Travel Medicine Flashcards
(28 cards)
What pre-travel advice should be considered?
Consider route of transmission of different infections Discuss appropriate behavioural advice Non-infectious risks Vaccination - Update routine - Travel-related considerations Medications; eg: - Malaria prophylaxis - Rx for travellers' diarrhoea
What pre-travel advice should be considered concerning food?
Raw food high risk
Avoid food from street vendors
What pre-travel advice should be considered concerning water?
If chlorinated tap water unavailable/sanitation poor, stick to - Beverages made with boiled water - Cans and bottles - Beer and wine Avoid - Ice - Brushing teeth with tap water
What general preventative advice should be considered concerning vector-borne infections?
Minimise exposure
- Sleep in screened and/or air conditioned room
- Avoid outside activities, especially between dusk and dawn
- Cover arms and legs
- Insect repellents = DEET
- Permethrin impregnated clothing/mosquito nets
- Insecticide aerosol in room
Malaria prophylaxis
Which vaccines are live vaccines?
“MOBY-JeVRT” mnemonic
- M = MMR
- O = oral polio
- B = BCG
- Y = yellow fever
- Je = new Japanese encephalitis
- V = Varicella
- R = Rotavirus
- T = oraly typhoid
What is travellers’ diarrhoea?
3+ loose stools/day
Begins abruptly
Generally self-limited
- Most resolve within 1-2 days
What is the most commonly identified causative agent of travellers’ diarrhoea?
Enterotoxigenic E coli (ETEC)
What are the most common causes of watery travellers’ diarrhoea?
ETEC
Viral cholera
What are the most common causes of bloody travellers’ diarrhoea?
Shigella
Salmonella
Campylobacter
Entamoeba histolytica
What defines chronic travellers’ diarrhoea?
Usually >2 weeks
What is the common cause of chronic travellers’ diarhroea?
Parasites; eg: Giardia
What defines severe travellers’ diarrhoea?
Any of
- > 7 bowel movements/day
- Blood in stool
- > 3 days without improvement
- Fever
- Abdominal pain
- Chills
What is the management for travellers’ diarrhoea?
Rehydration with oral rehydration solution
Anti-diarrhoeal; eg: loperamide - symptom control
Empirical self-treatment for moderate-to severe cases
- Most places: azithromycin
- Few places: quinolone; eg: ciprofloxacin
What are the most common syndromes in the unwell returned traveller?
Travellers' diarrhoea Respiratory tract infections Skin problems - Infections - Rashes - Bites Febrile illnesses
What points should be covered in a travel history?
Destination Duration Type of activity and exposures Symptom onset/incubation period Pre-travel vaccines Chemoprophylaxis - Compliance
What are the symptoms of malaria?
Initially resembles flu-like illness Fever and chills Pain - Headache - Muscles - Back Fatigue Malaise Nausea Vomiting Diarrhoea Cough
What investigations are used to diagnose malaria?
FBE - May be haemolytic anaemia - WCC normal - Thrombocytopaenia Thick blood smear Thin blood smear - Species ID Ag capture tests - Dipstick tests: finger-prick blood sample
What is the treatment for malaria?
Blood stage = chloroquine Liver stage (eg: vivax) = primaquine
What are the options for malaria prophylaxis?
Mefloquine
Doxycycline
Malarone
What are the causative agents of enteric fever?
Salmonella typhi
S paratyphi
What are the symptoms of enteric fever?
Non-specific febrile illness
+/- diarrhoea/constipation
Sometimes a rash
What is the treatment for enteric fever?
Ceftriaxone
Azithromycin
What is the causative agent of dengue fever?
Flaviviruses, spread by mosquitoes
What are the possible bacterial causes of fever in a returned traveller?
Enteric fever Meningococcus Pneumococcus Rickettsial Zoones
