Malaria and other travel related illness

Question 1

Malaria overview

Answer 1

Mosquitos → parasite → human

Epidemiology:
Hot climate
Travelers

Prevention:
Anti malarial tablets
Insect repellant
Mosquitos nets
Other prophylaxis

Presentation:
Fever
Fatigue
Confusion
Myalgia
Vomit
Headache
Sepsis
Dehydration
Abdominal pain →large spleen and liver
Seizures
Anaemia
Acute kidney

Investigations:
Thick and thin bloods →have to test every day for 3 days →could be negative at the start of the 3 but positive at the end
Bloods
History→travel

Management:
Anti patristic drugs
IV fluid
Drugs to reduce fever

Severe:
IV

Not severe:
Oral

Prognosis:
If treated, good
Can be asymptomatic

Question 2

Gastroenteritis

Answer 2

Bacterial or viral →(campylobacter, salmonella, e. Coli. Nora virus, rotavirus, Astro virus)

D&V

Diagnosis: clinical & stool testing
Treatment: antibiotics if bacterial
Fluids

Question 3

Viral hepatitis A&E

Answer 3

E:
Enterically transmitted viral pathogens
Foods and water borne virus
Avoid unclean water
Avoid eating food not prepped by you

Vaccines in China and Nepal

A:

Enterically transmitted viral pathogens
Foods and water borne virus
Avoid unclean water
Avoid eating food not prepped by you

Pre exposure vaccines
High risk countries → post exposure

Question 4

Mosquito/Tick associated disease

Answer 4

Malaria

Dengue fever

Yellow fever

Zika

(Lyme)

Question 5

Dengue fever

Answer 5

From the bite of an aides mosque with dengue →virus

Fever
Fatigue
Myalgia
Headaches

After 2-7 days:
Fever subsides And get more severe symptoms:
Abdominal pain, vomiting, dyspnea, haemorraging

Treatment:
IV fluids
Treat systemic symptoms

Question 6

Crimean-Congo harmorrhagic fever

Answer 6

Same symptoms as dengue but also has kidney and liver failure

Question 7

Tuberculosis

Answer 7

Bacterial infection

Will usually go to the lungs →also systemic features

Droplet infection

Antibiotics
BCG vaccines → partial protection

6 months on:
Isoniazid, rifampicin, ethanbutol, pyrazibinide

Question 8

Rabies

Answer 8

Animals (mainly dogs) →humans
Virus

Treatment:
Washing wounds out
Get vaccines ASAP after exposure

Question 9

MERS-Cov

Answer 9

Middle eastern respiratory syndrome
Transmitted by camels
Spread via droplets

Systemically unwell
Cough
Shortness of breath
GI symptoms

Question 10

Epidemiology malaria

Answer 10

More common in tropical and subtropical countries are hit hardest
‘Malarial belt’ – region around the equator inc. Latin America, Sub-Saharan Africa, South East Asia, South Asia
Countries with significant seasonal shift in temperature and rainfall

People more susceptible
Young children <5yo
Pregnant women
Patients with immunosuppressive conditions – e.g. HIV and AIDs
Travelers with no prior exposure
People with no spleen
Immunocompromised

people less susceptible
People with Sickle Cell Anemia – their blood lacks Duffy antigen on surface of RBC, plasmodium Vivax is unable to enter and infect as a result.
People with Thalassemia or G6PD deficiency – makes parasite infected erythrocyte more susceptible to dying from oxidative stress