Lecture 9 Diseases of the Returning Traveller Flashcards
why travel health
trips increasing abroad , 70% of travellers to developing countries report health problems , 15% seek medical care
now we don’t prescriptions anymore - going to places with exotic infections and think about doctor last
viral - haps , HIV
bacterial - TB typhoid
parasites - malaria
evaluation of a fever what are you looking for
geography of infections risk factors for acquisition incubation period clinical presentation appropriate lab investigations most have common infections a minority have a life threatening infection like malaria
what is the incubation period
number of days between when your infected with something and when you might see symptoms
Short time (< 10 days): gastroenteritis, respiratory tract infections, dengue
Medium (10-21 days): malaria, viral
haemorrhagic fevers
Long (> 21 days): amoebic liver abscess,
leishmaniaisis, trypanosomiasis
Most tropical infections become symptomatic
within 21 days of exposure and most febrile
returning travellers present within one month of
leaving endemic areas
associated sings and symptoms in the returning febrile traveller
rash jaundice lymhadednpathy hepatomegaly splenomegaly eschar and haemorrhage
ruine
GI
dysentry
what are red flags on a risk assessment
haemorrhage VHF
nerulogic impairment
acute respiratory distress
skin changes
most retuning from abroad will have
seasonal flu
malaria
typhoid
legionnarire diseasee
rare are avian flu
cov
ebola
malaria is transmitted by anopheles mosquitos and presentation with what
fever, headache, myalgia , arthralgia and malaise and complications include confusion and seizures as well as pulmaory oedema and blackwater fever
always exclude malaria first
after malaria what is the next most common serious topical disease requiring treatment in retuning travellers
enteric fever like typhoid presenting wth fever, headache cosntopiatin , rose spots, bradycardia
how do diagnose typhoid
Diagnosis: Clinical & Blood + Stool
cultures
Serology lacks specificity
Blood culture has the highest yield early in the
illness, stool and urine become positive after the
first week
Treatment – i.v Ceftriaxone, if
sensitive Ciprofloxacin is the
preferred oral antibiotic, if not then
azithromycin can be used
Complications occur in 10 -15% if
illness continues untreated: GI
bleeding intestinal perforation and
encephalopathy.
viral haemorrhage fever
Diagnosis: Clinical & Blood + Stool
cultures
Serology lacks specificity
Blood culture has the highest yield early in the
illness, stool and urine become positive after the
first week
Treatment – i.v Ceftriaxone, if
sensitive Ciprofloxacin is the
preferred oral antibiotic, if not then
azithromycin can be used
Complications occur in 10 -15% if illness continues untreated: GI bleeding intestinal perforation and encephalopathy. Fever evaluation:
Has the patient got a fever of more than 38 C?
Travel history (geography and risk factors):
Have they returned from a VHF endemic area in the last 21 days?
Have they been in contact with clinical specimens from a VHF patient, or given
care to a patient with VHF?
Other symptoms:
Extensive bruising or uncontrolled vomiting or diarrhoea
Suspicion of VHF increased if
Been in an area with a VHF outbreak
Been in basic rural conditions in a Lassa endemic area
Been in caves/mines or been in contact with primates/bats in a Marburg or
Ebola area
Or suffered a tick bite in a CCF endemic
what can PHE do for you
Risk Assessment to the public’s health
Risk management:
Co-ordinate response to investigate source and routes of transmission
Identify possible contacts and tracing them
Epidemiological and environmental investigations
Risk communications: media, public, patients and stakeholders
40 yr man
2 day history of fatigue, fever, muscle aches
Currently apyrexial
Took paracetamol earlier because temp was 38C
What other questions will you ask him now?
Any recent travel?
Admits to travelling back from the Liberia
When?
Returned one week ago
What did he do whilst travelling?
Expert in bats
What are your next actions?
Presentation title - edit in Header and Footer
HIGH POSSIBILITY OF VHF
- ISOLATE PATIENT IN A SIDE ROOM
- Urgent Malaria investigation
-Full blood count, U&Es, LFTs, Clotting screen, CRP, glucose,
blood cultures
-Inform laboratory of possible VHF case (for specimen
Malaria test comes back positive
Can you let down your guard?
No!
Has the patient been in a VHF endemic area?
Yes!
So be cautious
Where can you get advice from?
Discuss with
-Infectious Disease Consultant
(Infectious Disease/Microbiology/Virology)
