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Infectious Diseases > Returned Traveler > Flashcards

Returned Traveler Flashcards

1
Q

Fever in returned traveler: walking bare foot?

A

Strongyloides

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2
Q

Fever in returned traveler: Lived / worked with pigs?

A

JE

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3
Q

Fever in returned traveler: aid work, development work (more prolonged period of time overseas)?

A

TB, Cholera, JE

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4
Q

Fever in returned traveler: fresh water?

A

Schistosomiasis, leptospirosis

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5
Q

Fever in returned traveler: sea water?

A

Vibrio spp infections

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6
Q

Fever in returned traveler: Birds?
Fever in returned traveler: Bats?
Fever in returned traveler: rates?

A

Birds = influenza
Bats = lyssa
Rates = leptospirosis

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7
Q

Fever in returned traveler: Jungle trek / lots of hiking?

A

Scub typhus

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8
Q

Fever in returned traveler: caving?

A

Histoplasmosis

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9
Q

Fever in returned traveler: wading in rice paddy?

A

Leptospirosis

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10
Q

What is ebola? briefly describe transmission, incubation period, presentation, tretment?

A

Ebolaviruses are part of the family of filoviridea. It is a type of haemorhagic fever, others include lassa, junin

Transmission from fruit bats to human.
Person to person transmission via blood, bodily secretions, or other bodily fluids (nil airborne transmission)

Incubation 2-21 days

Presentation: sudden onset fevers, rash, GI upset (vom, dia). Can present with internal and external bleeding

Treatment is quarantine and supportive

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11
Q

How is ebola vaccinated against currently?

A

Ring vaccination
- vaccination given to contacts and contacts of the contacts
- prevents transmission

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12
Q

What is neurocysticercosis? briefly describe transmission, incubation period, presentation, treatment?

A

THis is disease due to accidental ingestion of and infection with the paracite Taenia solium (pork tape worm). This is ingested via way of food contaminated with taenia solium.

It is the most common parasitic infection of the CNS worldwide. Also a common form of acquired epilepsy

Presentation depends on host immune system
Often can be aspymptomatic
Main presentations inc:
- epilepsy (70%)
- headache or dizziness
- stroke
- neuropsychiatric dysfunction

Treatment depends on viability of organisms as per imaging. consists of combination of:
- supportive care (ie antiepileptics)
- Steroids
- antiparasitic drugs

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13
Q

High clinical suspicion for malaria but first smear negative. What is the next step?

A

Repeat thick and thin film (smear) at least 3 times over next 36-48hrs

parasitaemia is often transient and can be missed with one smear, therefore when have high suspicion need to repeat

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14
Q

What are the five types of malaira spp? Which one is the worst?

A
  • Plasmodium Falciparum (severe disease, worst)
  • Plasmodium Vivax (severe disease, common but slightly less common in aus)
  • Plasmodium ovale
  • PLasmodium Malariae
  • P. Knowlesi (seen more in malaysia, philipines, thiuland, burma)
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15
Q

Pt returning from africa and papa new guinea. What type of malaria spp is he most likely to have?

A

P. Falciparum

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16
Q

Pt returning from asia pacific. What type of malaria spp is he most likely to have?

A

P. Vivax

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17
Q

Briefly explain the lifecycle of malaria?

A
  • Mosquito bite
  • Sporozoite injected into blood
  • Travels to liver and develops further in liver parenchyma
  • Merozoite is released fom liver into blood
  • Penetrates RBCs, initially forms a ring form, then immature schizont, then mature schizont, then multiple microgammetocytes.
  • Microgammetocytes exit RBC, killing it
  • mosquito bite takes up the released microgametocyte and macrogametocyte
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18
Q

Which forms of malaria form hyponozoites? what is the implication of these?

A

Vivax and ovale

hypnozotites can persist in liver for approx 5 years or so leading to delayed development of malaria (many years after travel)

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19
Q

How does Malaria present?

A

Presentation is often non specific
- fever, rigors, headache, malaise and myalgias (whole body pain)

Non specific examination findings:
- jaundice and splenomagaly are suggesting

Mild anaemia and thrombocytopenia are common

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20
Q

How is severe malaria defined?

A

Malaria that:
- involves teh CNA (cerebral malaria)
- kidneys (AKI, renal failure)
- Severe anaemia
- Macroscopic haemaglobinuria
- Haemorhage
- Shock
- ARDS
- Shock

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21
Q

At what level of parasitaemia would malaria be treated as severe malria regardless of presentation?

A

Parasitaemia >2% treat as sever because of risk of developing clinical severe malaria at these levels is high

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22
Q

Explain the tests involved in Dx malaria?

