Infectious Disease and Travel Health Flashcards
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
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
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.
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
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
Who should have annual HIV testing?
MSM
Sex workers
People who inject drugs
more frequently for those reporting higher risk behaviours
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)
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
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.
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.
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
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
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
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
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
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
Complications of typhoid and paratyphoid fever?
encephalopathy, intestinal perforation/haemorrhage, toxic myocarditis
Tx of typhoid and paratyphoid fever?
seek micro advice due to Abx resistance
ciprofloxacin and ceftriaxone commonly used
Examples of viral haemorrhagic fevers?
Ebola virus disease, yellow fever, dengue
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
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
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
