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MICRO ADYA > Microbiology 24 - Fever in the Returning Traveller + PUO > Flashcards

Microbiology 24 - Fever in the Returning Traveller + PUO Flashcards

1
Q

Recall some differentials for fever and rash in the returning traveller

A

Viral: dengue, chickungunya, measles
Bacterial: typhoid (look for rose spots)

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2
Q

Recall some differentials for fever and abdo pain in the returning traveller

A

Typhoid fever
Amoebic liver abscess

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3
Q

Recall some differentials for fever and cytopaenias in the returning traveller

A

Dengue, chickungunya, typhoid (anaemia), malaria

**the mosquito ones + typhoid

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4
Q

Recall some differentials for fever and haemorrhage in the returning traveller

A

Viral haemorrhagic fevers (dengue/ ebola)
Meningococcaemia

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5
Q

Recall a differential for fever and eosinophilia in the returning traveller

A

Schistosomiasis

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6
Q

Recall some differentials for fever > 6 weeks post-travel in the returning traveller

A

Vivax malaria
Acute hepatitis
TB
Amoebic liver abscess

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7
Q

What % of parasitaemia constitutes a severe malaria?

A

>2%

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8
Q

What type of mosquito carries malaria?

A

Female Anopheles

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9
Q

Recall the different types of malaria

A

Falciparum
Vivax
Ovale
Malariae
Knowelsi

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10
Q

What acid base abnormality may be seen in malaria?

A

Metabolic acidosis

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11
Q

Why is malaria sometimes known as ‘blackwater fever’?

A

Due to the haemaglobinuria

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12
Q

What is the gold standard test for malaria?

A

Thick and thin blood films

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13
Q

What type of mosquito is a vector for dengue virus?

A

Aedes

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14
Q

What are the symptoms of dengue?

A

Fever
Headache
Myalgia
BLANCHING RASH - this spares the hands and feet (unlike chickengunya)

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15
Q

What cytopaenias are expected in dengue infection?

A

Thrombocytopaenia
Neutropaenia

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16
Q

What are the possible causative organisms in typhoid (enteric) fever?

A

Salmonella typhi/ paratyphi

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17
Q

What is the phrase “himalaya peak fevers” pathognemonic for?

A

Typhoid fever

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18
Q

What is the treatment of typhoid fever?

A

Ceftriaxone then azithromycin

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19
Q

What is the definition of pyrexia of unknown origin?

A

>38.3 degrees on several occaisons persisiting >3/52 without diagnsois depsite 1/52 of intensive investigations

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20
Q

What are the 3 types of PUO?

A
  1. classical
  2. healthcare associated
  3. neurtopaenic PUO
  4. HIV associated PUO
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21
Q

What can cause PUO?

A
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22
Q

What are some common causes of fever in a returning traveller?

A

Causes: tropical diseases (especially malaria, typhoid, dengue, viral haemorrhagic fevers), bacterial diarrhoea (E. coli, cholera) - Don’t forget about common UK causes too, e.g. UTI, pneumonia, influenza - Beware of questions pointing you towards STIs (e.g. HIV seroconversion)

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23
Q

What causes typhoid?

A

salmonella typhi or parathyphi

anaerobic gram -ve bacilli

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24
Q

symptoms of typhoid fever

A

Travel to India, transmitted in food and water, incubation 1-2wks
• Causes enteric fever by infecting Peyers patches in intestines
o Fever, headache, constipation (not diarrhoea!) o Rose spots, relative bradycardia, hepatosplenomegaly

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25
Q

treatment of typhoid fever

A

IV ceftriaxone –> PO azithromycin

need to vaccinate them as well

**need to treat them as it can cause GI perforation**

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26
Q
A
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27
Q

What type of virus is dengue virus? what transmits it?

A

flavivirus

transmitted by ades mosquito

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28
Q

Where is dengue commonly spread from?

A

South-East Asia, urban environments, short incubation (days)

**think vietnam**

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29
Q

symptoms of dengue

A

myalgia, fever, rash. Reasonably mild + self-limiting

**not as bad as malaria (but bad if you get infected again with a different serotype**

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30
Q

what causes dengue haemorrhagic fever?

A

if you get re-infected with a different serotype

**rare in travellers - as uncommon to be re-infected

needs supportive management

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31
Q

what type of infection is malaria?

A

protozoal infection (Plasmodium spp.)

spread by female anopheles mosquito- bites at
night, attracted by heat + CO

Areas of the world: Asia/africa/south america

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32
Q

classification of malaria

A

falciparum and non-falciparum

**falciparum - most common and most severe

**non-falciparum: P. vivax, p ovale, p malariae, p knowlesi

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33
Q

Treatment of non-falciparum malaria

A

Chloroquine then primaquine

(c then p)

primaquine prevents relapse of symptoms as non falciparum malaria has a hypnoxzoite stage

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34
Q

Pattern of fever in non-falciparum malaria

A

All 48 hour (tertian fever) except for P. malariae - 72h fever

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35
Q

What do you see on blood film in non-flaciparum malaria?

