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Y1 - Infection > Lecture 15 - Travel Related Infections And NTDs > Flashcards

Lecture 15 - Travel Related Infections And NTDs Flashcards

1
Q

What is a NTD (Neglected Tropical Disease)?

A

Diseases that are almost absent from the global health agenda
They get little funding, have stigma and associated social exclusion

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2
Q

What is the goal of the NTD Road Map?

A

To eliminate as many Neglected Tropical Diseases as possible

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3
Q

Why is a good history important when it comes to Neglected Tropical Diseases?

A

There are lots of travel related infections
Certain disease are specific to certain areas
Different strains of pathogen from different areas may be resistant to certain drugs

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4
Q

What information are you trying to establish where asking a patient:

“Where have you been/travelled to?”

A

What potential diseases are in that area

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5
Q

What information are you trying to establish where asking a patient:

“When were you last in that place?”

A

Evaluating the incubation time

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6
Q

What needs to be considered when you think a patient may have an NTD?

A

Where have they been?
When were they there?
How may they have acquired the infection
Any prophylaxis or vaccinations?
Anyone else in their group unwell?

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7
Q

What are the steps of the infection model?

A

Pathogen + Patient + Mechanism of infection = Infection
Management
Outcome

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8
Q

What must be considered about a patient ini the infection model?

A

Age group
Immune status
Drug use
Where have the been
Timeline

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9
Q

What are some potential mechanisms of infection of a NTD?

A

Food/water
Insect/tick bite
Swimming
Sexual contact
Animal contact
Recreational activities

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10
Q

What is carried out in the management phase of the infection model?

A

History taken
Examinations done
Investigations carried out
Treatment given (Specific and/or supportive treatment)

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11
Q

What is a common infection acquired via an animal bite?

A

Rabies

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12
Q

What is a common infection acquired via rodents?

A

Leptospirosis

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13
Q

What are 2 common infections acquired via a mosquito or insect bite?

A

Malaria
Dengue

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14
Q

What is a common infection acquired via a Tick bite?

A

Rickettsia

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15
Q

What are 2 common infections acquired from freshwater?

A

Schistosomiasis
Leptospirosis

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16
Q

What is a common infection acquired via undercooked meat/fish?

A

Salmonella
E. Coli

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17
Q

What is a Rickettsia/spirochaete?

A

Small non motile gram negative bacteria usually spread by ticks

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18
Q

What are the 5 species of malaria that affect humans?

A

Plasmodium falciparum
Plasmodium vivax
Plasmodium ovale
Plasmodium malariae
Plasmodium knowlesi

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19
Q

Which is the most common and most severe species of malaria?

A

Plasmodium falciparum

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20
Q

What are the 2 less severe and relapsing species of malaria compared to plasmodium falciparum?

A

Plasmodium vivax
Plasmodium ovale

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21
Q

What is special about the transmission of Plasmodium knowlesi?

A

From macaque monkeys (ZOONOTIC Transfer)

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22
Q

What is the general life cycle of Plasmodium Falciparum?

A

Female mosquito bites
Sporozites travel to liver cells
Form schizont
Liver cells burst releasing Merozoites
Merozoites infect red blood cells
Form schizonts
Then burst RBCs releasing more Merozoites (cycle continues

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23
Q

What can happen to a Plasmodium Falciparums Merozoite once its burst form a RBC?

A

Renter cycle by infecting another RBC
Or
Form Gametocyte which gets picked up by mosquito and forms more sporozoites

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24
Q

What is the vector for Malaria?