A

Thick and thin film
- Thick film: blood put on slide, air dried, then stained with dye that lyses red cells and releases the parasite to be viewed with microscope
- Thin film: blood on slide, smears aiming for monolayer. Heated to fix red cells then stained (process prevents lysis of RBCs). Can see parasites inside intact RBCs
- Malaria ICT (antigen test) - detection of plasmodium LDH or falciperum LDH, or HRP
- PCR

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23
Q

What is the utility of a separate thick and thin film in malaria Dx?

A

Thick film is initial test, very sensative but unable to detect morphology of RBCs, unable to tell spp of malaria
- this is because there are layers and layers of RBCs on top of each other

Thin film subsequent test, gives more info on morphology of RBCs and parasites in RBCs

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24
Q

What can cause false positive for the malria ICT (antigen test)?

A

Rheumatoid factor positive pts

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25
Q

What tests are used to monitor response to malaria treatment?

A

BLood smears

Cant use malaria ICT (antigen test) as the antigen can persist despite treatment

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26
Q

Treatment of severe malaria?

A

1st line - IV artesunate
2nd line - IV quinine (more adverse events, inferior to IV artesunate)

When pt improved, switch to oral

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27
Q

Whers does resistant malaria typically originate from? how is it treated initially?

A

Originoates along the mekong river area (THailand, vietnam, cambodia, Laos, Myanmar)

Treated with IV artesunate and IV quinine epmirically due to developing artesunate resistance

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28
Q

How is uncomplicated malaria (ie not severe malaria) treated?

A

1st line - PO artemether + Lumefantrine (20+100mg RIamet)
- Note need to use IV medications if pt vomiting ie cant keep tabs down

Can use alternative regime (if teh pt was not taking for prophylaxis)
- Atovaquone + proguanil (Malerone)
- Mefloquine
- Quinine + doxycycline
- Quinine + clindamycin - use in preg and children

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29
Q

Pt has confirmed P ovale, P vivax infection. How are hypnozoites treated? What needs to be check prior to adding this drug?

A

Add primaquine
- Check G6PD

30
Q

In whom should mefloquine be avoided?

A

Depression, psychosis, seizures

31
Q

Which malaria drugs can be used in preg?

A

artesunate
Quinine
Chloroquine
Clindamycin
? mefloquine

32
Q

What is dengue fever?

A

Dengue fever is caused by a RNA flavivirus that is transmitted by mosquites (Aedes Egypti). there are 4 serotypes Den 1-4

33
Q

In which parts of Aus is A. Egypti endemic?

A

North queensland (daintree and torres strait)

34
Q

Why is secondary infection with dengue often more severe than initial infection?

A

When infected initially, you have immunity to only that serotype of dengue (DEN1-4).
when infected by another serotype, the antibody dependent enhancement of re-infection response often leads to a more severe infection than initially

35
Q

Is there a dengue vaccine? who gets it?

A

Yes there is, but only availible to children in highly endemic regions
Ie not available to travelers typically

36
Q

Classic dengue fever presentation?

A

Acute febrile illness that presents with fevers and 2 or more of the following:
- Nausea and vomiting (50%)
- Rash (50%)
- Aches and pains (often severe “break bone” pain)
- Torniquet test positive
- leucopenia
- Any warning signs

37
Q

What is the torniquet test? what does it aim to measure /assess?

A

Test in which a torniquet is applied
After release, the number of petichiae are counted

It is a test of capillary fragility and hemorrhagic tendency
Used to estimate platlet count

38
Q

How is dengue fever Dx? Other blood test findings?

A

NS1 antigen test
- usually done as POC test via ELISA
Often also a IgM and IgG test included on the POC testing

Leaukopenia is common
Thrombocytopenia is common
Hct fluctuations (important in Dx severe dengue)
Low albumin
CXR - pleural effusions

Malaria smear, ICT required as malaria is endemic in same regions as dengue
Impossible to tell apart clinically sometimes

39
Q

At what stage in the illness is haemorhage/shock most likely to occur in dengue infection?
How is dengue monitored clinically and biochemically over this period?

A

After the initial fever and viraemia have resolved (day 4-6)

Clinically monitored by looking for warming signs:
- vomiting
- Abdo pain
- bleeding
- liver enlargement

Biochem monitoring with plt count and Hct
- If >20% rise in Hct, or >20% drop after fluids this indicates significant fluid shifts are occurring -> severe dengue

40
Q

Pts with severe dengue can get significant fluid shifts. What is the main risk when managing these pts clinically?

