Lecture 11: Travel Related Infection Flashcards

1
Q

list some climate or environment related health problems

A
  • sunburn
  • heat exhaustion and heatstroke
  • fungal infections
  • bacterial skin infections
  • cold injury
  • altitude sickness
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2
Q

list some water-related infections in returning traveller

A
  • schistosomiasis
  • leptospirosis
  • liver flukes
  • strongyloidiasis
  • hookworms
  • guinea worms
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3
Q

list some arthropod-borne infections

A
  • malaria (mosquitos)
  • dengue fever (mosquitos)
  • rickettsial infections (ticks:typhus)
  • leishmaniasis (sand flies: Kala-azar)
  • trypanosomiasis (tsetse fly: sleeping sickness)
  • filariasis (mosquitos: elephantiasis)
  • onchocerciasis (black flies: river blindness)
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4
Q

list some important tropical diseases

A
  • malaria
  • typhoid
  • dengue fever
  • schistosomiasis
  • rickettsiosis
  • viral haemorrhagic fevers
  • zika fever
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5
Q

what is the most severe species of malaria?

A

plasmodium falciparum

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6
Q

malaria symptoms

A
  • Fever (up to 41ºC) with sweats and rigors
  • Fatigue
  • Myalgia (muscle aches and pain)
  • Headache
  • Nausea
  • Vomiting
  • Urinary symptoms
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7
Q

malaria signs

A
  • none
  • pallor
  • splenomegaly
  • hepatomegaly
  • mild jaundice
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8
Q

list the complications of malaria

A
  • Cerebral malaria
  • Seizures
  • Reduced consciousness
  • Acute kidney injury
  • Pulmonary oedema
  • Disseminated intravascular coagulopathy (DIC)
  • Severe haemolytic anaemia
  • Multi-organ failure and death
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9
Q

how is malaria diagnosed?

A
  • thick and thin blood films: shows parasites, the concentration (as a %) and the type.
  • three negative samples taken over 3 consecutive days are required to exclude malaria.
  • Quantitative buffy coat (QBC): centrifugation, UV microscopy
  • rapid antigen tests: OptiMal, Parasight-F
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10
Q

list the treatment options for uncomplicated P.falciparum malaria

A
  • Riamet is the usual first choice for 3 days
  • Quinine plus doxycycline (or clindamycin) for 7 days
  • Proguanil with atovaquone (Malarone)
  • Chloroquine (there are increasing rates of resistance to chloroquine)
  • Primaquine (can cause severe haemolysis in patients with G6PD deficiency)
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11
Q

quinine side effects

A

nausea
tinnitus
deafness
rash
hypoglycaemia

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12
Q

what are the treatment options for complicated or severe P.falciparum malaria?

A
  • IV artesunate (unlicensed in the UK)
  • IV quinine + oral doxycycline (or clindamycin)
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13
Q

what is the general advice for preventing malaria when travelling to endemic countries?

A
  • No method is 100% effective alone
  • Use mosquito spray (e.g., 50% DEET spray)
  • Use mosquito nets and barriers in sleeping areas
  • Seek medical advice if symptoms develop
  • Take antimalarial medication as recommended
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14
Q

list the main anti-malarial medications for prophylaxis

A
  • Proguanil with atovaquone (Malarone)
  • Doxycycline
  • Mefloquine (risk of psychiatric side effects)
  • Chloroquine with proguanil (less often used due to high resistance)
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15
Q

signs and symptoms of typhoid

A
  • fever
  • weakness
  • abdominal pain
  • constipation
  • headaches
  • diarrhoea (uncommon)
  • vomiting (not usually severe)
  • skin rash with rose-coloured spots
  • confusion (if severe)
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16
Q

typhoid investigations

A

laboratory (salmonella typhi, s.paratyphi):
- culture blood, urine and stool
- culture bone marrow

17
Q

typhoid fever treatment

A
  • oral azithromycin
  • IV ceftriaxone if complicated, or concerned regarding absorption
  • increasing ciprofloxacin resistance
18
Q

what is the most common human arbovirus infection?

A

Dengue

19
Q

what are the classical dengue fever clinical features?

A
  • sudden fever
  • severe headache, retro-orbital pain
  • severe myalgia and arthralgia
  • macular/maculopapular rash
  • haemorrhagic signs: petechia, purpura, positive tourniquet test
20
Q

dengue diagnosis

both clinical and lab

A

clinical:
- thrombocytopenia
- leucopenia
- elevated transaminases
- positive tourniquet test

lab:
- PCR
- serology

21
Q

complications of dengue fever

and treatment

A
  • Dengue haemorrhagic fever (DHF)
  • dengue shock syndrome (DSS)
  • TREATMENT: IV fluids, fresh frozen plasma, platelets
22
Q

schistosomiasis clinical features

A
  • swimmers itch
  • invasive stage: cough, abdo discomfort, splenomegaly, eosinophilia
  • Katayama fever: fever, urticaria, lymphadenopathy, splenomegaly, diarrhoea, eosinophilia
  • acute disease
  • chronic disease
23
Q

schistosomiasis diagnosis

A
  • clinical diagnosis
  • antibody tests
  • ova in stools and urine
  • rectal snip
24
Q

schistosomiasis treatment

A
  • praziquaantel 20mg/kg, two doses 6hrs apart
  • prednisolone if severe
25
Q

clinical features of rickettsiosis

tick typhus

A
  • abrupt onset swinging fever
  • headache
  • confusion
  • endovasculitis
  • rash (macular, petechial)
  • bleeding
26
Q

what drug is used to manage rickettsiosis?

A

tetracycline

27
Q

zika virus clinical features

A
  • no or mild symptoms
  • headache
  • rash
  • fever
  • malaise
  • conjunctivitis
  • joint pain
  • in pregnancy can cause microcephaly
  • can cause Guillain-Barre syndrome