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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
yellow fever transmission African countries
Angola DRC Kenya Uganda Nigeria Senegal Rep of Congo Mali, Togo, Gabon, Ethiopia, South Soudan
26
YF transmission Americas
Bolivia Brazil Colombia Ecuador French Guiana Peru Suriname Venezuela
27
rate of YF cases by continent
Africa 90% South America 10%
28
YF risk 2 week stay
West Africa illness 1/2,000 death 1/10,000 South America illness 1/20,000 death 1/100,000
29
YF: clinical
- 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
JE vector
culex mosquito SE Asia
31
JE cause
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
Culex patterns
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
JE in travelers
estimated risk <1/1 million most were rural most in high season 1
34
JE clinical
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
JE dx
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
West Nile - culex
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
west Nile clinical
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
West Nile dx
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
Rift Valley fever
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
RV fever clinical
Inc: 2-6 days mild - fever, sxs suggestive of meningoencephalitis severe- ocular, meningoencephalitis, hemorrhagic ocular form can cause blindness
41
RV fever dx
serology viral culture PCR tx supportive prev: vector avoidance, unpasteurized milk
42
emerging viruses
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
Ixodes scapularis
Lyme, Babesia, Anaplasma
44
Ticks
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
African trypanosomiasis
Tsi tsi fly
46
American trypanosomiasis
reduvid bug (triatoma) carries chagas dz
47
Leishmaniasis
sand fly
48
filariasis
Loa loa Onchocerca volvulus Wucheria bancrofti
49
Arbor viruses
dengue, chikungunya, zika, mayaro
50
dengue
4 serotypes vector: aedes aegypti and albopictus most common arboviral dz in travelers "breakbone fever" vast majority South Asia and South America
51

ISTM certification (8 decks)

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