Travel medicine Flashcards by alice Sawka

Appearance of red cells in P falciparum and P vivax?

Falciparum: normal size cells, loads of ring forms, crescent shaped gametocytes
Vivax: large RBC, fewer infected, fine, eosinophilic dots

Thick film is to concentrate the parasites
Thin film is for species identification

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In cerebral malaria, what are the LP and imaging findings?

Normal opening pressure

No evidence cerebral oedema on imaging usually

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Lab findings in malaria?

Anaemia
NO eosinophilia
If anaemia ALWAYS have thrombocytopaenia
Acidosis
Hypoglycaemia

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What malaria prophylaxis in T2 and T2 pregnancy?

mefloquine

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What should you use as malaria resistance when not sure about resistance patterns?

mefloquine
Doxycycline
Primaquine
Atovaquone-proguanil

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What do you have to give in P Vivax or P Ovale to prevent relapse?

Chloroquine should always be followed by course of Primaquine (check G6PD def first) to eradicate hypnozoites
A 14 day course can cause haemolytic anaemia

Dominant liver stages

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Treatment for bad malaria?

What elements of supportive care?

IV Artesunate- assume chloroquine resistant P falciparum
Ensure no hypo
Transfuse if haematocrit drops below 20%
Treat seizures with benzos
When can take tabs should have full course of artemisinin combination
-artemether + lumefantrine
-atovaquone + proguanil
-quinine sulphate + doxy

If non life threatening antemether-lumefantrine ok

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At what point in the life cycle does fever happen in malaria?

Schizont rupture (RBC)

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P falciparum incubation period

1-4 weeks
So fever under 1 week after ariving in endemic area unlikely malaria
Vivax can come on weeks to months post return

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What is the use of the immunochromatographic test in malaria? ICT

Rapid test not dependent on expertise for P falciparum and vivax
Good negative predictive value
Quite sensitive
Stays positive post treatment

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What is the mutation that gives resistance to mefloquine and chloroquine?

Pfmdr1

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SE asia there is lots of resistance to what malaria agent?

Mefloquine- so need to give doxy or atovaquone - proguanil

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Contraindications to mefloquine use?

Psychiatric disorders
Epilepsy
Cardiac conduction defects

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How long do you have to continue agents after coming back (prophylaxis?)

Atovaquone proguanil
Doxy
Mefloquine

AP: 1 day before 7 days post return
D:1 day before 4 weeks post
M: 2 weeks before travel 4 weeks post

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Typhoid fever classic presentation

Fever, abdominal pain and CONSTIPATION
(not diarrhoea)
Hepatosplenomegaly
Neuropsych
RELATIVE BRADYCARDIA
Rose spots on trunk

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Febrile and brady in the returned traveller, think…

Typhoid!!

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Complications of typhoid- what time frame and when are they?

3rd or 4th week

Intestinal perforation
Bone and joint
Endocarditis and pericarditis
Splenic or liver abscess
Endovascular infection- especially old aneurysms, plaques, grafts

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Diagnosis for Typhoid?

Blood culture
Stool culture
bone marrow!
See leukopaenie and anaemia, low eosinophils, low plt
Abnormal LFTs
Mild CK rise

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Treatment for typhoid?

NOT cipro- lots of resistance now 
Ceftriaxone
Azith if there is drug resistance
Dex if severe and neuropsych
take ages 5-7 days to stop fever

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What is the risk of chronic typhoid carriage?

LIKE TYPHOID MARY!!!!
Higher frequency if biliary abnormality or concurrent bladder infection with Schistosoma
Gallbladder cancer!

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Incubation period of S Typhi?

Usually about 2 weeks, but can be longer weeks to a month or two

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Classic dengue presentation?

Fever
Headache
RETROORBITAL PAIN
MSK pain "breakbone fever"
Rash- macular rash with "islands of white"
palpable liver

WITHIN 14 DAYS of even brief trip to tropics or subtropics
Incubation 3-7 days

remember that defervesce for 1-2 days after the vomiting and diarrhoea and lymphadenopathy stage. Then get more fever, morbilliform rash, skin peels off, possible dengue shock. DONT SEND TOO EARLY HOME

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How do you make a dengue diagnosis?

Study These Flashcards

Often of exclusion, hard to do
Flavivirus PCR or ELISA to NS1 (whilst febrile)
High IgM with paired samples
Increase in IgG by 4 fold over 2 weeks if already present at diagnosis
See leukopaenia, thrombocytopaenia, neutropaenia
Hypoalbuminaemia and proteinuria
Arbovirus IgM specific
If plt under 100 or transaminases more than 3-5–>warning severe

What is the feared complication of dengue?

