Session 9-Travel Infection

Question 1

Why is travel history important?

Answer 1

• recognise imported diseases
• different strains of pathogen (antibiotic resistance)
• infection prevention (on the ward, in the lab)

Question 2

How many days after symptoms begin is classified as:

1) acute
2) sub-acute
3) chronic

Answer 2

1) <10 days
2) 10-21 days
3) >21 days

Question 3

What are the symptoms/signs of infection from:

1) sub-Saharan Africa
2) SE Asia
3) S/C America
4) N Africa/M East
5) S/C Asia
6) N Australia
7) N America

Answer 3

1) resp (cough)
2) GI (diarrhoea)
3) skin (rash)
4) jaundice
5) CNS (headache)
6) haematological (lymphadenopathy/splenomegaly/haemorrhage)
7) eosinophilia

Question 4

How do people acquire infection from:

1) sub-Saharan Africa
2) SE Asia
3) S/C America
4) N Africa/M East
5) S/C Asia
6) N Australia

Answer 4

1) food/water
2) insect/tick bite
3) swimming
4) sexual contact
5) animal contact (bite)
6) beach

Question 5

What are the key aspects of taking a travel history?

Answer 5

1) any unwell travel companions/contacts?
2) pre-travel vaccinations/preventative measures?
3) recreational activities?
4) healthcare exposure?

Question 6

Which three species of malaria (Plasmodium) do we need to know?

Answer 6

Falciparum
Vivax
Ovale

Question 7

What is the vector of malaria?

Answer 7

Female anopheles mosquito (night biter)

Question 8

What is the minimum incubation period of malaria?

Answer 8

6 days

Question 9

What is the incubation period of Plasmodium falciparum?

Answer 9

Up to 6 months

Question 10

What is the incubation period of Plasmodium vivax/ovale?

Answer 10

Up to 1 year +

Question 11

What is the history of a patient with malaria?

Answer 11

Fever chills and sweats

Question 12

What are the symptoms of malaria?

Answer 12

Headache 
Fever
Fatigue
Pain
Chills
Sweating 
Dry cough 
Splenomegaly 
Nausea
Vomiting

Question 13

What are the cardiovascular symptoms of severe falciparum malaria?

Answer 13

Tachycardia
Hypotension
Arrhythmia

Question 14

What are the respiratory symptoms of severe falciparum malaria?

Answer 14

Acute respiratory distress syndromes (fluid in lungs)

Question 15

What are the GI symptoms of severe falciparum malaria?

Answer 15

Diarrhoea
Deranged LFTs
Bilirubin

Question 16

What are the renal symptoms of severe falciparum malaria?

Answer 16

Acute kidney injury

Question 17

What are the CNS symptoms of severe falciparum malaria?

Answer 17

Confusion
Fits
Cerebral malaria

Question 18

What are the blood-related symptoms of severe falciparum malaria?

Answer 18

Low/normal WCC
Thrombocytopenia
DIC

Question 19

What are the metabolic symptoms of severe falciparum malaria?

Answer 19

Metabolic acidosis

Hypoglycaemia

Question 20

Why are three blood smears needed to test for malaria?

Answer 20

Need 3 negatives to exclude malaria

Question 21

Which investigations are conducted to test for malaria?

Answer 21

Blood smear x3
FBC
U&Es
LFTs
Glucose
Coagulation 
Head CT
Chest x ray

Question 22

What is used to treat Plasmodium falciparum?

Answer 22

Artesunate

Quinine and doxycycline

Question 23

What is used to treat Plasmodium vivax and ovale?

Answer 23

Chloroquine + primaquine

Question 24

How can malaria be prevented?

Answer 24

• assess risk
• bite prevention (repellant, adequate clothing, nets)
• chemoprophylaxis

Question 25

What does salmonella typhi cause?

Answer 25

Typhoid (enteric fever)

Question 26

What is the mechanism of infection of enteric fever?

Answer 26

Faecal-oral from contaminated food/water

Question 27

Describe the gram stain of salmonella typhi?

Answer 27

Gram-negative rod

Question 28

What are the virulence factors of salmonella typhi?

Answer 28

1) gram-negative endotoxin 2) survives gastric acid 3) invasin-allows intracellular growth 4) fimbriae adhere to epithelium over ileal lymphoid tissue

Question 29

What is the incubation period of enteric fever?

Answer 29

7-14 days

Question 30

What are the signs/symptoms of enteric fever?

Answer 30

``` Fever Headache Abdominal discomfort Constipation Dry cough Relative bradycardia ```

Question 31

True or false: the signs and symptoms of paratyphoid are milder than typhoid

Answer 31

TRUE

Question 32

What are the complications of enteric fever?

Answer 32

Intestinal haemorrhage and perforation

Question 33

What do the investigations done for a patient with enteric fever show?

Answer 33

Moderate anaemia Relative lymphopenia Raised LFTs Culture (blood)

Question 34

How can enteric fever be prevented?

Answer 34

Food and water hygiene precautions Typhoid vaccine Capsular polysaccharide antigen Live attenuated vaccine

Question 35

What are the symptoms of non-typhoidal salmonella infections (eg food poisoning)?

Answer 35

Diarrhoea Fever Vomiting Abdominal pain

Question 36

What is the commonest arbovirus?

Answer 36

Dengue

Question 37

How does the first dengue infection present?

Answer 37

Ranges from asymptomatic to severe febrile illness

Question 38

How does a re-infection of dengue present?

Answer 38

Dengue haemorrhagic fever | Dengue shock syndrome

Question 39

Give an example of a viral haemorrhagic fever

Answer 39

Ebola

Question 40

What are the symptoms of Ebola?

Answer 40

Flu-like illness with vomiting, diarrhoea, headaches, confusion and rash

Question 41

What type of virus is Zika virus?

Answer 41

Arbovirus

Question 42

What are the symptoms of Zika virus in pregnant women?

Answer 42

Foetal loss | Baby has congenital microcephaly