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ISTM certification > Travel medicine > Flashcards

Travel medicine Flashcards

1
Q

% of global populations who are international migrants

A

steady increase to 3.5%

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2
Q

number of migrants worldwide forced migration

A

84 million

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3
Q

travel associated health risks

A

motor vehicle accidents
psychological sequelae
environmental risks (exposure, sun exposure
infectious diseases

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4
Q

risk of vaccine preventable diseases during travel

A

find the graph J Travel Med 2018

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5
Q

approaches to reduce travel related illness

A

Prevent and treat illness
Maintain immunization rates
Support global efforts for clean air, water and access to healthcare
Plan for mass gatherings- Hajj, olympics, etc
Improve immunization rates for migrants
Address health risks and behaviors(extreme sports, etc)
Travel med education - CME for PCP’s

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6
Q

travelers’ study

A

roughly 35-60% got some kind of advice pre-travel
If no advice - did not perceive risk

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7
Q

medical history

A

Itinerary - activities/potential exposures
Med Hx: vaccines, meds, allergies, medical problems
Risk behaviors and approaches to medical dec. making

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8
Q

travel consultation

A

Immunizations
Malaria prevention and bites prevention
Traveler’s diarrhea
Travel related risks: swim, sunburn, swim, animal bites, accidents

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9
Q

travel insurance

A

available services?
dental coverage
evacuation coverage

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10
Q

what is needed for vector borne diseases?

A
  • pathogen presence and amplification
  • reservoir (suitable host)
  • vector presence and survival
  • opportunity for human exposure
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11
Q

vector competence

A

can this vector transmit this particular pathogen
- depends on infection, dissemination and transmission

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12
Q

vector capacity

A

how important is this vector in transmission of the particular pathogen
- depends on vector competence, time of year, life span, where they feed, etc

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13
Q

most important vector for malaria transmission in sub-Saharan Africa

A

Anopheles gambiae

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14
Q

most important vector for transmission of yellow fever, dengue, chikungunya and zika

A

Aedes aegypti

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15
Q

vector of transmission for transmission of dengue, chikungunya and zika. also, to lesser degree, YF

A

Aedes albopictus
- container/ waterbodies(plants/pools) not brackish or salt water

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16
Q

YF and West Nile

A

culex mosquitos

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17
Q

Malaria mosquito

A

Anopheles

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18
Q

Mosquito for Dengue, Chknya, YF, Zika

A

Aedes
- container breeding
- adults are indoor dwelling
- bite humans - frequently, erratically

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19
Q

mosquito Rift Valley fever

A

Aedes, Culex

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20
Q

Mosquito JE and West Nile

A

Culex

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21
Q

mosquito for Filariasis, lymphatic

A

various mosquito vectors

22
Q

mosquito life cycle

A

egg - aquatic - 5-14 days
larva “
pupa “
adult

23
Q

Anopheles mosquitos habitat

A

clean unpolluted water

24
Q

A. gambiae

A

major African malaria vector, breed in diverse habitats, ie tire tracks, rice fields, irrigation water
- feeding: crepuscular (dusk/dawn) or nocturnal (night)

25
Q

yellow fever transmission African countries

A

Angola DRC Kenya Uganda Nigeria
Senegal Rep of Congo
Mali, Togo, Gabon, Ethiopia, South Soudan

26
Q

YF transmission Americas

A

Bolivia Brazil Colombia Ecuador
French Guiana Peru Suriname Venezuela

27
Q

rate of YF cases by continent

A

Africa 90%
South America 10%

28
Q

YF risk 2 week stay

A

West Africa illness 1/2,000 death 1/10,000
South America illness 1/20,000 death 1/100,000

29
Q

YF: clinical

A
  • incubation 3-9 days
  • no sx or mild (fever, chills, HA, back pain, myalgia, rash vomiting, fatigue) in most- improves in 1 week
  • after sxs onset, viremia for 3 days and some have persistent weakness, fatigue for months
  • severe dz 5-26% - high fever, jaundice, bleeding, shock, organ failure
  • case fatality 30-60%
30
Q