A

schuffner’s dots

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36
Q

What pattern of fever do you get in falciparum malaria?

A

tertian fever (48 hourly)

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37
Q

investigations for falciparum malaria

A

thick and thin blood films - x 3

thick- shows malaria

thin - shows the species

38
Q

treatment of falciparum malaria

A

Mild: artemesin combination therapy (Riamet – artemether + lumefantrine) § Severe: IV artesunate

39
Q

Features of severe falciparum malaria

A
40
Q

What infections are spread through mice?

A 
Hantan viruses(fleas), Lyme borreliosis, Ehrlichia, Bartonella
Lymphocytic choriomeningitis
41
Q

What infections are spread by rats?

A 
Rabies, Leptospirosis, Lassa fever, Hantan viruses, Plague, Pasteruellosis,
Haverhill fever (Rat-bite)
42
Q

what diseases can be spread by cats?

A

Bartonellosis (cat scratch), Leptospirosis, Q-Fever, Toxoplasmosis, Rabies,
Ringworm, Toxocariasis

43
Q

what diseases are spread by dogs?

A

Hydatid disease, Leptospirosis, Brucellosis, Q-Fever, Rabies, (MRSA!!), Ringworm,
Toxocariasis

44
Q

what diseases are spread by small ruminants

A

Anthrax, Leptospirosis, Brucella, Bovine TB, Anaplasmosis, Toxoplasmosis,
E. coli 0157, Rift Valley fever, Ringworm

45
Q

what diseases are spread by swine?

A

Brucellosis, Leptospirosis, Erysipeloid, Cysticercosis, Trichinella, HEV, Influ A!, Swine Streptococcal sepsis

46
Q

what diseases are spread by birds?

A

Psitticosis, Influenza, Cryptococcus, Influ A!!!, Poultry- salmonella, West-
Nile fever

47
Q

what diseases are associated with water sports?

A

Leptospirosis, HAV, Giardia, Toxoplasmosis, Mycobacterium marinum/ulcerans, Burkholderia pseudomallei, E. coli

48
Q

what diseases are water borne?

A

Campylobacter, Salmonella, VTEC O157, Cryptosporidium

49
Q

what diseases are food-associated?

A

Listeria (cow cheese-human), Taenia, Cysticercosis, toxoplasmosis, trichinellosis, Food-associated
yersiniosis, Giardia

50
Q

What type of bacteria is brucella?

A

gram negative

aerobic bacillus

**BRUtal - negative

**b for bacillus

51
Q

How is brucellosis transmitted?

A

contaminated food (untreated milk / dairy products), direct animal contact (cows, goats, sheep, pigs)

52
Q

presentation of brucellosis

A 
undulant fever (peaks in evening), myalgia, arthritis, spinal tenderness,
hepatosplenomegaly, epididymo-orchitis

MAIN THING- UNDULANT FEVER

(think brucella–>cow–>udder–>UNdulant fever)

53
Q

diagnosis of brucellosis

A

Serology - anti-O-polysaccharide antibody. WCC usually normal / neutropenia

54
Q

treatment of brucellosis

A

4-6wks doxycycline + streptomycin

55
Q

what type of virus is rabies?

most common vectors?

A

rhabdovirus

most common vectors: dogs and bats

56
Q

presentation of rabies

A

Prodrome – fever, headache, sore throat b. Acute encephalitis (hyperactive state) c. Migration to CNS (after months – yrs) à fatal encephalitis, hypersalivation,
hydrophobia

57
Q

what are negri bodies indicative of?

A

rabies

58
Q

treatment of rabies

A

IgG post exposure before the development of symptoms

59
Q

what causes plague?

what type of bacteria ?

A

yersinia pestis

gram negative lactose fermenter

60
Q

presentation of plague

A

Bubonic plague – flea bites human – Swollen LN (Bubo) – dry gangrene Pneumonic plague – Usually seen during epidemics, person-person spread

61
Q

treatment of plague

A

Streptomycin, Doxycycline, Gentamicin, Chloramphenicol (in meningitis)

62
Q

what bacteria causes leptospirosis?

A

L. interrogans

63
Q

what type of bacteria is L. interrogans?

A

gram negative

obligate

aerobic

motile spirochaete

64
Q

presentation of leptospirosis

A

high fever, conjunctival haemorrhages, jaundice, meningism, renal failure,
haemolytic anaemia

buzzword: swimming in tropical waters

65
Q

treatment of leptospirosis?

A

amoxicillin, erythromycin, doxycycline or ampicillin

66
Q

what causes anthrax?

A

bacillus anthracis

67
Q

how does anthrax present?

A

cutaneous: painless round black lesions + rim of oedema
pulmonary: massive lymphadenopathy + mediastinal haemorrhage

**skin + lungs **

68
Q

treatment of anthrax

A

doxycycline/ciprofloxacin

69
Q

what causes lyme disease?

