accident prevention
  3. Insects
  4. Wear shoes
  5. Thrombosis prophylaxis
  6. Altitude sickness
  7. STIs
  8. Diving
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10
Q

Which enteric infections can be severe and become chronic in the immunocompromised?

A

Salmonella
Campylobacter
Cryptosporidium

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11
Q

Are prophylactic quinolones routinely recommended for enteric infections?

A

No!
But lower threshold for use (and azithromycin in areas with resistance)

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12
Q

What is the risk of traveller’s diarrhoea in patients with impaired renal function?

A

Dehydration complications

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13
Q

What are specific conditions to consider at risk for malaria?

A

Asplenia (severe malaria)
HIV (bidirectional interaction)
SOT (can lead to rejection)

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14
Q

Which ARVs interact with antimalarials?

A

NNRTIs
PIs

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15
Q

Which anti-malarials do NNRTIs interact with?

A

Mefloquine (specifically efavirenz and NVP)

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16
Q

Which anti-malarials do PIs interact with?

A

Quinidine
Lumefantrine
Halofantrine

17
Q

What is the reason for contraindication of PIs with quinidine?

A

Cumulative cardiac toxicity

18
Q

Which condition can protect from fatal hemorrhagic dengue fever complication?

A

Impaired T cell function

19
Q

Which arbovirus can precipitate SOT rejection?

A

Dengue

20
Q

Name encapsulated organisms to consider in asplenic patients

A

S. pneumonia
N. meningitidis
Haemophilus
Capnocytophaga

21
Q

What bacterial prophylaxis can you give an asplenic traveller?

A

Levofloxacin
Moxifloxacin
Augmentin

22
Q

What is the risk of Babesia infection in asplenic patients?

A

Highest in 1st 2 years
Children higher risk
Sickle cell at risk
Severe disease

23
Q

Which travellers are at increased risk of hepatic decompensation follow HAV infection?

A

HCV

24
Q

How does TST perform in the immunocompromised?

A

Decreased sensitivity

25
Q

Is scrub typhus different in HIV infected patients?

A

No

26
Q

Is leptospirosis different in HIV infected patients?

A

More severe
Same mortality

27
Q

What is a well recognised complication of HIV infection with Chagas disease?

A

Brain abscess

28
Q

Is trypanosomiasis different in HIV infected patients?

A

Decreased treatment response

29
Q

Which illnesses should be considered if less than 1 week after returning?

A

Bacteria
- diarrhoea
- resp infection
- meningitis
sepsis
Virus
- VHFs
- resp infection
- meningitis
- measles
- covid

30
Q

Which illnesses should be considered if >1w but <1m after returning?

A

Bacteria
- typhoid
- sepsis
- pertussis
Virus
- covid
Parasites
- malaria falciparum
- amoebic colitis
- schistosomiasis
Fungal

31
Q

Which illnesses should be considered if >1m after returning?

A

Parasites
- malaria non falciparum
- leishmaniasis
- amoebic liver abscess
- schistosomiasis
Virus
- hepatitis
- rabies

32
Q
A