JE vector

A

culex mosquito
SE Asia

31
Q

JE cause

A

flavivirus
67,000 cases per year
up to 20,000 deaths per year
overall 1.8 cases per 100,000
tropical year round
temperate - May through Oct

32
Q

Culex patterns

A

mosquitos get from feeding on domestic pigs, wild birds
feeding dusk to dawn
often outdoors, but sometimes indoors
increased risk- rural areas, outdoors, long-term travel

33
Q

JE in travelers

A

estimated risk <1/1 million
most were rural
most in high season
1

34
Q

JE clinical

A

incubation 5-15 days
symptomatic only <1%
more severe- encephalitis, meningitis, fevers
- quick onset fever, HA, vomiting, neck stiffness,
- mental status change- stupor, disorientation, coma
- Parkinsonian- mask-like facies, tremor, cogwheel rig.
- acute flaccid paralysis
- seizures

35
Q

JE dx

A

often clinical
inc WBC, dec Na
CSF pleocytosis, lymphocytes
IgM CSF day 4+/serum day 7+
plaque reduction neutralization test
Nucleic amp tests are insensitive

36
Q

West Nile - culex

A

flavivirus
Transmission: mosquitoes primarily culex spp
mainly C.tarsalis in western US
also blood transfusion, organ transpx, Mat-fet, breast fx
mainly infects birds, but other animals as well

37
Q

west Nile clinical

A

incubation 2-6 days (up to 14)
70-80% subclinical/asymptomatic
WN fever - fever HA, malaise, back pain, etc
- eye pain, pharyngitis, abd pain
- rash in 50%
WN neuroinvasive dz in <1% (1 in 150) risk ^ advage
- encephalitis, meningitis, flaccid paralysis, GBS,
- dysrhythmias, optic neuritis, etc

38
Q

West Nile dx

A

CSF lymphocytic pleocytosis with ^ protein
IgM antibodies in serum or CSF
may need convalescent test to confirm
false pos ELISA after YF or JE vaccine
PCR, viral cx

39
Q

Rift Valley fever

A

Bunyavirus, zoonosis
vector: mosquitoes - Aedes
other: blood / organs of infected
inhalation with animal slaughter, labs
unpasteurized or uncooked milk of infected animals
blood feeding flies
- some endemic African countries otherwise occasional in Africa

40
Q

RV fever clinical

A

Inc: 2-6 days
mild - fever, sxs suggestive of meningoencephalitis
severe- ocular, meningoencephalitis, hemorrhagic
ocular form can cause blindness

41
Q

RV fever dx

A

serology
viral culture
PCR

tx supportive
prev: vector avoidance, unpasteurized milk

42
Q

emerging viruses

A

Mayaro virus (MAYV) dz
French Guiana since 1998
vector: Haemagogus mosquitoes
inc 1-12 d with nonspecific fever like dengue

Oropouche virus (OROV)
orthobunyavirus
South America and Caribbean
inc 4-8 days with sudden ^ fever, HA, myalgia, rash

43
Q

Ixodes scapularis

A

Lyme, Babesia, Anaplasma

44
Q

Ticks

A

Life: egg, 6-leg larva, 8-leg nymph, adult
encephalitis, tick-borne
Lyme, anaplasmosis, babesiosis, Powassan
Rickettsiosis
crimean congo hemorrhagic fever
Kyasanur Forest disease, Omsk hemorrhagic fever

45
Q

African trypanosomiasis

A

Tsi tsi fly

46
Q

American trypanosomiasis

A

reduvid bug (triatoma)
carries chagas dz

47
Q

Leishmaniasis

A

sand fly

48
Q

filariasis

A

Loa loa
Onchocerca volvulus
Wucheria bancrofti

49
Q

Arbor viruses

A

dengue, chikungunya, zika, mayaro

50
Q

dengue

A

4 serotypes
vector: aedes aegypti and albopictus
most common arboviral dz in travelers
“breakbone fever”
vast majority South Asia and South America

51
Q
A

ISTM certification (8 decks)

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