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Tropical Medicine > Returning Traveller > Flashcards

Returning Traveller Flashcards

1
Q

What diseases to consider with history of Tick Bite?

A
  • Common
    • Lyme disease
    • tick typhus
  • Occasional
    • Q fever
  • Rare but important
    • Other borreliosis (tick bite fever, relapsing fever)
    • cchf
    • ehrlichiosis
    • tick-borne encephalitis
    • tularemia
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2
Q

Tsetse Fly

A

Trypanosomiasis

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3
Q

Animal Exposure

A
  • Common
    • Cellulitis
  • Occasional
    • Q fever
    • tularemia
  • Rare but important
    • Anthrax
    • rabies
    • rat bite fever
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4
Q

Dust Exposure

(eg caves, mines, deserts)

A
  • Common
    • coccidoidomycosis
    • histoplasmosis
  • Rare but important
    • Rabies (caves)
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5
Q

Cruise Ships, resorts

A
  • Legionella
  • norovirus
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6
Q

Farms

A
  • Common
    • Brucella
    • Q fever
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7
Q

Fresh water exposure

A
  • Common
    • Katayama fever (acute schistosomiasis)
    • leptospirosis
  • Rare but important
    • acanthameba
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8
Q

Game parks

A
  • Common
    • tick typhus
  • Rare but important
    • anthrax
    • trypanosomiasis
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9
Q

Ingestion: fecal contaminated water

A
  • Common
    • amebiasis
    • enteric fever (typhoid, paratyphoid)
    • gastroenteritis (bacterial or viral)
    • hepatitis A/E
  • Rare but important
    • poliomyelitis
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10
Q

Unpasteurized milk

A
  • Common
    • Listeria
    • Salmonella
    • Shigella
  • Occasional
    • Brucellosis
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11
Q

Undercooked/raw food

A
  • Common
    • Bacterial gastroenteritis
    • amebiasis
  • Rare but important
    • trichinosis
    • clonorchiasis
    • opisthorchiasis
    • paragonomiasis
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12
Q

Sexual Exposure

A
  • Common
    • HIV
    • hepatitis A/B/C
    • syphillis
    • gonorrhea
    • reactive arthritis
    • PID
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13
Q

Immunocompromised

A
  • Common
    • amebiasis
    • non-typhoidal salmonella
    • TB
  • Occasional
    • Visceral leishmaniasis
    • STI (eg syphilis)
  • Rare but important
    • Blastomyces dermatitides
    • coccidoidomycosis
    • histoplasmosis
    • penicilliosis
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14
Q

Sub-saharan Africa

A
  • Common
    • malaria
    • rickettsial infection (tick typhus)
  • Occasional
    • amebic liver abscess
    • brucellosis
    • dengue
    • enteric fever
    • Katayama fever
    • HIV seroconversion
    • meningococcus
  • Rare but important
    • other arbovirus (West Nile, Rift Valley Fever etc.)
    • histoplasmosis
    • trypanosomiasis
    • VHF (CCHF, Lassa, Ebola, Marburg)
    • visceral leishmaniasis
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15
Q

North Africa, Mid-East, Mediterranean

A
  • Occasional
    • Brucellosis
    • Q fever
    • Toscana (sandfly fever)
  • Rare but important
    • Visceral Leishmaniasis
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16
Q

Eastern Europe and Scandinavia

A
  • Occasional
    • Lyme disease
  • Rare but important
    • Hantavirus
    • Tick borne encephalitis
    • tularemia
17
Q

South and central Asia

A
  • Common
    • Dengue
    • enteric fever
    • malaria
  • Occasional
    • Chikungunya
    • visceral leishmaniasis
  • Rare but important
    • CCHF
    • other arbovirus (Japanese encephalitis, Nipah)
    • rickettsial infections
18
Q

South East Asia

A
  • Common
    • Dengue
    • enteric fever
    • malaria
  • Occasional
    • Chikungunya
    • leptospirosis
  • Rare but important
    • arboviruses (JEV, Nipah, Hantavirus)
    • melioidoisis
    • penicilliosis
    • rickettsial infection (scrub typhus)
19
Q

North Australia

A
  • Occasional
    • Dengue
    • Murray Valley Fever
    • Q fever
    • rickettsial infection
    • Ross River Fever
  • rare but important
    • arboviruses (Barmah forest)
    • melioidosis
20
Q

