Travel related infection Flashcards
1
Q
Why are travel infections more prevalent?
A
Exotic destinations More comorbidities War/natural disasters Migration Emerging infections Accidents abroad
2
Q
Important factors to consider
A
Calendar time (certain infections prevalent at certain times of the year) Relative time (incubation period can allow some to be ruled out) Place (important infections)
3
Q
Bacterium associated with travel
A
Rickettsia
Spirochaete
4
Q
Parasites associated with travel
A
Protozoa (Malaria)
Helminths (worm)
5
Q
Why is travel history important?
A
Different strains - present differently Antibiotic resistance (less strict policies) Prevent infection (to ward and lab workers)
6
Q
Key places where encounter pathogens abroad
A
Sub-saharan Africa
SE Asia
S/C America
7
Q
Acute incubation/onset
A
<10 days
8
Q
Subacute onset
A
10-21 days
9
Q
Chronic onset
A
> 21 days
10
Q
What is eosinophilia a sign of?
A
Allergy
Parasite infection
11
Q
Different signs/symptoms of travel illness
A
Resp: SOB/Cough GI: Diarrhoea Skin: Rash Jaundice (Liver/RBC breakdown?) CNS: headache/meningism Haematological (spleno/hepatomegaly/lymphadenopathy) Eosinophilia
12
Q
Ways of acquiring travel infections
A
Food/water Insect bite/tick swimming sexual Animal contact Recreational activates (eg caving = fungal risk)
13
Q
Rodents = risk for
A
Leptospirosis
14
Q
Tick bite = risk for
A
Rickettsia (AND game parks)
15
Q
Dead slaughtered = risk for
A
Anthrax
Ebola
16
Q
Farm = risk for
A
Q-Fever
17
Q
Fresh water = risk for
A
Schistosomiasis
Leptospirosis
18
Q
Caves = risk for
A
Histoplasmosis
19
Q
Unpasteurised dairy
A
Brucellosis
20
Q
Malaria patient presentation
A
High temp Low BP Tachycardia Low O2 sats Confusion Icterus (jaundice of eyes) Bite marks Hepatosplenomegaly
21
Q
FCB malaria
A
Anaemic
WCC low
Platelets low
22
Q
Biochem malaria
A
Urea high creatinine high bilirubin high Liver ALT and ALP = normal CRP high
23
Q
ADDITIONAL test malaria
A
BLOOD FILMS = show presence of parasite
headphones
24
Q
5 main species of malaria
A
Plasmodium: falciparum vivax ovale malariae knowlesii
25
Vector malaria
Female Anopheles Mosquito
26
Malaria incubation
Minimum 6 days
Falciparum: 4 weeks
Vivax/ovale: 1 year+
27
History malaria
fever, chills and sweats (3rd/4th day)
28
Examination malaria
Few signs
| Bites/splenomegaly
29
Cardiovascular severe malaria
Tachycardia
Hypotension
Arrhythmias
30
Respiratory severe malaria
ARDS
31
GI severe malaria
```
Diarrhoea
LFT's deranged
Bilirubin high (haemolysis)
```
32
Renal severe malaria
Acute kidney injury
33
CNS severe malaria
Confusion/fits
34
Blood severe malaria
Low/normal WBC
Thrombocytopenia
DIC
35
Metabolic severe malaria
Metabolic acidosis
| Hypoglycaemia
36
Life cycle malaria
Mosquito gut--> salivary gland and bites human
Salivary gland of mosquito --> liver of human = sporozoite (exoerythrocytic)
Liver schizont then merozoites --> blood (erythocytic and haemolysis)
Back to mosquito via gametocytes
37
Malaria investigations/tests
```
3x blood film
FBC
U&E
LFT
Glucose
Coagulation
```
```
CT scan (cerebral oedema?)
Chest X ray (pulmonary oedema?)
```
38
Treatment P.falciparum
Artesunate
| OR Quinine + doxycycline
39
Treatment P. vivax, ovale, malariae
```
Chloroquine
Additional primaquine (for dormant hypnozoites in liver)
```
dormant can cause recurrent malaria
40
Prevention of malaria
```
Know high risk area
Bite prevention (repellent, clothing, bed nets)
Chemoprophylaxis (continue after returning)
```
41
Typhoid/paratyphoid (enteric fever) presentation
slightly anaemic
low WCC
high CRP
abdominal discomfort
42
Blood culture typhoid/paratyphoid
Gram -ve bacilli
Salmonella typhi/paratyphi
(paratyphi A, B or C type)
43
Virulance factors salmonella typhi/paratyphi
Low infectious dose
Survives gastric acid
Fimbriae adhere to epithelial over lymphoid tissue (peyers patches)
Reside within macrophages
44
Signs and symptoms enteric fever
Systemic disease (sepsis/bacteraemia)
Incubation period: 7-14 days
fever, headache, abdominal discomfort, dry cough
BRADYCARDIA
45
Complications enteric fever
Intestinal haemorrhage/perforation
10% mortality
Chronic carrier
46
Which is milder paratyphoid/typhoid?
PARA
47
Enteric fever investigation results
Moderate anaemia
Lymphopaenia
Mild raised LFT's
Blood culture and faeces/bone marrow
48
Treatment enteric fever
```
Multi drug resistant (to penicillin)
Fluoroquinalones Ciprofloxacin (maybe but some resistant)
```
```
IV Ceftriaxone (cephalosporin)
Azithromycin (macrolide)
```
49
If enteric is resistant to cetriaxone?
Meropenem
50
Prevention enteric fever
Food and water hygiene precautions
| Typhoid vaccine
51
Non typhoidal salmonella symptoms
Food poisoning
| diarrhoea, vomiting, abdo pain
52
Non typhoidal salmonella eg
S typhimurium
| S enteritidis
53
Fever and rash causes
```
Childhood viruses (measles, rubella, parvovirus)
Infectious mononucleosis (EBV/CMV)
Acute HIV
Rickettsia (spotted fever)
Dengue fever
```
54
Investigations / signs dengue fever
severe myalgia
headache
Dengue PCR +ve
Rash
55
What virus is dengue? Where is it found?
Arbovirus - aedes mosquito
| Tropical/subtropical regions
56
Range of infections dengue
4 serotypes
1st infection = asymptomatic/simple rash (classic dengue) only need supportive treatment
REinfection with new serotype = haemorrhagic/shock syndrome
57
What is reinfection dependent on?
Antibody dependent enhancement (need to have had dengue before)
58
What is Myiasis?
Fly larvae inside skin (tumbu/bot fly)
hang washing out, fly lays eggs, wear clothes and eggs burrow into skin and hatch
59
Emerging diseases
Influenza pandemics
SARS Cov
MERS
SARS Cov 2
60
Ebola
Viral haemorrhagic fever
Filovirus
50% mortality rate
61
Symptoms ebola
```
Flu like
Vomiting
Confusion
Diarrhoea
Rash
Internal/external bleeding
```
62
Ebola spread
Direct contact with bodily fluids
63
Zika virus type and risk
Arbovirus (like dengue is)
Aedes mosquito and Sexual transmission
Congenital microcephaly, foetal loss
64
Malaria order of cells
Sporozoite in liver
Matures into schizont
Then merozoites
Mosquito reinfected via gametocytes
