S13C156 - World Travelers

Question 1

5 causes of rash in returning traveler:

Answer 1

• dengue
• typhus
• syphilis
• gonorrhea
• ebola
• brucellosis
• chikungunya
• HIV

Question 2

Infections spread by fleas

Answer 2

• typhus

- plague

Question 3

Infxn spread by tse tse flies

Answer 3

-african sleeping sickness

Question 4

Infxn from sandflies

Answer 4

-leishmanisiasis

Question 5

2 Infxn spread from barefeet exposure

Answer 5

-strongyloidiasis, hook worm

Question 6

5 causes Jaundice in returning traveller

Answer 6

-hepatitis, malaria, yellow fever, leptospirosis, relapsing fever

Question 7

3 causes of hepatomegaly in returning traveler

Answer 7

• amebiasis
• malaria
• typhoid
• hepatitis
• leptospirosis

Question 8

3 causes of eschar’s in travellers:

Answer 8

• typhus
• borrelliosis
• crimean-congo hemorrhagic fever
• anthrax

Question 9

Infections of africa:

Answer 9

• malaria
• hookworm/tapeworm/roundworm
• yellow fever
• relapsing fever
• tick typhus
• filariasis
• schistosomiasis

Question 10

Infections of South America

Answer 10

• malaria
• relapsing fever
• dengue
• filariasis
• schistosomiasis,
• chagas
• typus

Question 11

Infectiosn of Mexico/Caribbean

Answer 11

• dengue
• hookworm
• malaria
• cysteicercosis
• amebiasis

Question 12

Infections of australia/nz

Answer 12

• dengue
• q fever
• murray valley encephalitis
• japanese encephalitis

Question 13

Infections of china and east asia

Answer 13

• dengue
• hookworm
• malaria
• strongyloidiasis
• hemorrhagic fever
• japanese encephalitis

Question 14

Causes of fever with incubation >14d

Answer 14

-malaria, typhoid, HAV, HEV, schistosomiasis, amebic liver dz, leptospirosis, q fever, trypanosomiasis

Question 15

Causes of fever with incubation >6w

Answer 15

-malaria, TB, HBV, leishmaniasis, filariasis, schistosomiasis, rabies, amebic liver abscess, african trypanosomiasis

Question 16

Yellow Fever

Answer 16

• flavivirus
• monkey reservoir, mosquito vector
• south/central america and africa
• flu-like illness, hemorrhagic fever, conjunctival injxn, abod pain, faical flushing, prostration, bradycardia, bleeding diathesis
• incubation 3-6d
• classic triad: jaundice, black emesis, albuminuria
• tx: supportive

Question 17

Lass Fever

Answer 17

• arenavirus, west africa
• viral syndrome, fever, h/a, sore throat, retrosternal c/p, multi-organ failure, bleeding in 1/3 of pts
• dx: ELISA serology, Cx

Question 18

5 tropical dz causes of severe h/a and fever:

Answer 18

• malaria
• rickettsia
• dengue
• typhoid
• human african trypanosomiasis

Question 19

Japanese Encephalitis

Answer 19

• flavivirus
• rural rice paddy fields, Asia, western pacific
• sudden high fever, h/a, nuchal rigidity, vomiting, Sz
• Dx: clinical, CSF for virus
• tx: supportive

Question 20

Cysticercosis

Answer 20

• pork tapewarm, taenia solium
• mexico, latin america, sub-saharan africa, india, east asia
• ingestion from food, soil, undercooked pork
• neurocysticercosis: seizures, obstructive hydrocephalus, meningoencephalitis, stroke, h/a,

Question 21

African sleeping sickness

Answer 21

• human african trypanosomiasis
• protozoans via tse tse fly
• painless chancre x2-3 after bite, then intermittent fever, malaise, rash, wasting, CNS involvement, encephalits, coma, hemolysis, anemia, pancarditis, meningoencephalitis
• dx: blood smears
• tx: suramin, eflornithine, melarsoprol

Question 22

American trypanosomiasis (Chagas dz)

Answer 22

• protozoan
• kissing bug
• unilateral periorbital edema, painful cutaneous edema (chagoma), LA, HSM, depressed cardiac and GI fxn over months, myocarditis, dysrhythmias, CM, CHF
• dx: blood smear, serology if chronic
• tx: nifurtimox

Question 23

Leishmaniasis

Answer 23

• intracellular protozoan, via sandflies
• africa, asia, mediterranean basin, central/south am.
• visceral leishmaniasis: most lethal, TB, pna, dysentery, pentad of fever, wt loss, HSM, pancytopenia, hypergammaglobulinemia
• cutaneous
• mucocutaneous: chronic, relentless
• diffuse cutaneous
• dx: bone marrow bx or LN bx
• tx:
  visceral: sodium stibogluconate

Question 24

Schistosomiasis

Answer 24

• blood fluke, AFrica, middle east, SA, Asia
• GI Sx, freshwater exposure, penetrate wet skin or are ingested
• pruritic dermatitis, fever, h/a, cough, urticaria, diarrhea, HSM, hyperesoinophilia, Sz, paralysis, acute transverse myelitis, hematuria, SCC,
• dx: eosinophlia, microscopy or bx, serology
• tx: praziquantel

Question 25

4 causes of diarrhea with blood AND fever

Answer 25

• bacillary dysentery
• campylobacter enterocolitis
• salmonella enterocolitis
• e coli

Question 26

4 causes of bloody diarrhea with no fever

Answer 26

• amebiasis
• blantidium coli
• schistosoma
• trichuris

Question 27

Amebiasis

Answer 27

-entamoeba histolytica, Asia, Africa, latin america
-alternating constipation/diarrhea x3w, abdo pain, fever, dehydration, wt loss, hepatic abascess
-dx: stool o+p
-tx:
asymptomatic - iodoquinol or paromomycin
-symptomatic: flagyl

Question 28

Giardia

Answer 28

• flagellated protozoan, infects small intestine and biliary tree
• cramping, flatulence, foul-smelling watery diarrhea +/- blood/mucus, wt loss, anemia
• dx: stool o+p, giardia antigen test in stool
• tx: flagyl

Question 29

Cholera

Answer 29

• SA
• bacteria: vibrio cholerae
• fecal contamination of water/food
• incubation 2-3d, sodium pump inhibition in GIT by toxin
• profuse, painless watery diarrhea (rice water stools), dehydration, vomiting, leg cramps, fever
• tx: PO rehydration
• tetracyline, septra

Question 30

Worms

Answer 30

• ascariasis (Roundworm): fecal oral, dry cough, pna, bowel obstruction, hepatic abscess, pancreatitis, appendicitis
• enterobiasis (pinworm): fecal-oral, children sharing toys/utensils/bedding, perianal itching
• trichuris: whipworm, contaminated soil/veggies
• hookworm: chronic, severe anemia, cutaneous form, skin contact with soil with feces, penetrate skin
• cestodes: tapeworm, undercooked pork, fish, beef, n/v, h/a, abdo pain, pruritus, constipation, diarrhea, obstruction, cysticercosis
• strongyloides: small intestine, pna, wheeze, bloody diarrhea
• tx: mebemdazole 100mg BID x3d
• tapeworm: praziquantel
• strongyloides: albendazole

Question 31

Infectious causes of petechiae, hemorrhage

Answer 31

• meningococcemia
• dengue fever
• viral hemorrhagic fefvers
• yellow fever
• RMSF
• louse-borne typhus
• leptospirosis