A

Difficult to manage fluids clinically
Main risk is overfilling leading to APO, massive pleural effusions

Best managed in ICU

41
Q

How is dengue managed?

A

Supportive

42
Q

What are arboviruses? which ones are we particularly concerned about and why?

A

Arbo viuruses are any virus that is spread via arthropods

We are most concerned with the ones that cause encephalitis
- Flaviviruses:
-> West Nile
-> Yellow fever virus
-> Dengue virus
-> JE virus
- Bunyaviruses
-> Hantaan virus
- Alphaviruses
-> Chikungunya virus

43
Q

What is yellow fever?

A

Yellow fever is an incfection caused by a flavivirus transmitted to human via a mosquito vector (usually A. Aegypti)

It presents as a non specific viral infection with fever, chills, loss of appetite, nausea, muscle pains – particularly in the back – and headaches

Symptoms uisually last a few days then self resolve

However in a minority of cases, fever can reoccur within a day of resolving, abdominal pain onsets and liver damaged begins causing jaundice. AKI and bleeding can also occur

44
Q

What is Zika infection?

A

ZIka is an infection caused by a flavicirus transmited to humans via the A. egypti mosquito bite

it is endemic to northern south america, the caribean and mexico. as well as parts of the asia pacific and central africa

Most infections are asymptomatic
Main complication is neurological complications
- GBS
- myelitis, meningioencephalitis
- Microcephaly in babies of women infected during preg

45
Q

What is gastric anisarkis? what is the classic story for pt with gastric anasarkis?

A

Parasitic worm infection. Anisakiasis of the gastrointestinal tract is caused by the consumption of raw or undercooked seafood infected with Anisakis larvae. Penetration of Anisakis larvae into the gastrointestinal mucosa leads to severe epigastric pain, nausea, and vomiting, usually within hours of ingestion of the parasite.

traveler eats sushimi (raw fish) in japan from street vendor

46
Q

What bacteria causes Typhoid fever? What type of bacteria is it?

A

Salmonella Typhi, salmonella paratyphi A-C
gram negative rods

47
Q

What bacteria causes salmonella gastroenteritis?

A

Salmonella Typhimurium, Salmonela Enteriditis
Gram negative rids

48
Q

How does salmonella typhimurium / salmonella enteriditis present? how is it treated?

A

These are organisms causeing salmonella gatroenterieis
12-24hr incubation
presentation with diarrhoea, vomiting, fever lasting 2-5 days

Spontaneous resolves
Not Rx abx unless risk of sever infection, lots of resistance

49
Q

What is typhoid fever / enteric fever?

A

This is an illness caused by S. Typhi and S. paratyphi A-C
Human to human transmission by faecal oral spread

Most typhoid is from india and kpakistan

bacteria migrate to LN. Bacteria and toxin is released causing septicaemia

Presentation (classic): fever, diffuse abdo pain, alaise, constipation
Rose spots - faint salmon macules on trunk and abdomen

Investigations:
Leukopenia and thrombocytopenia common
Elevated LFTs
Culture positive -> this is how Dx made
Typhoid serology not widely used

50
Q

Person is vaccinated against typhoid fever. Can they get typhoid fever?

A

Yes
Vaccination is agaist typhoid, not paratyphoid which can also cause typhoid fever

51
Q

What are the main complications of typhoid infection?

A

Intestinal hemorrhage and perforation (main one)
Neuropsychiatric (permanent)
Resp complications + cardio complications (myocarditis)

52
Q

Empirical treatment for typhoid fever?

A

IV ceftriaxone 2g daily 7d + azithromycin 1g oral daily 5d

53
Q

Pt remains febrile despite treatment of typhoid fever. What to do?

A

Continue treatment. Pts often remain febrile for 5-7 days post treatment even if treatment is working

54
Q

What causes rabies?

A

Lyssa virus

55
Q

Pt has had vaccine for rabies in the past. Then bitten by animal. Next step?

A

Need to give post exposure prophylaxis depsite past vaccination, just a different regime

56
Q

What are common rabies vectors? What are warning signs of a infected animal?

A

Canines (domestic dogs predominantly, as well as foxes, coyotes), cats, raccoons, skunks, and bats

Aggressive animals
Docile or placid animals (ie downed bat that is sitting on the ground)

57
Q

What is treatment for Rabies? Explain this treatment (ie timing)?

A

Pre-exposure prophylaxis
- for ppl who are exposed to rabies virus or who handle specimens considered high risk for rabies and persons who visit countries where rabies is a significant problem.

