Infectious Disease and Travel Health Flashcards by Laura Martin

In a HIV positive patient, the presence of which cancers would classify the patient as having AIDS?

Cervical cancer
Kaposi’s sarcoma
Non-Hodgkin’s lymphoma

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Which vaccines for use in the UK are live attenuated vaccines?

MMR
nasal influenza
chickenpox
shingles
rotavirus
BCG

live travel vaccines: yellow fever
oral typhoid

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When should a HIV test be repeated if negative testing after a potential exposure?

at 4 weeks post exposure

recommended test=4th generation lab HIV test (HIV antibody and p24 antigen)

if exposure event deemed to cause pt to be at high risk of infection then if -ve at 4 weeks should rpt again at 8 weeks.

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If exposure to HIV how long should PEP be taken for?

at least 4 weeks

should be started as soon as possible after exposure-ideally within 1 hour, definitely within 48-72hrs

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Window period for 4th generation serology for HIV testing?

45 days

POCTs 90 days
4th generation-IgM and IgG antibodies, and monoclonal antibody to p24 antigen

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Who should have annual HIV testing?

MSM
Sex workers
People who inject drugs

more frequently for those reporting higher risk behaviours

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Antibiotic tx if pt systemically unwell or immunocompromised and campylobacter suspected e.g. undercooked meat and abdo pain?

clarithromycin 250-500mg BD for 5-7/7, if treated early (within 3 days)

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Most common malaria parasite outside sub saharan Africa?

plasmodium vivax-often acquired in South Asia

note long incubation period-can present months after travel

plasmodium falciparum-most prevalent malarial parasite in Africa, UK travellers often pick up in West Africa

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Prophylactic regimen of chloroquine?

Take for 1 week prior to travel, continue in area and continue for 4 weeks after travel.

Shouldn’t be co-prescribed with amiodarone, don’t give if hx of epilepsy.
May exacerbate psoriasis and myasthenia gravis.

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Contraindications to mefloquine for malaria prophylaxis?

hx of psychiatric disorder

caution in 1st trimester pregnancy
recommended in 2nd and 3rd trimesters if chloroquine resistant area e.g. sub saharan africa. Most areas now chloroquine resistant.

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Prophylactic regimen of doxycycline for malaria?

start 1-2 days before travel, continue in area and continue for 4 weeks after leaving area

CI IN PREGNANCY AND BREASTFEEDING

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Prophylactic regimen of atovaquone+proguanil (malarone) for malaria?

start 1-2 days before travel, continue there and for 1 week after return

generally avoid in pregnancy and breastfeeding
CI if eGFR<30

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Advice re standby emergency medication prescribing for malaria?

consider if person taking chemoprophylaxis and going to remote area where more than 24hrs away from medical care
should be different from chemoprophylaxis
should take within 24hrs of development of malaria sx, restart chemoprophylaxis 1/52 after tx

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Tx of dengue fever?

sx usually resolve within 1 week with oral rehydration and paracetamol
spread by aedes aegypti mosquito (also spreads yellow fever and zika and chikungunya)
severe dengue needs hosp admission-resp distress, bleeding, fluid overload, organ damage
usual sx: severe myalgia, headache

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Tx of rickettsial infections e.g. african tick typhus?

PO doxycyline
milder cases may not require tx

px-fever, central macular rash with eschar and lymphadenopathy

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Cause of enteric fever?

ingestion of food/water contaminated with salmonella typhi and paratyphi (typhoid and paratyphoid fever)
usually travellers from South Asia
10-20 days incubation period
px: fever, malaise, abdo pain, diarrhoea, hepatosplenomegaly, macular rash, typhoid can cause a relative bradycardia-*also seen with yellow fever, brucellosis and some pneumonias

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Complications of typhoid and paratyphoid fever?

encephalopathy, intestinal perforation/haemorrhage, toxic myocarditis

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Tx of typhoid and paratyphoid fever?

seek micro advice due to Abx resistance

ciprofloxacin and ceftriaxone commonly used

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Examples of viral haemorrhagic fevers?

Ebola virus disease, yellow fever, dengue

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Tx of giardiasis?

NICE states tinidazole 2g single dose if giardia confirmed or suspected

?alternative= metronidazole

presents with pale watery stools and large amounts of flatus

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When should babies born to Hep B positive mothers be vaccinated against Hep B?

monovalent vaccine at birth and 4 weeks
then into routine immunisation schedule with hexavalent vaccine at 8, 12 and 16 weeks
then monovalent vaccine again at 1 year with test for HBsAg

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PEP after significant exposure to HBsAg positive source and person who has been exposed is not vaccinated?

accelerated course of vaccine (0, 1 and 2 months) and HBIG with 1st dose
if partially vaccinated give 1 dose of vaccine and finish course
if fully vaccinated but been 1yr or more since last dose give booster dose
if known non-responder to vaccine given HBIG, booster dose of vaccine and rpt HBIG at 1 month

Abx treatment for Lyme disease?

PO doxycycline 100mg BD for 3 weeks
OR PO amoxicillin 1g TDS for 3 weeks
OR PO azithromycin 500mg OD for 17 days

Most common cause of traveller’s diarrhoea?

E coli

Tx of suspected meningococcal septicaemia before t/f to hospital?

IV or IM benzylpenicillin adults/child 10+ = 1.2g child 1-9 =600mg child <1yr =300mg

Tx of C.difficile infection?

