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Travel related infection Flashcards

1
Q

what are unfamiliar features of imported disease?

A

Presenting features hepatomegaly
Isolation requirements ecoli
Diagnostic methods
Treatment/Management
Unexpected complications bleeding coma shock seizures

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2
Q

what can affect vulnerability of travellers to infection?

A

Temptation to take risks away from home
food, water, animals, sex
Different epidemiology of some diseases
HIV, TB, polio, diphtheria
Incomplete understanding of health hazards
Stress of travel
Refugees: deprivation, malnutrition, disease, injury

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3
Q

what are common infections worlwide?

A

influenza
community-acquired pneumonia
meningococcal disease
sexually transmitted diseases

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4
Q

what are climate ir environment related health problems?

A

Sunburn
Heat exhaustion and heatstroke
Fungal infections
Bacterial skin infections
Cold injury
Altitude sickness

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5
Q

what are infections controllable by sanitation?

A

Travelers’ diarrhoea
Typhoid
Hepatitis A or E
Giardiasis
Amoebiasis
Helminth infections
Viral gastroenteritis
Food poisoning
Shigella dysentery
Cholera
Cryptosporidiosis

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6
Q

what are infections controlled by immunisation?

A

Poliomyelitis
Diphtheria

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7
Q

what infections are controlled by education?

A

HIV
STD’s

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8
Q

what are water related infections?

A

Schistosomiasis
Leptospirosis
Liver flukes
Strongyloidiasis
Hookworms
Guinea worms

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9
Q

what are arthropods borne infections?

A

Malaria (mosquitos)
Dengue fever (mosquitos)
Rickettsial infections (ticks: typhus)
Leishmaniasis (sand flies: Kala-azar)
Trypanosomiasis (tsetse fly: sleeping sickness)
Filariasis (mosquitoes: elephantiasis)
Onchocerciasis (black flies: River Blindness)

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10
Q

what are important tropical diseases?

A

Malaria
Typhoid
Dengue Fever
Schistosomiasis
Rickettsiosis
Viral haemorrhagic fevers
Zika fever

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11
Q

what is the life cycle of malaria?

A
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12
Q

what are 5 species causative of malaria?

A

Plasmodium falciparum
SEVERE

BENIGN
Plasmodium vivax
Plasmodium ovale
Plasmodium malariae
Plasmodium knowlesi (like P malariae; Far East, 2004)

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13
Q

what are symptoms of malaria?

A

fever
rigors
aching bones
abdo pain
headache
dysuria
frequency
sore throat
cough

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14
Q

what are signs of malaria?

A

none
splenomegaly
hepatomegaly
mild jaundice

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15
Q

what are complications of malaria?

A

Cerebral malaria (encephalopathy)
non- immune visitors, children in endemic areas hypoglycaemia, convulsions, hypoxia
Blackwater fever
severe intravascular haemolysis, high parasitaemia, profound anaemia, haemoglobinuria, acute renal failure
Pulmonary oedema
Jaundice
Severe anaemia
Algid malaria
Gram-negative septicaemia

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16
Q

how is malaria diagnosed?

A

Thick & thin blood films
Giemsa, Field’s stain
Quantitative buffy coat (QBC)
centrifugation, UV microscopy
Rapid antigen tests
OptiMal
ParaSight-F

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17
Q

how is the severity of malaria assessed?

A

Complicated malaria = one or more of…
Impaired consciousness or seizures

Hypoglycaemia

Parasite count ≥2%

Haemoglobin ≤ 8mg/dL

Spontaneous bleeding / DIC

Haemoglobinuria

Renal impairment or pH <7.3

Pulmonary oedema or ARDS

Shock (algid malaria)
?Gram negative bacteraemia

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18
Q

what are malaria treatment drugs?

A

Quinine from Chinchona
Artemisinins from Quinghaosu

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19
Q

what are treatment options for Treatment options for
uncomplicated P. falciparum malaria?

A

Riamet ® (artemether-lumefantrine) 3 days

Eurartesim ® (dihydroartemisinin-piperaquine) 3 days

Malarone ® (atovaquone-proguanil) 3 days

Quinine 7 days
S/E nausea, tinnitus, deafness (cinchonism), rash, hypoglycaemia
plus oral doxycycline (or clindamycin)

20
Q

Treatment options for
complicated or severe P. falciparum malaria?

A

IV artesunate (unlicensed in UK)

IV quinine
(S/E cardiac depression, cerebral irritation, N&V)
plus oral doxycycline (or clindamycin)

When patient is stable & able to swallow, switch to oral treatments

21
Q

Treatment of
P. vivax, P. ovale, P. malariae, P. knowlesi?

A

chloroquine 3 days

Riamet ® (artemether-lumefantrine) 3 days

add primaquine* (14 days) in vivax and ovale, to eradicate liver hypnozoites

*check for G6PD deficiency

22
Q

Malaria Control Programmes?

A

Mosquito breeding sites
Drainage of standing water
Larvacides
(Paris green), temphos, biological
Mosquito killing sprays
DDT, malathion, (dieldrin)
Human behaviour
Bed nets
Mesh windows

23
Q

what is Typhoid (Enteric) Fever?

