Other Travel-related infections Flashcards
Other than malaria the main travel related infections are?
Typhoid Dengue Fever Schistosomiasis Typhus Viral Haemorrhagic fevers e.g. ebola or lassa fever Zika
What causes Typhoid?
Salmonella Typhi Salmonella Paratyphi (paratyphoid)
How does typhoid first present?
In the 1st week you get:
- High fever, Malaise & Neutrophilia
- Bradycardia
- Headache & CNS issues e.g. confusion
- Constipation & Abdo Pain
- Cough
How does Typhoid progress?
In week 2: The fever peaks & rose spots appear on the patient's trunk Constipation -> Diarrhoea Bradycardia --> Tachycardia Neutrophilia --> Neutropenia
By week 3 the patient develops intestinal bleeds, perforation, peritonism and metastatic infections
By wk 4 they either recover or relapse
How do we test for Typhoid?
Blood Cultures
Marrow Cultures
Later urine and stool cultures
How do you treat typhoid?
Supportive care
Either Oral Azithromycin (uncomplicated) or IV ceftriaxone for complicated.
How are typhoid and dengue spread?
Typhoid - Faecal-oral
Dengue Fever - Aedes Aegypti Mosquitos
How does Dengue Fever present?
A sudden fever + Macular/maculopapular rash
Can develop a headache, myalgia or arthralgia
As well as some haemorrhagic signs including petechial rash, +ve tourniquet test & Purpura
If the fever lasts more than 2 wks or its been more than 2 wks since potential exposure its not dengue
How do we test for dengue fever?
PCR & Serology
A clinical diagnosis can be made with:
- +ve tourniquet test
- Elevated transaminases
- Luecopenia
- Thrombocytopenia
How do you treat dengue fever?
Supportive - Fluids, fresh frozen plasma and platelets
Prevention with Dengvaxia vaccine
What causes Schistosomiasis?
S. Haematobium (Africa)
S. Japonicum (Far East)
How is schistosomiasis transmitted?
Fresh Water & Freshwater Snails
Describe the progression of schistosomiasis?
Swimmers itch within the first few hours
15-20 days later they develop katayama fever (acute) which includes fever, urticaria, diarrhoea, abdo pain, splenomegaly, eosinophilia & lymphadenopathy
6-8 wks later they develop the chronic phase of the disease depending on the location the eggs grow:
- Intestinal –> Dysentery, portal HTN & varices
- Urinary –> Cystitis, haematuria etc
How do we test for schistosomiasis?
Clinical diagnosis is possible
Antibody tests
Rectal Biopsy
Ova in the stool or urine
How do we treat schistosomiasis?
Praziquantel
add Prednisalone if its severe
What causes Typhus
Rickettsia Conorii
Rickettsia Africae
They are parasitic bacteria
How does typhus present?
Think in anyone with exposure and septicaemia + -ve blood cultures
Abrupt fever, headache, confusion, jaundice and a rash (mostly macular or petechial)
As well as bleeds and thrombosis
How do you test for and treat Typhus?
Clinical diagnosis + serology to confirm
Treat with tetracycline
What are the main viral haemorrhagic fevers?
Ebola and Lassa Fever
How do Viral Haemorrhagic fevers present?
Sudden onset:
- Headache
- Pleuritic Pain
- Backache
- Myalgia
- Conjunctivitis
- Prostration
- Dehydration
- Fever
Then insane bleeding
How do we prevent and treat viral haemorrhagic fevers?
High security infection unit to isolate patients
Most treatments are supportive
What spreads Zika?
Aedes Mosquito
Sex
Blood Transfusion
What spreads typhus?
Ticks
What is the presentation of Zika?
None or mild symptoms e.g.:
- Headache
- Rash
- Fever
- Malaise
- Conjunctivitis
- Joint Pain
Possibly Guillain-barre
The main feature is microcephaly in babies