Wound amangment if bitten:
- Wash wound with soap and water
- FLush with saline
- Exploration for forgin body ie broken tooth
- Allow wound to heal by secondary intention

Post exposure prophylaxis is the only treatment
- passive immunization with immunoglobulin, and active immunization with rabies vaccine post exposure
- should be commenced as soon as possible following exposure
- Usually very effective (nearly 100%) if commenced prior to symptom onset
- Rabies is invariably fatal once Sx onset

58
Q

Incubation period of rabies?

A

Typically 1-3 months but depends on the site of inoculation
- May be years if bitten on lower leg
- May be 1-3 days if bitten on neck or head (short path to brain via cranial nerves)

59
Q

What is Bot fly infection?

A

This is an infection by larvae of the bot fly
Fly usually lays eggs on clothes which are then worn by human, transmission occurs

Larve bury into skin
Main complicaiton is secondary infection. The bot fly infection itself does not cause too many problems although it feels like larvae moving under skin

Prevent by ironing clothes (heat kills )

60
Q

What are manifestations of infection with entamoeba histolytica? How does it usually present?

A

Amoebic liver abscess is due to infection with the protozoa Antamoeba histolytica, specifically the trophozoite form which can cause extrintestinal disease

In the cysts phase, Entamoeba histolytica causes Amoebiasis (self limiting diarroheal illness)

Usual presentation:
- initial infection with cyst form from faecal oral transmittion leads to diarhoeal illness. This self resolves
- presentation of liver absces includes fever, RUQ pain, weight loss. Dia usually resolved at time of abscess formation

61
Q

Who is most at risk of entamoeba histolytic infection in developed countries (ie Aus)?

A

Plumbers
MSM

62
Q

Diagnosis of Amoebic liver abscess? Features of amoebic liver abscess on imaging (pre and post Rx)?

A

Dx based on imagign and high titre eof E.Histolytica serology

Pre:
- Solitary right lobe abscess
Post:
- often can look very bad for many years after successful Rx. Dont be surprised

63
Q

Rx for amoebic liver abscess?

A
  • Metro 500mg TDS 10d for liver cysts
  • Erradiaction of intestinal cysts with Paramomycin 10mg/kg TDS 10d
64
Q

What causes elaphantitis? What is the technical name?

A

Lymphatic filiariasis
- caused by either Wuchereria bancrofti, or brugia

It is a parasitic disease caused by infection with microscopic worms that solely infection the lymphatic system and cause lymphagitis and diability

A. Egypti vector

65
Q

What is rickettsia? How does it present?

A

Small gram negative rods, intracellular growth (so cannot be cultured) causing riocketsial infection
Spread by ticks, fleas, mites

There are numberous organisms causing Riketsia, therefore the presentation varies

Generally speaking, present with:
- Rash (to varying degrees)
- Eschar (at site of bite)
- Headache, myalgia
fever, lymphadenopathy

66
Q

What are three types of rickesia causing bacteria spp found in aus and their vectors?

A

Ricketsia australis - ticks
Ricketsia typhi - fleas
Orientia Tsutsugamushi - mites

67
Q

Rare but serious complications of Riketsia infection?

A

Myocarditis
Meningioencephalitis

68
Q

How is Riketsia treated?

A

Doxycycline mono empirically

69
Q

What is Schistosomiasis? Explain the transmission, demographic, presentation, Dx, treatment?

A

Disease caused by infection with flat worms called schistosomes.

Transmission occurs by contact with fresh water infected with schistosomes. Schistosomes are released into water by fresh water snails that are infected

Mostly affects young children and women in developing countries who are more likely to come intro contact with contaminated water

Can present as an acute or chronic illness
Acute illness:
- Occurs 2-8 weeks after exposure
- non specific Sx: Fever, lethargy, malaise, and myalgia.
- Skin penetration can cause urticaria and itchy rash hours to days following

Chronic infection:
- Granulomatous reaction to cells infected with eggs
- results in multisystem granulation formation that leads to organ damage that is only partially reversible (due to deposition of collogen etc)

70
Q

Sewer worker. What infection?

A

Leptspirosis

71
Q

What is leptospirosis? Explain the transmission, demographic, presentation, Dx, treatment?

A

Leptospirosis is infection with the gram negative bacteria (pathogenic spirochetes) of the genus leptospira
Most commonly caused by leptospira interegans

Caused from contact with infected animals (esp rodents), or water contaminated with urine from infected animals

Presentation is very similar to dengue fever (non specific)

Dx weith PCR of blood or urine

Treatment with doxycycline, amoxicillin / ampicillin

Infectious Diseases (3 decks)

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