Travel Related Infection

Question 1

What are some infections controllable by sanitation measures?

Answer 1

Travellers diarrhoea, typhoid, hepatitis A and E, giardiasis, cholera, food poisoning and viral gastroenteritis

Question 2

What are some infection controllable by immunisation?

Answer 2

Poliomyelitis and diphtheria

Question 3

What are some water related infections?

Answer 3

Schistomiasis, Leptospirosis, liver flukes, hookworms, guinea worms and strongyloidiasis

Question 4

What are some arthropod-borne infections?

Answer 4

Malaria, dengue fever, rickettsial infections, leishmaniasis, trypanosomiasis, filariasis and onchocerciasis

Question 5

What are some important tropical diseases?

Answer 5

Malaria, typhoid, dengue fever, schistosomiasis, rickettsiosis, viral haemorrhage fevers and zika fever

Question 6

What is the malaria vector?

Answer 6

Female anopheles mosquito

Question 7

Describe the malaria life cycle

Answer 7

Mosquito takes blood meal and implants sporozoites which change to merozoites in liver
RBCs then carry the gametocyte which is picked up by mosquito

Question 8

What are the 5 species of Malaria?

Answer 8

Plasmodium falciparum (potentially severe), vivax, ovale, malariae, and knowlesi

Question 9

What are the symptoms of Malaria?

Answer 9

Fever, rigors, aching bones, abdomen pain, headache, dysuria, frequency, sore throat and cough

Question 10

What are the signs of Malaria?

Answer 10

None
Splenomegaly, hepatomegaly and mild jaundice

Question 11

What are some complications of Malaria?

Answer 11

Cerebral malaria - encephalopathy
Blackwater fever
Pulmonary oedema
Jaundice
Severe anaemia
Algid malaria

Question 12

Describe blackwater fever

Answer 12

Severe intravascular haemolysis
High parasitaemia and profound anaemia
Haemoglobinuria
Acute renal failure

Question 13

Describe cerebral malaria

Answer 13

Non invasive visitors and children in endemic areas
Get hypoglycaemia, convulsions and hypoxia due to reduced BF

Question 14

How is malaria diagnosed?

Answer 14

Thick and thin blood films - Giemsa and field stain
Quantitative buffy coat - centrifugation and UV microscopy
Rapid antigen test - OptiMal and ParaSight-F

Question 15

What does complicated malaria have one or more of?

Answer 15

Impaired consciousness or seizures, hypoglycaemia, parasite count more than 2%, haemoglobin less than 8mg/dl, spontaneous bleeding, haemoglobinuria, renal impairment, pulmonary oedema, and shock

Question 16

What are the Malaria drugs?

Answer 16

Quinine from Chinchona
Artemisinins from Quinghaeosu

Question 17

What are the treatment options for uncomplicated P. falciparum malaria?

Answer 17

Riamet 3 days
Eurartesim 3 days
Malarone 3 days
Quinine 7 days plus oral doxycycline

Question 18

What are the treatment options for complicated or severe P. falciparum malaria?

Answer 18

IV quinine plus oral doxycycline
When patient is able to swallow and is stable then switch to oral treatment
IV artesunate - not in UK

Question 19

What is the treatment for the other types of malaria?

Answer 19

Chloroquine 3 days
Riamet 3 days
Add primaquine in vivax and ovale to eradicate liver hypnozoites

Question 20

What are malaria control programmes?

Answer 20

Mosquito breeding sites
Larvacides
Mosquito killing sprays
Human behaviour

Question 21

Describe typhoid fever

Answer 21

Salmonella typhi and salmonella paratyphi
Widespread - poor sanitation and unclean drinking water
Incubation period - 7 days to 4 weeks

Question 22

What are the clinical features of typhoid fever?

Answer 22

1st week - fever headache, abdomen pain, constipation, dry cough, bradycardia, neutrophilia and confusion
2nd - fever peaks, rose spots, diarrhoea, tachycardia and neutropenia
3rd - complications
4th - recovery

Question 23

What are the complications of typhoid fever?

Answer 23

Intestinal bleeding, perforation, peritonism and metastatic infections

Question 24

How is typhoid fever diagnosed?

Answer 24

Clinical - not easy
Lab - culture blood, urine and stool
Culture bone marrow

Question 25

What is the treatment for typhoid fever?

Answer 25

Oral Azithromycin IV Ceftriaxone

Question 26

Describe Dengue

Answer 26

Swahili Commonest human arbovirus infection Infection - 100 million cases a year and 25000 deaths a year

Question 27

How is Dengue transmitted?

Answer 27

Aedes aegypti - mosquito daytime biting near pools of water

Question 28

What is the classical Dengue fever?

Answer 28

Sudden fever Severe headache and retro-orbital pain Severe myalgia and arthralgia Macular rash Haemorrhagic signs - petechiae, purpura and positive tourniquet test

Question 29

What is the Dengue rash?

Answer 29

Muscular and petechial rash

Question 30

How is Dengue diagnosed?

Answer 30

Clinical - thrombocytopenia, leukopenia, elevated transaminases and positive tourniquet test Lab - PCR and serology

Question 31

What is included in management of Dengue?

Answer 31

No specific therapeutic agents Complications - IV fluids, fresh frozen plasma and platelets Prevention - avoid bites and new vaccine

Question 32

What are the complications of Dengue?

Answer 32

Dengue haemorrhagic fever Dengue shock syndrome

Question 33

How is Schistosomiasis transmitted?

Answer 33

Fresh water and freshwater snails

Question 34

What are the types of schistosomiasis?

Answer 34

S. haematobium, mansoni and japonicum

Question 35

Describe the Schistosomiasis life cycle

Answer 35

Eggs hatch releasing miracidia - penetrates snail tissue then sporocysts in snail Penetrates skin - shistosomulae go into circulation and migrate to liver and mature Paired adult worm migrates to bowel to lay eggs in stool

Question 36

What are the clinical features of Schistosomiasis?

Answer 36

Swimmers itch - 1st few hrs Invasive stage - cough, abdo discomfort, splenomegaly and eosinophilia Katayama fever Acute disease - eggs in bowel or bladder Chronic disease

Question 37

What is katayama fever?

Answer 37

Prostate, fever, urticaria, lymphadenopathy, splenomegaly, diarrhoea and eosinophilia

Question 38

How is schistosomiasis diagnsoed?

Answer 38

Clinical Antibody test Ova in stool and urine Rectal snip

Question 39

What is the treatment for schistosomiasis?

Answer 39

Praziquantel Prednisolone if severe

Question 40

What are characteristics of tick typhus?

Answer 40

Tick bite eschar Maculopapular rash

Question 41

What is the main type of Rickettsiosis?

Answer 41

Tick typhus