Infections in the returning traveller Flashcards
What is the commonest cause of death amongst travellers to the tropics?
Cardiovascular disease
What are the common presentations of disease after travelling?
Systemic febrile illness (sub-Saharan Africa)
Acute diarrhoea (Central asia)
Dermatological disease (Everywhere)
Chronic diarrhoea (Everywhere)
What are the commonest causes of fever in returning travellers?
Malaria (sub-Saharan Africa)
Dengue (Caribbean and Asia)
Infectious mononucleosis
Rickettsial infection (sub-Sahar Africa)
Salmonella (Asia)
40% have no identifiable cause
What are Rickettsial infections?
Caused by a variety of bacteria in Rickettsia genus
- behave like viruses as they live inside cells
Cause fever, headache, malaise, nausea, or vomiting
What included in a travel history?
- Where? Precisely.. rural vs urban
- When? Incubation periods and exposure Interval
- What? Exposures
Prophylaxis: Antimalarials, Vaccination, ‘Prophylactics’
Which diseases have a short incubation period <10 days?
Malaria (P. falciparum)
Enteric bacteria
Pneumonia
Dengue and other arboviral infections
Rickettsial infections
Viral haem. fever
Plague
Influenza
Anthrax
What is anthrax?
Caused by bacteria Bacillus anthracis
Lays dormant as a spore for as long as decades (not contagious)
Gets into the body and causes severe illness in humans and animals
Releases toxins
Which diseases have a medium incubation period (11-21 days)?
Malaria (P. falciparum)
Typhoid
Strongyloides
Leptospirosis
Rickettsial infections
Brucellosis
Lyme disease
Cutaneous myiasis
What is Strongyloides?
Parasitic worms
Eg,
Thread worm
Round worm
What is Lyme disease?
A bacterial infection spread by ticks
Its rarely fatal
Which diseases have a long incubation period (>21 days)
Malaria
Amoebic liver abscess
Viral hepatitis
Tuberculosis
Enteric protozoa
Enteric helminths
HIV
Schistosomiasis
Leishmaniasis
Which infection cause a high neutrophil count?
Septisaemia
Staph or strep infections
Meningicoccal infections
Non-typhoid salmonella
Bacillary dysentery
Tonsilitis
All the tropic ones have normal/low neutrophil counts
What is dysentery?
Infection of the intestines causes diarrhoea containing blood or mucus
Only severe cases require antibiotics
What is the platelet count in malaria and dengue fever?
Low
Infection is unlikely is platelet counts are normal
Which conditions cause low platelet counts?
Dengue
Enteric fever
HIV seroconversion
Malaria
Sepsis
Other viral infections
In what type of infection is CRP high?
In pyogenic infections
Often elevated in malaria
What is the most common malaria species presenting in the UK?
Plasmodium falciparum
It’s most serious
Others include: P.vivax, P, ovale, P.malriae, and P.knowlesi
What is the first-line treatment for c.diff?
Vancomycin 125mg for 10 days
- For uncomplicated healthy patients
What is the first-line treatment for aspiration pneumonia?
Amoxicillin and metronidazole
Replaced with clarithromycin if allergic
Doxycycline is preferred to clarithromycin when transferring from IV to oral
What is the management of infective endocarditis?
Take 3 cultures, 6 hours apart before starting antibiotics
Which bacteria is the most common cause of infective endocarditis?
Staphylococcus aureus
What is the first-line antibiotic for pneumonia?
Amoxicillin
What is the first-line antibiotic for neutropenic sepsis?
Piperacillin-Tazobactam (Tazosin)
What are the malaria identifying symptoms?
Intermittent fever
M.vivax can cause fever months after infections because it incubates in the liver
Where is each type of malaria most commonly contracted?
Vivax: Asia
Falciparum: sub Saharan Africa
What are the dengue fever identifying symptoms?
Gradually rising fever
Can turn into haemorrhagic fever
Where is dengue fever most commonly contracted?
South Americas
Also sometimes sub Saharan Africa and Asia
What is Rabies?
A virus causes progressive brain and spinal cord inflammation
Transmitted through saliva (bites and scratches)
How does rabies present?
Weakness or discomfort, fever, or headache
Later turns into abnormal behaviour
Always causes death if untreated
What is the treatment for Rabies?
No actual cure
Treatment with immunoglobulins
Prevented with vaccine
What are haemorrhagic fevers?
Infections that cause blood vessels to leak if untreated
Eg. Ebola, yellow fever, Dengue
What are the contraindications for acyclovir?
Renal damage (low eGFR)
Pregnancy and breastfeeding
