the returning traveller Flashcards
what causes MERS
coronavirus
clinical features of mers
severe acute resp tract infection
- fever
- short of breath
- cough
- pneumonia
- gi upset
what is pertussis
whooping cough
cause of pertussis
bordella pertussis gram negative fastidious bacteria
pathogenesis of pertussis
-toxin
attaches to and paralyses respiratory cilia that if followed by inflammation of the resp tract
3 stages of pertussis
catarrahl
paroxysmal
convalescent
catarrhal stage
mild fever, coryza and cough 1 week
paroxysmal stage
intermittent cough becomes paroxysmal and ends in an inspiratory “whoop”
-2-6 weeks
convalescent stage
non-paroxysmal cough 2-6 weeks
complication pertussis
apnoea
pneum
seizures
management of pertussis
- vaccine 5 in 1
- antibiotics clarithromycin
viruses that cause hepatomegaly
malaria
typhoid
hepatitis
viruses that cause splenomegaly
- malaria
- relapsing fever
- typhoid
viruses that cause lymphadenopathy
- HIV
- rickettsial
- brucellosis
viruses that cause haemorrahge
viral haemorrhagic fever
dengue fever
yellow fever
meningococcal sepiteciaemia
2 main mosquitoes that carry viruses
aedes aegypti
aedes albopictus
risk if person bites you and treatment
-risk of bacterial infection
give phx co-amoxicalv
low risk of tetanus
dogs bites treatment
- bacterial infection
- tetanus
- rabies
treatment: co-amoxiclav
risk of infection from bat bite
rabies
money risk of infection and treamtnet
- bacterial
- rabies
- tetanus
- hep b prophylaxis aciclovir
- bacterial co-amoxiclav
main causes of fever in the returning traveller
- malaria
- enteric fever
- dengue
- HIV seroconversion
- Rickettsia
what causes malaria
- parasite
- plasmodium falciparum (main one)
- vivax
- malariae
- ovale (west africa)
- knowlesi
where is plasmodium knowlesi found
in long tailed and pig tailed macques in SE asia
which malaria parasite has the highest parasitaemia and merozoites produced
falciparum then vivax ovale malariae
where does malaria replicate and what is produced
replicates in liver and produces merozoites that invade mostly rbc
dx of malaria
is a blood film -thick film for sensitivity -thin film for quantification - do it 3 times
what is the rapid diagnostic test for malaria
- parasite lactate dehydrogenase
- plasmodium histidine rich protein 2 in falciparum only
presentation of malaria
- prodromal episodes of tiredness, aching
- non specific fever, -myalgia, headache, gi upset and cough
how does the fever present in malaria
-cyclical occurrence of sudden coldness followed by rigor then fever then sweating lasting 4-6 hours occurring every 2 days -or every 36-48 hrs for falciparum or even an almost continuous fever
lab findings for malaria
decreased platelets
increased bilirubin
severe malaria presentation
- cerebral malaria
- ards
- anaemia
- aki
- hypo
- shock (algid malaria)
- gi
- secondary infections gnb
what is complicated falciparum malaria
- impaired consciousness or seizures
- renal impairment
- acidosis and elevated lactate
- hypo
- pulmonary oedema or ARDS
- haemoglobin <80
- spontaneous bleeding/ disseminated IV coagulation
- shock algid malaria BP <90/60
treatment of malaria falciparum
-IV therapy artesunate
or quinine
treament for non-falciparum malaria
- chloroquine
- primarquine
what causes enteric fever
-bacteraemia with salmonella enterica serotype
typhi or paratyphi
treatment of enteric fever
ceftriaxone 3rd generation for gram negative cover
clinical features of enteric fever
- abdo-> non specific-> fever
- abdominal pain
- constipation
- diarrhoea
- chills
- headache
- cough
- myalgia
- sore throat
complication after week 3 enteric fever 3
- intestinal perforation and haemorrhage
- endocarditis
- hepatic and splenic abscess
exam findings for enteric fever
- fever
- abdo tenderness
- hepato and splenomegaly
- rose spots
- chest signs
enteric fever labs
increase ALT
decrease eosionphilics
another name for enteric fever
typhoid
what family member are dengue viruses
flaviviridae viruses
how is enteric fever transmitted
faecal oral
how is dengue fever transmitted
aedes aegypti and albopictus viruses
clinical features of dengue
- asymptomatic
- fever and rash
- retro-orbital headache
- msk pain
- leukopenia
- thrombocytopenia
dx of dengue
-serology or PCR
complications of dengue
- dengue haemorrhagic fever
- dengue shock syndrome
- severe plasma leakagen and organ impairment
what is dengue haemorrhagic fever and how is it tested
-fever
-positive tournique test
platelets <100 haemoconcentration
what is dengue shock syndrome
dhf plus shock
what family is chikungunya from
genus alphavirus
transmission of chikungunya
aedes mosquitoes
clinical features of chikungunya
- fever
- arthralgia
- joint swelling
- rash
- headache
- muscle pain
- nausea
- fatigue
persistent symptoms of chikungunya
- persistent arthritis and arthralgia
- oedematous polyarthritis
- severe tenosynovitis
- new onset raynaud phenomena
zika virus transmission
- aedes mosquito
- sexual transmssion
what monkey was zika originaly from
rhesus
manifestation of chikungunya
- maculopapular rash
- arthralgia
- conjunctivitis
- myalgia, headache, retro-orbital pain
- low grade fever
complications zika virus
-pregnancy causes congenital microcephaly, fetal loses and guillain barre syndrome
what is schistosomiasis
worms
treatment schistosomiasis
steroids and then praziquantel
what is rickettsial
The rickettsiae are a diverse collection of obligately intracellular Gram-negative bacteria found in ticks,
triad of rickettsial
- fever, headache and malaise within 1-2 weeks of infection
- rash or an eschar at site of tick infection
types of rickettsial 3
- african tick bite fever
- mediterrranean spotted fever
- scrub typhus: mites in asia: splenomegaly, cough, hearing difficulties, and encephalitis
dx of rickettsial
serology
treamtent of rickettsial
doxycycline
4 viral haemorrhagic fevers
- Arenaviridae
- Bunyaviridae
- Flivoridae
- Flaviridae eg dengue
when does HIV seroconversion take place
2-3 weeks after exposure
how does hiv seroconversion present
like mononucleosis -fever adenopathy pharyngitis rash myalgia diarrhoea headache
what is hiv seroconversion
when hiv antibodies start to develop
what is the commonest identified cause of traveller diarrhoea
giardia
pathophysiology of giardai
cyst are passed in stools with motile trophozoites in duodenal aspirates
presentation of giardia
-foul smelling malabsorptive diarrhoea, floating stool, post prandial bloating
treatment of giardia
with metronidazole
where is cutaneous larva migrans found
jamaica
presentation of cutaneous larva migrans
- feet and buttock
- pruritic serpiginous eruption
- rash
treatment larva migrans
ivermectin
albendazole
what is myasis
maggots of african tumbu fly that burrow larvae into skin
presentation of myasis
-boils which exude serous fluid
what is tungiasis
parasite flea in indies eggs put by flea into broken skin