A

Female Anopheles mosquito

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25
What are the signs and symptoms of Malaria?
Fever Chills Headache Confusion Seizures Jaundice Haemoglobinuria
26
What investigations would be done for suspected malaria?
FBC U + E Liver function test (AST + ALT) CXR (Chest X-ray) CT head
27
What can be done to manage malaria?
Remove the mosquito (Bed nets, avoid still lakes and sanitation facilities) Drugs: Artesunate, Quinine and Doxycylcine
28
What drug is given for liver related Malaria?
Primaquine
29
Why may you not be able to administer Primaquine to a patient? (What condition might they have)
May have Glucose-6-Phosphate-Dehydrogenase Deficiency
30
Why can you not give Primaquine or Chloroquine to a patient with G6PDH deficiency?
Primaquine is an exogenous oxidant People with G6PDH deficiency are vulnerable to oxidative stress G6DPH needed in the Pentose phosphate pathway No G6DPH means no NADPH made which is needed to regenerate GSH from GSSG GSH = Important defence against oxidising damage
31
Why can G6PD deficiency lead to Haemolytic Anaemia?
RBCs wont have the protection from GSH so will likely be broken down
32
What is the mechanism of infection of Enteric Fever/Typhoid fever?
Faecal oral from contaminated food/water
33
What are some virulence factors of enteric/typhoid fever?
Low infectious dose Survives gastric acid Resides within macrophages Fimbriae adhere to epithelium over ideal lymphoid tissue
34
Who is susceptible to enteric fever/typhoid fever?
Children Travellers from Asian countries
35
What are the signs and symptoms of Enteric/Typhoid fever?
Systemic manifestation: -Fever -Headache -Abdominal discomfort -Dry cough -Bradycardia
36
How can Typhoid/enteric fever be diagnosed?
Blood cultures
37
What are the treatment options for typhoid/enteric fever?
IV Ceftriaxone Azithromycin Ciprofloxacin
38
What are some preventative methods for typhoid/enteric fever?
Vaccination Good food + water hygiene
39
What might an individual with malaria present with?
Tachycardia Low BP Low O2 sats Mild confusion Bite/puncture marks Hepatosplenomegaly Vomiting and nausea
40
When does a person experience the symptoms of malaria?
When merozoites are destroying the red blood cells
41
What May Malaria go onto cause in an infected individual?
Haemolytic anaemia
42
What are the signs and symptoms of Haemolytic anaemia?
Pallor Jaundice Dark coloured urine (Hb in the Urine) Weakness Dizziness and confusion
43
Why can malaria lead to jaundice?
RBC destroyed by the malaria Hb builds up so bilirubin builds up as the Hb gets broken down
44
When a blood test and blood film is taken, what will be seen with malaria?
Normocytic and normochromic anaemia Thrombocytopenia Elevated lactate dehydrogenase
45
As well as destroying RBCs how does Plasmodium falciparum cause damage?
Produces sticky protein Coats surface of erythrocytes causing them to clump together Occludes blood vessels leading to organ ischaemia
46
Why is Chloroquine not used for Plasmodium falciparum?
Widespread resistance to it
47
What does a doctor treat for if they cannot confirm the species of plasmodium in malaria?
Chloroquine-resistant plasmodium falciparum
48
What is Recrudescence? (Malaria)
The treatment didn’t kill of all the parasite so they have it again
49
What is relapse in terms of patients being cured from malaria?
All merozoites cleared But dormant malaria in the liver
50
What is reinfection in terms of patients being cured from malaria?
A completely new case of the same disease so in this case malaria again
51
What causes Legionnaires disease?
Gram negative Legionella bacteria
52
How is Legionella pneumophilia transmitted?
Inhaling contaminated water droplets from the environment
53
What is the pathophysiology of Legionella pneumophilia infection (Legionnaires disease)?
Legionella pneumophilia invades macrophages in lungs and replicates inside them
54
What are the initial symptoms of Legionnaires disease?
Headaches Muscle/chest pain Chills Fever (can be 40º or higher)
55
What could be some progressive symptoms of Legionnaires disease?
Cough (mucus maybe blood) Shortness of breath GI symptoms (nausea, vomitting and diarrhoea) Mental changes
56
What is used to treat Legionnaires disease?
Carithromycin
57
What causes schistosomiasis?
Flatworm common in tropical areas
58
How is schistosomiasis contracted?
Unprotected skin contact from freshwater contaminated with the helminths released from snails
59
What are the symptoms of schistosomiasis?
Fever Diarrhoea Coughs Rashes Abdominal pain Muscle and joint pain Causes Chronic Inflammation
60
How is schistosomiasis diagnosed?
Egg found in a urine or stool sample Blood test for antibodies
61
How is Acute Schistosomiasis treated?
Steroids = reduce inflammation Praziquantel (Most effective once the worms have matured)
62
What is the causative organism for Typhoid fever (enteric fever)?
Salmonella typhi
63
What type of organism is Salmonella typhi?
Rod-shaped Gram negative bacteria
64
What type of organism causes Dengue?
Virus (4 different strains)
65
What transmits the Dengue virus?
Mosquitos
66
What may an individual present with if they have Dengue?
Intense headache Fever Muscle/joint pain Widespread red rash
67
What is the treatment for Dengue?
NO TREATMENT Usually self resolves Can only treat symptoms (supportive treatment)
68
What are some supportive treatments for Dengue?
Paracetamol (analgesic + anti pyretic) Plenty of water
69
What is the danger of re infection of Dengue?
Can progress to severe dengue or Dengue Haemorrhagic fever
70
What supportive treatments can be give to someone with Dengue haemorrhagic fever?
IV fluids Oxygen therapy Blood and platelet transfusions
71
What are the symptoms of Dengue Haemorrhagic fever?
Restlessness Acute/sudden fever Severe abdominal pain Bleeding or bruising under the skin (petechiae) Nosebleeds Large drop in BP (shock)
72
What is a characteristic feature of the blood in Dengue Haemorrhagic fever?
Thrombocytopenia (low levels of platelets)
73
If giving painkillers to help with Dengue haemorrhagic fever what must you NEVER GIVE? Why?
Aspirin It’s an Anti platelet drug which will make the bleeding worse

Y1 - Infection (21 decks)

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