PO metronidazole for 10-14/7 if severe, recurrent or type 027 then PO vancomycin fidaxomicin=2nd line

Standby antimicrobial for traveller's diarrhoea if pt visiting high risk area or at high risk of severe illness?

azithromycin 500mg OD for 1-3/7

Abx for acute diverticulitis?

5/7 course of PO co-amoxiclav OR cefalexin and metronidazole OR trimethoprim and metronidazole

Tx of threadworm?

mebendazole 100mg STAT if child over age of 6 months, rpt in 2 weeks if persistent if child under 6 months or pregnant then only hygiene measures for 6 weeks tx all household contacts at the same time

Which vaccines are not routinely recommended in non-clinical staff in healthcare settings?

BCG | influenza

Which infection are patients receiving complement inhibitor therapy at heightened risk of?

meningococcal infection | therefore they should receive MenACWY and Men B vaccines ideally at least 2 weeks before starting tx

Vaccinations for patients post splenectomy/functional hyposplenism due to sickle cell/haemoglobinopathy/coeliac disease?

national schedule vaccination PLUS annual influenza PLUS pneumococcal vaccine and booster every 5 years (5 yr booster also needed for patients with CKD-4/5) additional vaccination against Men ACWY and Men B if absent or dysfunctional spleen at appropriate opportunity

Which babies born prematurely require 1st vaccination in hospital?

if born at 28 weeks or earlier gestation due to risk of apnoea, should have resp monitoring for 48-72hrs and if develop apnoea/bradycardia/decrease sats then second immunisation should also be given in hospital

Specific vaccination recommended for pt with CSF leak?

pneumococcal

Which vaccine do patients with CKD in addition to influenza and pneumococcal require?

Hep B

Specific vaccinations for patients with haemophilia?

Hep A and B

Which immunosuppressed patients require Abx prophylaxis?

asplenic/hyposplenic patients and those with complement disorders (+if taken complement inhibitors) usually Penicillin V

Children at what age are eligible for the annual influenza vaccine?

- 2-11 years old who are not at risk, should be offered the live intranasal vaccine unless contraindicated - at risk groups should receive annual live intranasal vaccination from age of 2 until 18 years - if age 6 months to 2 years and at risk should have the inactivated IM influenza vaccine

Which travel vaccines are free on the NHS?

``` Hepatitis A diphtheria tetanus (combined and booster) polio cholera-gives 2 years of protection typhoid ```

When is Meningitis ACWY a required vaccine for travel?

for pilgrims to Hajj/Umra +seasonal workers

Vaccine interval between MMR and yellow fever?

4 weeks

Vaccine interval between MMR and varicella?

can be administered on same day but if not then minimum 4 weeks between

Interval between MMR and tuberculin skin testing?

MMRI should be delayed until skin test read | if recent MMRI, tuberculin skin test should be delayed for 4 weeks

Management of tetanus prone wound if patient had full course of vaccination completed more than 10 years ago?

booster vaccine

Management of high risk tetanus prone wound if patient had full course of vaccination completed more than 10 years ago?

booster vaccine and human tetanus Ig

Management of tetanus prone and high risk tetanus prone wound in patient who hasn't completed vaccination programme/uncertain?

vaccine and human tetanus Ig if clean wound then should get immediate vaccine

Which organisms causing gastroenteritis have an incubation period of more than 7 days?

parasites: giardiasis amoebiasis-bloody diarrhoea

Presenting features of diphtheria?

sore throat with diphtheric membrane on tonsils caused by necrotic mucosal cells bulky cervical lymphadenopathy neuritis heart block tx: IM penicillin, diphtheria anti toxin

Tx if woman not immune to chickenpox is exposed in pregnancy and is more than 20 weeks gestation?

VZIG or antivirals given at 7-14 days post exposure

Investigation/Management of suspected Lyme disease in patient without erythema migrans?

- offer ELISA test-if +ve or equivocal then offer immunoblot test and consider starting Abx tx whilst waiting results if high clinical suspicion - if ELISA -ve and pt still has sx and still suspect Lyme disease then if pt had ELISA within 4 weeks of sx onset repeat ELISA 4-6 weeks after 1st test. If still sx after 12 weeks and Lyme disease suspected then do immunoblot. - if immunoblot -ve and sx persist consider d/w or r/f to specialist

Abx treatment for whooping cough?

- admit if under 6 months and acutely unwell - if admission not needed prescribe Abx if onset of cough within last 21 days-clarithromycin if under 1 month, azithromycin or clarithromycin if over 1 month, and erythromycin if pregnant-prior to 36/52 likely to only be useful if within 21 days of illness or may be advised if likely to come into contact with vulnerable person. - prescribe co-trimoxazole if macrolides CI or not tolerated.

Management of contacts of patients with Hepatitis A?

- vaccination should be offered to any healthy contact aged between 1 and 50 - vaccine is unlicensed in 2 months-12 months age group-advised that carers should be vaccinated - vaccine is contraindicated in those under 2 months

If the 2nd dose of MMR vaccine is given early to child, how many weeks after the 1st vaccine can it be given?

if over 18 months of age can be given 1 month after 1st MMR if under 18 months of age can be given 3 months after 1st MMR may give early if measles in local area or travelling to destination with high prevalence of measles