Travel Medicine

Question 1

What are causes of persistent diarrhoea after travelling to less developed countries?

Answer 1

Protozoal infection eg amoebiasis (especially if fever and mucus or blood in stools)
Giardiasis (abdominal cramps, flatulence, bubbly and foul smelling diarrhoea that persists > 4 days)

Question 2

Which subgroup of patients are at greater risks of contracting p falciparum (malignant malaria)?

Answer 2

People who have had a splenectomy

Question 3

What are two main causes of travellers’ diarrhoea?

Answer 3

E. coli and campylobacter

Question 4

What things increase malaria risk?

Answer 4

Being in a malaria region, especially around wet season
Sleeping in unscreened rooms without mosquito nets
Wearing dark clothing
Short sleeves and shorts
Inappropriate or incomplete drug prophylaxis

Question 5

What are risk factors for DVT?

Answer 5

Increasing age
Clotting tendency
Past history of DVT 
Smoking
Obesity
Varicose veins
Dehydration
Significant illness
Recent major surgery
Oestrogen therapy

Question 6

What are clinical features of altitude sickness?

Answer 6

Usually within 8-24 hours of exposure
Frontal headache (worse in the morning and when supine)
Malaise, fatigue, anorexia, nausea, insomnia
More severe: fluid retention, dyspnoea, vomiting, dry cough, dizziness
Serious: marked dyspnoea, neurological symptoms/ signs

Question 7

What are the most common causes of fevers in returned travellers?

Answer 7

Malaria
RTI
Gastroenteritis
Dengue

Question 8

In a well but febrile returned traveller, what are first line tests?

Answer 8

FBC
ESR
Thick and thin films
LFTs
Urine M/c/s

Question 9

What are the clinical features of malaria?

Answer 9

High fever, chills, rigor, sweating, headache
Usually abrupt onset
Can have atypical presentation eg diarrhoea, abdominal pain, cough

Question 10

What are the clinical features of typhoid fever?

Answer 10

Incubation period 10-14 days
Insidious onset
Headache prominent
Dry cough
Fever gradually increases in ‘stepladder’ manner over 4 days or so
Early abdominal pain and constipation, followed by diarrhoea and rash (rose spots)

Question 11

What are the clinical features of scrub typhus?

Answer 11

Abrupt onset febrile illness with headache and myalgia
A black eschar at the site of the bite with regional and generalised lymphadenopathy
Short lived macular rash
Can develop severe complications (pneumonitis, encephalitis)

Question 12

What are the clinical features of African trypanosomiasis (sleeping sickness)?

Answer 12

Stage 1 (haemolymphatic)

• incubation period about 3 weeks
• Fever, headache, skin chancre/ nodule
• lymphadenopathy, hepatosplenomegaly

Stage 2 (meningoencephalitic)

• weeks or months later
• cerebral symptoms including hyper somnolence

Question 13

What are the symptoms of visceral leishmaniasis (kala azar)?

Answer 13

Transmitted by sandfly bites and blood transfusion or IVDU
Fever, wasting, hepatosplenomegaly, lymphadenopathy
Hyper pigmentation of the skin

Question 14

What are the symptoms of cutaneous leishmaniasis?

Answer 14

Erythematous papule

Question 15

What are the clinical features of bilharzia?

Answer 15

Faecal transmission route
Local skin reaction at site of penetration of the parasite (it then penetrates the liver, bowel and bladder)
Within a week there is a generalised allergic response with fever, malaise, myalgia and urticaria
A gastroenteritis like syndrome can occur

Question 16

What are the two forms of filariasis?

Answer 16

1. Lymphatic
   - acute adenolymphangitis
   - chronic lymphoedema (hydrocele, scrotal oedema, elephantiasis of extremities)
2. Onchocerciasis (river blindness)
   - nodule at bite site followed by chronic skin disease
   - eye lesions such at uveitis and optic atrophy
   - second leading cause of blindness world wide