Travel Medicine Flashcards
General counselling for motion sickness, jet lag + VTE on flights
Motion sickness: sit in centre of vehicle, take prophylactic antiemetic
Jet lag: active in sunlight on arrival
VTE: fluids, move about
What should you have in a travel Health kit?
bandages, gauze, insect repellant, bite treatment, antihistamine, ORS, analgesiic, sunscreen
Food + water safety
Avoid tap water, ice from tap water
Unpasteurized foods
Open buffers
High risk activities
STI, blood exposure, car safety
Water safety
High altitudes
Malaria counselling
Avoid dawn and dusk, full length clothes, insect repellant, inspect for ticks
Malaria rx: when to start, SE
Atovaquone/proguanil (Malarone) daily
Start 1 day prior, continue 7d after
Avoid in children <5kg
Mefloquine (Lariam) weekly
Start 3w prior, continue 4w after
AE: Severe intolerance in some patients
Chloroquine 500mg weekly: start 1-2 wks before until 4wks after
Resistant areas: sub-saharan africa, south america except argetina, Asia
Doxycyline 100mg once daily: start 1d before travel until 4wks after
Ix for malaria
CBC (anemia, lymphopenia, thrombocytopenia, eosinophilia)
Thick and thin blood smear r/o Malaria (consider repeat q12h until three negative smears as parasitemia is cyclical)
Sx, signs + cause of malaria
Plasmodium protozoa
Sx: cough, fatigue, malaise, arthralgia, myalgias, fever
Signs: splenomegaly, jaundice
Complications of malaria
Complications: sz, AKI, hypoglycemia, pulmonary edema, lactic acidosis, hemolysis + bleeding
Travellers diarrhea rx
Typically lasts 2-4 days
Management: loperamide 4mg then 2mg after each BM, azithromycin 1000mg x1
Altitude sickness cause + sx
Pulmonary edema, cerebral edema, usually >2500m
Sx: HA, weakness, fatigue, nausea, insomnia, reduced appetite, SOB, cough, hemoptysis
Altitude sickness prevention + rx
Prevention: slow ascent, acetazolamide (diuretic)/ dexamethasone
Rx: dexamethasone, nifedipine, sildenafil, ventolin
Causes of Fever based on when travel was:
<10d
<21d
>21d
>30d
<10d: travelers diarrhea, dengue fever, yellow fever, spotted fever, diphtheria, malaria, rabies, typhoid, typhus
<21d: leptospirosis, malaria, typhoid
>21d: viral hepatitis, malaria, acute HIV, schistosomiasis, leishmaniasis
>30d: TB, malaria, hep B or C, HIV, syphilis
Travel hx qs
when, where, how long, why, PMH, allergies
Vaccines for travellers
hep A, B, rabies, routine vaccinations (flu, shingrix, tetanus, pertussis, covid), typhoid, meningitis, yellow fever, encephalitis depending on country
What places would you recommend typhoid vax?
Central and SE Asia
Who would you advise NOT to have probiotics to prevent C diff?
Pregnant, ICU, prosthetic heart valves, IBD
Bacteria causing travellers diarrhea
campylobacter, salmonella, e coli, shigella
What to give before, during and after travel
before (antimalarials, vaccines)
during (antimalarials, antidiarrheals, insect precautions, activities)
after (antimalarials, Zika precautions)
1st line antimalarial + key points to remember
malarone (atovaquone + proguanil) - expensive, only need for 7 days after trip
2nd line antimalarial + key points to remember
doxycycline, cheap, photosensitivity rash, need for 30d after trip
Antimalarial for use in pregnancy
advise not to travel, if they have to use mefloquine - once weekly, SE are wild dreams + psychosis
Rx for confirmed malaria
artemisinin combo or quinine combo + prophylaxis drugs
Advice for travellers
limit high risk activites (MVA, sex), don’t check meds into luggage
Advice for travellers for diarrhea
Pack ORS, loperamide, azithromycin, pepto bismol (can use QID for prevention), boil/ peel/ cook food, avoid ice cubes/ salads, uncooked veggies, use bottled water, wash hands
Meds for altitude above 2800m
acetazolamide, dexamethasone, nifedipine, viagra
Causes of fever in travelers
malaria, travelers diarrhea, resp infections
When should loperamide not be used in travelers diarrhea?
Severe diarrhea w/ dysentry (blood in stool)
What can you use to prevent diarrhea when travelling?
Pepto bismol QID
SE of pepto bismol
black tongue, black stools, constipation
