Other Infections in a Returning Traveller

Question 1

What are some common causes of travellers Diarrhoes

Answer 1

Bacterial - Enterotoxigenic E.coli, Enteroaggregative E.coli
Viral - Norovirus, rotavirus, enteric adenovirus
Parasitic - Giardia, cryptosporidium

Question 2

What are the clinical manifestations of travellers diarrhoea?

Answer 2

• Often occurs on day 4 to 14 of travel but is self limiting with the majority only last 5 days.
• Symptoms enclude: Anoexia, malaise, abdo cramps, watery diarrhoea, fever, nausea and vomiting.
• If diarrhoea contains blood/colitic symptoms then think salmonella/shigella

Question 3

What is the treatment for traveller’s diarrhoea

Answer 3

• Fluid replacement,
• NO to antibiotics and caution with antimotility agents

Question 4

What is the most common cause of continued bowel symptoms after a GI infection

Answer 4

Post infectious IBS. Other possibilities include: ongoing bacterial gastroenteritis, parasitic GI infection or something else like IBD

Question 5

What is the management for continued bowel symptoms (irritation/bloating) after a period of traveller’s diarrhoea?

Answer 5

• Three stools for bacterial cultures and investivation for bacteria (microscopy or giardia PCR)
• Test TTG (coeliacs) and faecal calprotectin
• HIV testing
• Antibiotics only if giardiasis or diagnostic uncertainty

Question 6

Describe the pathogenesis and presentation of cutaneous larva migrans

Answer 6

• Occrs when exposed to dog fecaes often mixed in with sand. The larva penetrate the skin causing an extremely itchy rash (worm like rash).
• Treated with albendazole

Question 7

Explain the pathogenesis schistosomiasis

Answer 7

• Exposed via freshwater, this could be swimming, showers or drinking water.
• The parasite is released by snails which then penetrates the human skin where it travels to the liver where the parasite matures into worms. The worms mate and lat effs that circulate in the liver and shed in the stools or travel to the venous plexus of the bladder.

Question 8

Explain the presentation of schistosomiasis infections

Answer 8

Can be asymptomatic but if symptomatic then presents with a “swimmers itch” which causes a macular rash. 6 weeks later presents with katayama fever.
Chronic effects result in cirrhosis and portal hypertension, calcification of the bladder and an increased risk of bladder cancer

Question 9

Explain the diagnosis and prevention of schistosomiasis

Answer 9

• Serology to test for antibodies to egg antigens or a urine/stool sample. Must will take 6 weeks to become positive from exposure as it relies on presence of eggs.
• prevention by prevted exposure to fresh water, salt water is okay

Question 10

What is the treatment for schistosomiasis?

Answer 10

• Praziquantel 40mg/kg in one day.