A

borrelia burgdoferi

70
Q

what type of bacteria is borrelia bugdoferi?

A

spirochaete

71
Q

what transmits lyme disease?

A

arthropods - ixodes

i.e. ticks

eg on deer during hike

72
Q

presentation of lyme disease

A

Early: erythema chronicum migrans (bullseye rash), flu-like

Late persistent: focal neurology, neuropsychiatric, arthritis

73
Q

treatment of lyme disease

A

Rx: Doxycycline 2-3wks, (also amoxicillin, cephalosporins)
o If CNS issues, IV ceftriaxone 2-4wks

74
Q

what causes q fever?

A

coxiella burnetti

75
Q

how is q fever transmitted?

A

via cattle/sheep

76
Q

how does q fever present?

A

atypical pneumonia- dry cough, fever, no rash

77
Q

treatment of q fever

A

doxycycline

78
Q

what causes leishmania?

A

protozoa

L. major or L. tropica

79
Q

what are the types of leishmania?

A
  1. cutaneous
  2. diffuse cutaneous
  3. muco-cutaneous
  4. visceral = kala azar
80
Q

What causes cutaneous leishamniasis?

presentation?

A

L. major or L. tropica

Transmission: sandfly bite (South America, Middle East)

o Presentation: Skin ulcer at site of bite –> multiply in dermal macrophages –>heals after
1yr leaving depigmented scar
§ May be single or multiple painless nodules which grow + ulcerate

**key feature is ulceration**

81
Q

what causes diffuse cutaneous lieshamnia and how does it present?

A

Pts with immunodeficiency –> nodular skin lesions but do NOT ulcerate

82
Q

Muco-cutaneous leishamanisasis

A

Muco-cutaneous, eg: L. braziliensis
o Dermal ulcer (same as cutaneous leishmaniasis) o Months to yrs later à ulcers in mucous membranes of nose and mouth

83
Q

visceral leishamanisis?

A

Usually young malnourished child o Abdo discomfort and distension, anorexia, weight loss o Leishmania donovani: invasion of reticuloendothelial system à hepato-splenomegaly,
BM invasion. Later, disfiguring dermal disease (PKDL)

84
Q

Trypanosomiasis?

A

Transmitted by Tsetse fly

Causes sleeping disease

85
Q

most common cause of fever in returning traveller?

A

malaria

86
Q

what is torniquet test used for?

A

dengue fever

87
Q
A
88
Q

gram negatvie rod spread via unpasteurised dairy

A

brucellosis

89
Q

presentation of schistosomiasis

A

Acute infections

Acute symptoms typically only develop in people who travel to endemic areas, as they don’t have any immunity to the worms.

Acute manifestations may include:

  • swimmers’ itch
  • acute schistosomiasis syndrome (Katayama fever)

fever

urticaria/angioedema

arthralgia/myalgia

cough

diarrhoea

eosinophilia

Chronic infections

Schistosoma haematobium

These worms deposit egg clusters (pseudopapillomas) in the bladder, causing inflammation. The calcification seen on x-ray is actually calcification of the egg clusters, not the bladder itself.

Depending on the site of these pseudopapillomas in the bladder, they can cause an obstructive uropathy and kidney damage.

This typically presents as a ‘swimmer’s itch’ in patients who have recently returned from Africa. Schistosoma haematobium is a risk factor for squamous cell bladder cancer.

Features

frequency

haematuria

bladder calcification

Investigation

for asymptomatic patients serum schistosome antibodies are generally preferred

for symptomatic patients the gold standard for diagnosis is urine or stool microscopy looking for eggs

Management

single oral dose of praziquantel

Schistosoma mansoni and Schistosoma japonicum

These worms mature in the liver and then travel through the portal system to inhabit the distal colon. Their presence in the portal system can lead to progressive hepatomegaly and splenomegaly due to portal vein congestion.

These species can also lead to complications of liver cirrhosis, variceal disease and cor pulmonale.

Schistosoma intercalatum and Schistosoma mekongi

These are less prevalent than the other three forms, but are both attributed to intestinal schistosomiasis.

90
Q

describe the presentation of toxoplasmosis

A

immunocompteet

Most infections are asymptomatic. Symptomatic patients usually have a self-limiting infection, often having clinical features resembling infectious mononucleosis (fever, malaise, lymphadenopathy). Other less common manifestations include meningoencephalitis and myocarditis.

Serology is the investigation of choice.

No treatment is usually required unless the patient has a severe infection or is immunosuppressed.

HIV/immunosuppressed patients

Cerebral toxoplasmosis accounts for around 50% of cerebral lesions in patients with HIV

constitutional symptoms, headache, confusion, drowsiness

CT: usually _single or multiple ring-enhancing lesion_s, mass effect may be seen

management: pyrimethamine plus sulphadiazine for at least 6 weeks

Immunosuppressed patients may also develop a chorioretinitis secondary to toxoplasmosis.

MICRO ADYA (22 decks)

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