Study These Flashcards

Dengue haemorrhagic fever

haemorrhage spontaneously or with tournequet
plt unde 100
fever 2-7 days
evidence of PLASMA LEAK based on pleural effusions and changes in haematocrit

What is the treatment for dengue

Supportive Fluids Avoid vectors

What are the range of presentations of entamoeba histolytica?

Asymptomatic infection to acute dysentery to toxic megacolon and perforation Extraintestinal disease: liver, lung, brain abscess

Diagnosis of entamoeba histolytica?

3 fresh specimens stool for cysts and trophozoites | 99% with liver abscess with have positive serology

Treatment for entamoeba histolytica?

metronidazole + paromomycin or diloxanide furoate (prevents continued luminal infection)

What is the management of acute hep A?

Supportive Isolate Give IMMUNE GLOBULIN Vaccinate those at risk

Cruise ship gastro, think what?

Norwalk virus

What's the deal with campylobacter jejuni from Thailand?

Lots of cipro resistance

When do you need to give meningococcal prophylaxis?

Direct contact with respiratory secretions. | If sitting beside infected patient for longer than 8 hours.

What viral family is Ebola from?

Filovirus | There are 5 subspecies- the recent one was Zaire

Ebola mortality

70%

Ebola incubation period

11 days Present with fever, weakness, diarrhoea Join onto cells via GP1 and 2

Ebola diagnostic test

Ebola PCR positive 1 day before symptoms

Ebola treatment

Fluid and electrolytes Nutritional support Watch for bacterial superinfections

Schistosomiasis treatment

Single dose praziquantel

Schistosomiasis presentation

Itchy rash within a few days of swimming in fresh water 4-8 weeks post infection have acute self limiting febrile illness and marked eosinophilia Months to years later can get diarrhoea, abdo pain, or haematuria or painful ejaculation as there is an inflammatory response in the bowel or bladder Chronic infection can give you colitis, portal hypertension (most common cause of varices), chronic liver disease, SCC bladder, urolithiasis Eosinophils up in half. Serology is sensitive but takes months to go up Urine micro from 10 am to 2pm Semen analysis, stool micro, rectal biopsy

Ascariasis - what does it look like?

GROSS MASSIVE WORMS IN THE GUT!!! Most common human helminthic infection. usually asymptomatic Africa, SE asia Worms gut-->portal vein-->lungs-->cough and swallow Diagnosed on stool microscopy Tx: mebendazole

Rabies: what is the clinical picture?

``` Fever headache malaise prodrome Encephalitis with hydrophobia Delirium and agitation Autonomic dysfunction Ascending flaccid paralysis ```

How is Chikungunya spread?

Alphavirus- aedes aegypti mosquito that also spread dengue

What does Chikungunya look like clinically?

In someone back from India, Malaysia, Caribbean, indian ocean islands and after 1-14 days develop fevers, arthralgias, rash, myalgia Pointer is often painful JOINTS ++++-->chronic arthritis in 5-60%

How do you diagnose Chikungunya?

Aplhavirus PCR | Serology

When do you have higher risk of death with malaria?

``` Parasitaemia over 5% Pregnancy No prophylaxis Splenectomy Extremes of age Delayed time to treatment ```

Giardia- what are the stools like?

Slimy not explosive Treatment is metronidazole or tinidazole

Fever plus rash in the returned traveller?

``` Dengue Chikungunya Riclettsia Meningococcus, gonococcus, syphilis HIV, EBV, CMV Malaria less likely ```

Fever and lymphadenopathy?

``` Rickettsia TB Syphilis Filariasis Tularaemia ```

Name two helminths

Strongyloides | Schistosomiasis

Name five protozoa

``` Giardia Malaria Entamoeba Cryptosporidium Toxoplasma Leishmaniasis ```

What do you think if severe malaria and haemodynamically compromised?

Suspect sepsis overlying | Malaria alone does not often do this

WHat does japanese enceph look like and how to diagnose?

Diagnose with CSF IgE- PCR useless dystonic features, parkinsons movements

max number of times you can get dengue?

4- each time only temporary resistance against the other three strains but lifelong against the one you have had

Most specific deficit in early dengue in lab?

leukopaenia (not low plt)

LFTs in dengue?

AST>ALT

Dengue inc period

4-7 days

Fever and rash and African Safari

Rickettsial

Travel medicine Flashcards

(57 cards)