Infections in returning travellers

Question 1

What are the common infections in returning travellers?

Answer 1

Gastroenteritis

Tuberculosis

Hep A

Hep E

Schistomiasis

Malaria

Dengue fever

Viral haemorrhage fevers

Crimean- congo haemorrhage fevers

MERS

Rabies

Question 2

Gastroenteritis: region, causes, main agents, presentation, investigation, management?

Answer 2

Region: global

Caused by poor food hygiene & sanitation

Rotavirus, Norovirus and Astrovirus- main viral agents.

Campylobacter jejuni, Escherichia coli, Salmonella and Vibro cholerae - bacterial agents

Presentation:
- Anorexia
- nausea
- vomiting
- diarrhoea
- abdominal pain

Investigation:
- Clinical evaluation
- Stool sample

Treatment:
- Rehydration
- Antibiotics if appropriate

Question 3

Tuberculosis: regions, cause, how is it spread, presentation, investigation, management

Answer 3

Region: Africa, south & south east Asia

Caused by Mycobacterium tuberculosis

Passed via droplets human to human

Presentation:
- Chronic cough
- Sputum production
- chest pain
- breathing issues
- Weight loss
- Fever
- Night sweats
- Coughing up blood (hemoptysis)

Investigation:
- TB blood or skin test/ acid fast staining

Management- vaccine:
- Isoniazid (w/ pyridoxine), rifampicin, pyrazinamide & ethambutol for 2 months
- Isoniazid (w/ pyridoxine) & rifampicin for a further 4months (10 if there is CNS involvement).

Question 4

Hepatitis A: region, presentation, investigation, management?

Answer 4

Region:
South America, Africa, Asia

Presentation:
- Affects the liver
- Can be asymptomatic in children
- Abdominal pain
- Nausea
- Dark urine
- Low grade fever

Investigation:
- PCR
- antibody tests

Management:
- Self limiting condition
- Paracetamol and unnecessary drugs should be avoided
- Vaccine

Question 5

Hepatitis E: regions, transmission, presentation, Investigation, Management?

Answer 5

Region: Asia & Africa

Transmitted by faecal - oral route

Monsoon period brings outbreaks

Presentation:
- 3-7 week incubation
- Flu symptoms
- Jaundice
- Dark urine

Investigation:
- Anti-HEV blood test

Treatment:
Self limiting, avoid unnecessary medications
- Vaccine

Question 6

Schistomiasis: region, caused, presentation, investigation, management

Answer 6

Region- Africa

Caused by certain types of snails carrying schistosomes in fresh water lakes.

Presentation:
- Fever, chills
- Cough
- Myalgia
- Chronic symptoms: abdominal pain, enlarged liver, blood in the stool or blood in the urine, and problems passing urine.

Investigation:
- Travel history
- Stool or urine exam

Management:
- Short course of praziquantel

Question 7

Dengue fever: region, transmission, presentation, investigation, management?

Answer 7

Region: south east Asia, South America

Transmitted by Aedes mosquito

Presentation:
- High fever
- Severe headaches & pain behind eyes
- Myalgia
- arthralgia
- bone pain
- rash & mild bleeding
- Haemorrhagic fever will include vomiting & severe abdominal pain as fever starts to decline
- followed by circulatory failure if not corrected.

Investigation:
- Blood test

Treatment:
- Painkillers
- avoiding NSAIDs & Aspirin which could increase bleeding.

Question 8

Examples of Viral haemorrhagic fevers & their symptoms

Answer 8

Ebola, Crimean Congo, Rift Valley fever, Lassa fever & Yellow fever.

• It is a severe multi-system syndrome.
• Characteristically, the vascular system is damaged & body’s ability to regulate itself is weakened.
• Bleeding - can be life threatening.

Question 9

Crimean - Congo haemorrhagic fever: regions, symptoms, incubation period?

Answer 9

Region: africa & asia

1-3 day incubation period

Similar symptoms as dengue haemorrhagic fever
- Causes liver& kidney failure

Question 10

MERS: region, presentation, investigation, management

Answer 10

Region: China, Middle East

Presentation:
- Fever
- Shortness of breath
- Cough
- Pneumonia
- Diarrhoea

Investigation:
- Nose & throat swab sent to lab.

Management:
- Case by case treatment, aka good luck

Question 11

Rabies: region, cause, types, incubation period, presentation, investigation, management?

Answer 11

Region: Africa, Asia & South America

Virus attacks CNS
- usually passed by dogs

Incubation between 1 week & 1 year.

Presentation:
- Bite marks
- When symptoms develop move to palliative care
- Flu like symptoms
- anxiety, confusion, agitation, cerebral dysfunction

2 types: furious & paralytic
- Furious presents with hydrophobia and hyperactivity, usually takes a few days to kill.
- Paralytic causes paralysis from scratch site, coma, then death over a longer period of time.

Investigation:
- Patient history of bite
- Travel history

Management:
- Wash bite w/ soap & water asap
- Post exposure vaccination, ideally w/in 24 hours
- Immunoglobulin given ideally w/in 24 hours.