Posttravel Evaluation Flashcards
what are elements of complete travel history?
hx of present illness;
travel details;
recreational activities;
exposures;
vectorborne disease precautions;
vaccines received;
medications taken;
past medical history;
additional information
what are diseases with slightly longer icubation periods <4-6 weeks?
viral hepatitis
acute HIV
leishmaniasis
malaria
typhoid fever
some infections might become manifest months or even years after a travel returns. what are examples?
leishmaniasis, malaria, schistosomiasis, TB
what are the most frequently dianosed infection from a patient with fevers coming from Asia?
dengue
what are the most frequently dianosed infection from a patient with fevers coming from Africa?
malaria
what are the 3 most common clinical syndromes after travel to low- and middle-income countries ?
dermatologic conditions, diarrheal diseases, and systemic febrile illnesses
what does asymptomatic eosinophilia in a returning traveler suggest?
possible helminth infection;
Allergic diseases, hematologic disorders, and a few other viral, fungal, and protozoan infections also can cause eosinophilia.
Eosinophilia can be present during pulmonary migration of parasites (e.g., Ascaris, hookworm, schistosomiasis, Strongyloides).
lymphatic filariasis, chronic strongyloidiasis, acute trichinellosis, visceral larva migrans
if patnet has delayed illness onset and chronic cough after long-term travel / healthcare worker, what do you suspect?
TB
what are helminths and helminth infections associated with pulmonary symptoms?
Ascaris,
hookworms (Ancylostoma or Necator),
paragonimiasis,
schistosomiasis, and
strongyloidiasis.
what is the disadvantages of antigen rapid test?
less sensitive than nucleic acid testing;
does not provide type or strain information
what are some antigen rapid test available?
dengue; ebola; HIV; influenza; malaria; covid
what are the disadvantage of antibody rapid tetsing?
AB from prior exposure and cross-reactivity limit specificity;
insensitive in acute disease
what are the advantages of AB rapid test?
IgM+ in late-acute/early convalescent phase;
IgG+ in chronic infections or after previous exposure;
Rapid and inexpensive
what are some AB rapid test available?
Dengue, Hep B, Hep C, HIV, Syphilis
what are some Nucleic acid (RNA or DNA) rapid testing available?
Chlamydia, multiple respiratory and GI panels;
Neisseria
covid
what are the advantage of nucleic acid testing?
sensitive and specific in acute phase - can provide quantitative information
if you get negative from rapid antigen tests for influenza or GI pathogens (norovirus, rotavirus), do you still need confirmation test?
yes - with molecular testing
when do you screen dengue for asymptomatic travelers?
kids 9-16 yrs old living in dengue-endemic areas
what is the concern of zika screening?
IgM AB persists months after infection
what do you need to screen when people with relevant exposures of STI from travel?
HIV and syphilis serologic tests,
nucleic acid amplification testing for chlamydia and gonorrhea in urine and at sites of contact (e.g., pharynx, rectum);
HBV testing; hepatitis C virus (HCV) testing;
Test all travelers born between 1945 and 1965 for HCV if not previously tested.
who do you need to screen for stronglyoidiasis?
selectected high-risk with potential skin exposure to human feces, usually a result of a walking barefoot in areas without proper sanitation facilities
when do you need to consider serologic screening in asymptomatic travelers for schistosomiasis?
who bathed or swam in freshwater canals, lakes, or rivers in areas endemic for schistosomiasis.
what screening is preferred for stronglyoides and schistosoma spp?
serologic testing - urine and stool examination lack sensitivity
do you screen asymptomatic possible malaria infection?
no
when do you consider screening for trypanosoma cruzi?
travelers who lived for >6 months in rustic housing (e.g., shelters with mud walls and thatched roofs) in endemic areas of Latin America, especially if they report having seen triatomine bugs inside their dwelling.
consider testing in people who received blood products in an endemic area, or in travelers with clinical manifestations compatible with acute Chagas disease
what are the most common protozoa found in asymptomatic travelers?
is screening recommended?
Blastocystis and Giardia species;
no unless evidence of onward transmission is present
for long-stay (3-6 months) and poor sanitation or hygiene, what are suggested screening tests?
CBC with eosinophil count;
Creatinine
CRP
Liver transaminases
Consider stool ova and parasite
injection or intranasal drug use, medical or dental care, piercing, tattoo - what screen do you suggest after travel?
HBV, if not previously vaccinated (for injection drug use) ;
HCV (for injection or intranasal drug use, unregulated tattoos);
HIV
Pregnant people who traveled in known current Zika virus–endemic or epidemic area or sexual contact with a partner who traveled in these areas, what screening do you recommend?
Screening asymptomatic pregnant travelers who have potential exposure (but without ongoing risk) is not routinely recommended outside an outbreak situation
NAAT ≤12 weeks after potential exposure in endemic or epidemic regions can be considered in pregnant people
Exposure to freshwater rivers, lakes, or irrigation canals - what screening?
schistosoma serology
Walking barefoot on soil potentially contaminated with human feces or sewage - what screening?
strongyloides serology
which malaria species have shorter incubation time <30 days most of the time? which < 30 days after return?
Plasmodium falciparum;
Plasmodium vivax
where are considered tropic areas?
caribbean;
central america;
south america;
south-central Asia;
south-east Asia;
Sub-Saharan Africa;
what are common cause of fever in Caribbean and South America?
Chikung, deng, malaria, zika
what are common cause of fever in Central America?
Caribbean + typhoid or paratyphoid fever
what are the primary malaria species in Central America and South America?
P. vivax
what are common cause of fever in South-Central Asia?
Dengue, malaria (non-P.falciparum),
typhoid or paratyphoid fever
what are common cause of fever in South-East Asia?
Dengue, malaria (non-P.falciparum)
what are common cause of fever in sub-Saharan Africa?
Dengue, Malaria (p. falciparum), tickborne rickettsia (main cause of fever in southern Africa),
acute Schistosomiasis (Katayama fever)
what is the main cause of fever in southern Africa?
Tickborne rickettsia
what are other infections causing outbreaks or clusters of disease among travelers in Caribbean?
Histoplasmosis, acute;
Leptospirosis
what are other infections causing outbreaks or clusters of disease among travelers in Central America?
Coccidioidomycosis;
Histoplasmosis;
Leishmaniasis;
Leptospirosis
what are other infections causing outbreaks or clusters of disease among travelers in South America?
Bartonellosis;
Histoplasmosis;
Leptospirosis;
Yellow fever
what are other infections causing outbreaks or clusters of disease among travelers in Caribbean, Central America, and South America all in common?
leptospirosis
histolasmosis
what are other infections causing outbreaks or clusters of disease among travelers in South Central Asia?
Chikungunya,
Scrub typhus
what are other infections causing outbreaks or clusters of disease among travelers in SouthEast Asia?
Chikungunya
Leptospirosis
which countries are in South Asia?
Afghanistan, Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan, Sri Lanka
which countries are in Central Asia?
Kazakhstan, Kyrgyzstan, Tajikistan, Tukmenistan, Uzebekistan
which countries are in SE Asia?
Indonesia, Vietnam, Laos, Brunei, Thailand, Myanmar, the Philippines, Cambodia, Singapore, Malaysia
which countries are in the Caribbeans?
Antigua, Barbuda, the Bahamas, Barbados, Dominica, the Dominican Republic, Grenada, Guyana, Haiti, Jamaica, Saint Lucia, St. Kitts and Nevis, St. Vincent and the Grenadines, Suriname, Trinidad, Tobago, Puerto Rico
what are 4 main countries in South America?
Brazil, Colombia, Argentina, Peru