A

Salmonella typhi
Salmonella paratyphi

Global cases: 27 million infections/yr
Global deaths: over 200,000/yr
UK cases: 500/yr

Widespread
poor sanitation, unclean drinking water

24
Q

what are clinical features of typhoid fever?

A

1st week:
fever, headache, abdo. discomfort, constipation, dry cough, relative bradycardia, neutrophilia, confusion
2nd week:
fever peaks at 7-10 days, Rose spots, diarrhoea begins, tachycardia, neutropenia
3rd week (Complications):
intestinal bleeding, perforation, peritonism, metastatic infections
week 4 (Recovery):
10 - 15% relapse

25
how is typhoid fever diagnosed?
Clinical not easy evolution of features Laboratory (Salmonella typhi, S. paratyphi) Culture blood, urine & stool Culture bone marrow
26
what is the treatment for typhoid fever?
Oral Azithromycin now drug of choice for Asian-acquired, uncomplicated enteric fever IV Ceftriaxone if complicated, or concerned regarding absorption Increasing ciprofloxacin resistance
27
what is dengue?
Swahili: “Ki-Dinga pepo” Commonest human arbovirus infection Dengue infection: 100 million cases/year Dengue Deaths: 25,000/year
28
what is the classical presentation of dengue fever?
Sudden fever Severe headache, retro-orbital pain Severe myalgia and arthralgia Macular/ maculopapular rash Haemorrhagic signs: petechiae, purpura, positive tourniquet test
29
how is dengue diagnosed?
Clinical Thrombocytopenia Leucopenia Elevated transaminases Positive tourniquet test Laboratory: PCR, serology
30
how is dengue managed?
No specific therapeutic agents Complications Dengue haemorrhagic fever (DHF) Dengue shock syndrome (DSS) Rx: IV fluids, fresh frozen plasma, platelets Prevention avoid bites new vaccine (Dengvaxia), 2016; limited use
31
where is schistosomiasis trasmitted from?
fresh water/snails
32
how is schistosomiasis distributed?
S. haematobium S. mansoni S. japonicum
33
what are clinical features of schitosomiasis?
Swimmers Itch (1st few hrs) clears 24-48hrs Invasive stage (after 24hrs) cough, abdo discomfort, splenomegaly, eosinophilia Katayama Fever (after 15-20 days) prostrate, fever, urticaria, lymphadenopathy, splenomegaly, diarrhoea, eosinophilia Acute disease (6-8 weeks) eggs deposited in bowel (dysentery) or bladder (haematuria) Chronic disease
34
how is schistosomiasis diagnosed?
Clinical diagnosis Antibody tests Ova in stools and urine Rectal snip
35
how is schistosomiasis treated?
PRAZIQUANTEL 20mg/kg, two doses 6hrs apart Prednisolone if severe
36
what are clinical features of tick typhus?
37
what is rickettsiosis?
Tick typhus (R. conorii, R. africae) Rocky Mountain Spotted Fever (R. rickettsii) Epidemic typhus (R. prowazekii) Murine or endemic typhus (R. mooseri) Scrub typhus (R. tsutsugamushi) others
38
what are clinical features of rickettsiosis?
abrupt onset swinging fever, headache, confusion, endovasculitis, rash (macular, petechial), bleeding
39
how is rickettsiosis diagnosed?
clinical features, serology
40
how is rickettsiosis managed?
tetracycline
41
what are viral haemorrhagic fevers?
Serious infections but rare in UK Ebola Congo-Crimea haemorrhagic fever Lassa fever Marburg disease Maximum incubation period 3 weeks Rule out common severe infections Isolation: High Security Infection Unit Treatment: supportive!
42
what is Zika?
flavivirus Transmitted by daytime-biting Aedes mosquitos Also by sexual contact, blood transfusion Related to dengue, yellow fever, Jap B encephalitis and West Nile viruses Pacific outbreak 2013-14 Latin America pandemic 2015-16
43
what are clinical features of Zika?
Clinical: no or mild symptoms - headache, rash, fever, malaise, conjunctivitis, joint pains (like dengue) In pregnancy, can cause microcephaly and other neurological problems Can cause Guillain-Barre syndrome No antiviral therapy Mosquito control measures Vaccines in development
44
If a patient has travelled what should be covered in the history?
Is it tropical? Travel history Precautions taken Risks Symptoms Incubation periods
45
what examination signs should be lookse for In a travelled patient?
rash - typhoid, typhus, dengue jaundice - hepatitis, malaria, Yellow fever lymph nodes - leishmania, trypanosomiasis liver - malaria, typhoid, amoebic abscess spleen – visceral leishmaniasis, typhoid, malaria
46
what investigations should be done in a patient who has travelled?
FBC malaria films liver function tests stool microscopy & culture urine analysis & culture blood culture(s) CXR Specific tests (as indicated) dengue respiratory viral/atypical hepatitis A, B, C tick typhus (Rickettsia) schistosomiasis amoebic leptospirosis/hantavirus viral haemorrhagic fevers
47
how should a travelled patient be treated in general?
Isolation: ?personal protective equipment Supportive measures (resuscitation) Empirical treatment if patient unwell Antimicrobial therapy based on likely diagnosis aim to treat life-threatening conditions e.g. typhoid, septicaemia Specific treatment once diagnosis is established

Infection (14 decks)

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