Latin America and Caribbean

A
  • Common
    • Dengue
    • enteric fever
    • malaria
  • Occasional
    • coccidoidomycosis
    • histoplasmosis
    • leptospirosis
  • Rare but important
    • acute Chagas disease
    • arboviruses (hanta, yellow fever)
    • paracoccidoidomycosis
21
Q

North America

A
  • Occasional
    • Coccidoidomycosis
    • histoplasmosis
    • Lyme Disease
    • Rocky Mountain Spotted Fever
  • Rare but important
    • arboviruses (WEE, EEE, West Nile Fever)
    • babesiosis
    • ehrlichiosis
22
Q

Short Incubation Period (<10 days)

A
  • acute gastroenteritis (bacterial, viral)
  • arboviral infections (e.g. dengue, chikungunya)
  • meningitis (bacterial, viral)
  • Relapsing Fever (Borrelia spp)
  • Respiratory Tract Infections (bacterial, viral, incl influenza)
  • Rickettsial Infection (eg tick typhus, scrub typhus)
23
Q

Medium Incubation Period (10-21 days)

A
  • Bacterial
    • Brucellosis
    • Enteric fever (typhoid and paratyphoid)
    • Leptospirosis
    • Q fever
  • Fungal
    • coccidiodomycosis
    • histoplasmosis (can be as short as 3 days)
  • Protozoal
    • Acute Chagas disease
    • malaria (P. falciparum)
    • East African Trypanosomiasis (T. brucei rhodesiense)
  • Viral
    • ​CMV, EBV, HIV, Viral Hemorrhagic Fever (but note no VHF has incubation period >21 days)
24
Q

Long Incubation Period (>21 days)

A
  • Bacterial
    • Brucellosis
    • TB
  • Fluke
    • Schistosomiasis (Katayama Fever)
  • Protozoal
    • amebic liver abscess
    • malaria (inc p. falciparum)
    • West african trypanosomiasis (T. brucei gambiense)
    • Visceral leishmaniasis
  • Viral
    • HIV
    • Viral hepatitis (A-E)
25
Q

What investigations are recommended as initial investigations in returning travellers presenting with (undifferentiated) fever.

26
Q

What are the contraindications to common malarial preventatives?

Mefloquine

Chloroquine

doxycycline

Atovaquone/Proguanil

A
  • Mefloquine : personal or family history of epilepsy history of neuropsychiatric disorders

(pregnancy- first trimester and breast feeding)

Chloroquine: epilepsy, generalised psoriasis

Doxycycline: pregnancy >15weeks children < 12 years

Atovaquone/
Proguanil : (pregnancy, breast feeding)

not currently licensed in children under 11kg. weight adjusted dosing from 5kg

27
Q

What is the guidance regarding coadministration of live vaccines?

Which can be given together?

Which should be delayed?

28
Q

What is the recommended approach to advising travellers wrt treatment of traveller’s diarrhea?

29
Q

Which antimalarial prophylactics are contraindicated in pregancy and breastfeeding? (and when)

A
  • Mefloquine (1st trimester & breastfeeding)
    • although CDC recently changed recommendation so that mefloquine ok in pregnancy
  • Atovaquone/Proguanil (pregnancy & breastfeeding)
  • doxycycline (preg>15 wks, children<12 yrs)
30
Q

Which antimalarials are contraindicated with seizure disorders.

A
  • mefloquine (beware even family hx of epilepsy)
  • chloroquine
31
Q

What % of travel associated illnesses are vaccine preventable?

32
Q

For which of the live vaccines are there recommendations about spacing doses in time?

Why?

A
  • Yellow Fever and MMR should not be administered on same day. Minimum interval 4 weeks.
    • empirical evidence that administration together mutually lowers rates of seroconversion
    • supported by the theory that interferon production stimulated by the replication of first vaccine prevented replication of the second agent, thus leading to a poor response to the second vaccine
  • varicella zoster and measles vaccines if not administered together, should be spaced by 1 month
33
Q

Which are the live vaccines?

A
  • bcg
  • rotavirus
  • live attenuated influenza vaccine (LAIV) only
  • oral typhoid vaccine
  • yellow fever
  • varicella, zoster
  • MMR
  • ppd skin testing

Tropical Medicine (17 decks)

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